Roles for Anesthesiologists in the Future of Medicine in the United States

Alex S. Evers, MD; Jeanine P. Wiener-Kronish, MD

Disclosures

Anesthesiology. 2022;134(2):231-233. 

In This Article

Anesthesiology Excellence in Acute Episodes of Care Already Contributes Enormously to Population Health

Continuous advances in anesthesiology practice over 175 years have made surgeries and procedures safe and pain-free, transforming societal acceptance and enthusiasm for interventional care and dramatically improving public health. The real-time physiological monitoring and interventions that anesthesiology has developed for surgery have been widely applied to critical care medicine, producing dramatic life-saving effects, particularly in the current (and past) pandemics. Is there opportunity for additional major impact in our current arena? Mathis et al[2] have recommended several specific ways in which the horizons of current anesthesiology practice can be expanded to enhance public health. We suggest generalizing some of their recommendations (see no. 2 below), with some additional suggestions:

  1. The benefits of safe and pain-free surgeries and procedures have been preferentially distributed to economically prosperous communities and nations. Anesthesiology should prioritize increased access to safe surgical care by reducing costs and changing practice models.

  2. We should better protect our patients from the delayed and persistent adverse effects of surgical trauma. Anesthesiology has made death in the operating room a rare event, but 30-day perioperative death remains a leading cause of mortality in the world.[3,4] The physiological stresses of an episode of surgical trauma clearly alter a patient's health trajectory, leading to delayed strokes, myocardial infarction, and blood clots, as well as long-lasting changes in multisystem organ function, notably cognitive and renal function. Clearly, there is enormous opportunity to anticipate and prevent these complications.

  3. The skills and knowledge that anesthesiology brings to physiologic monitoring and interventions should be applied to all acute care. Abundant evidence indicates that handoffs and transitions of care are major contributors to morbidity and mortality in the acute care setting.[5] Anesthesiology, critical care medicine, emergency medicine, and acute care surgery need to partner to make acute care seamless and safe.

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