ANESTHESIOLOGY

also spelled anaesthesiology medical specialty dealing with anesthesia and related matters, including resuscitation and pain. The development of anesthesiology as a specialized field came about because of the dangers of anesthesia, which involves the use of carefully graduated doses of strong poisons to deaden pain. (See anesthetic.) In the 19th century, anesthesia in the operating room, where the surgeon was in command, was relegated to a minor role. Yet gradually physicians and surgeons recognized the need for anesthesiologists, well-trained specialist physicians dedicated full-time to anesthesia, who could extend surgical horizons by permitting operations previously scarcely conceivable and by allowing applications of surgical principles to patients previously considered too ill to withstand either anesthesia or operation. A few physicians were attracted by this opportunity early in the 20th century, but it was not until the mid-1930s that the specialty was officially recognized with the establishment of such medical societies as the American Board of Anesthesiology for certifying appropriately trained physician anesthetists. Today, in virtually every medical school, anesthesiology functions either as an autonomous academic department or as a division of surgery. Anesthesiology was originally concerned entirely with the administration of general anesthetics, and the anesthesiologist's activities were confined to the operating room. The advent of local anesthetics injected into the fluid surrounding the spinal cord broadened the methods available to provide relief of pain during an operation. The introduction into clinical anesthesia of drugs aimed specifically at relaxing muscles may have facilitated the surgeon's tasks but deprived patients of the ability to breathe spontaneously, thus creating a need for artificial respiratory support during the operation. As a result, anesthesiologists became specialists in respiratory and circulatory physiology, as well as in devices used to support and monitor these systems and in drugs that act upon them. Increasingly complex operations were undertaken, and more critically ill patients, including the very young and the very old, were treated surgically. Because the individualized attention provided to patients in the operating room could not be terminated abruptly upon completion of an operation, recovery rooms, intensive care units, and respiratory care units became necessities. The anesthesiologist came to be a central figure in all these areas. In general, anesthesiology may now be defined as a practice of medicine dealing with but not limited to: (1) the management of procedures for rendering a patient insensible to pain and emotional stress during surgical, obstetrical, and certain other medical procedures; (2) the support of life functions under the stress of anesthetic and surgical manipulations; (3) the clinical management of the unconscious patient, whatever the cause; (4) the management of problems in pain relief; (5) the management of problems in cardiac and respiratory resuscitation; (6) the application of specific methods of respiratory therapy; and (7) the clinical management of various fluid, electrolyte, and metabolic disturbances. Knowledge of physiology, biochemistry, pharmacology, and clinical medicine are absolutely necessary to the anesthesiologist.