Anesthesiology at 175 Years—How we got here, what’s to come

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On October 16, 2021, the medical field celebrated the 175th anniversary of anesthesiology.

The significance of this groundbreaking achievement extends far beyond the operating room (OR). Although anesthesia is a relatively new concept in the millennia that we've been talking about medicine, the ability to prevent pain during surgery has had a monumental impact on humanity.

Since the first use of ether anesthetic in 1846, anesthesia has facilitated surgical procedures that have improved life for people of all ages, and even animals, worldwide. And yet, anesthesiology is a relatively young medical specialty. It wasn’t until the 1930s that physicians could train distinctly in anesthesia, or that chairs of anesthesia were developed. As we commemorate this milestone, it is remarkable to acknowledge what has been accomplished in anesthesia, and how anesthesiology continues to transform patient care.

Pioneering patient safety

The patient safety movement that continues to revolutionize perioperative care was launched in the early 1980s by anesthesiologists focused on reducing patient injury and mortality. In 1985 the Anesthesia Patient Safety Foundation (APSF) was founded with a uniquely multidisciplinary approach to protecting patients. Seeking broad and diverse perspectives, the APSF Board of Directors is committed to including doctors, nurses, nurse anesthetists, hospital administrators, equipment manufacturers, pharmaceutical companies, and representatives from the insurance, risk management, and legal professions. This successful APSF model continues to foster and fund research, education, and evidence-based patient safety protocols developed by anesthesiologists, certified registered nurse anesthetists (CRNAs), and others among the spectrum of stakeholders.

Thus, in 2000, when the Institute of Medicine published “To Err is Human,” the landmark article which identified making mistakes as a normal human frailty, the anesthesia specialty was poised to champion creating a culture of safety. Instead of blaming clinicians for the errors that will naturally happen, anesthesia pioneered a holistic approach that creates a safety net designed to catch mistakes, plus preoperative and postoperative protocols that help protect patients and enhance recovery throughout the continuum of care.

Continuously improving patient safety is a pillar of our patient-first philosophy at North American Partners in Anesthesia (NAPA), so I am excited by the new era of technology that I believe will take anesthesia to the next level, making us safer and smarter. Connecting monitors and systems that can identify profiles and patterns, using technology that can “see” impending disasters to change the course of a patient’s progression earlier, is anesthesia’s next wave of patient safety. New technologies will also enable us, as a company and a specialty, to report more effectively on what actually happens, so if we deploy a quality improvement protocol, we can then measure more effectively how patients do better as a result of that initiative.

As an early adopter of quality data reporting, NAPA already has the nation's largest quality outcome database, with the greatest ability to report on what we collect, so that others—including our partner hospitals and ambulatory surgery centers (ASCs), and academic centers—may benefit from our experience and our investments in leading-edge data analytics. This includes excellent examples of platform-level protocols, such as Anesthesia Risk Alerts, in which data from thousands of cases show that patients in our hands are actually safer, with lower mortality and morbidity. Looking forward, I envision using deeper data to fuel multidisciplinary think tanks, where everyone who works in the perioperative space comes together in a purposeful manner to improve the OR environment and develop strategies for safer patient care.

Promoting safer care in outpatient settings

Anesthesia increasingly plays a critical role in the movement to perform more cases in outpatient settings, which benefits both patients and providers. For patients, ASCs are typically comfortable, lower cost environments, and going home the same day reduces the risk of infection. Moving more patients to surgery centers, which are often owned by hospitals, also preserves hospital beds for the sickest of the sick—a need, as we’ve learned during the pandemic, that becomes greater with an aging population. At NAPA, we are committed to leading the industry in this effort, by exploring more ways to create an envelope of safety in ASCs for more patients having surgical procedures across a range of service lines.

One promising path is a broader use of regional anesthesia (RA), which in some locations has enabled a wide variety of total joint procedures, as well as breast and other surgeries, to move out of hospital ORs. For both inpatient and outpatient settings, RA has proved to be highly effective in managing intraoperative anesthetics and postoperative pain, often with little or no opiates, which improves clinical and operational outcomes and reduces the risk of chronic post-surgical opioid abuse.

Training for the future

The greatest current challenge to healthcare in general and anesthesia in particular is a demand for clinicians that is outpacing the supply. We, as members of the anesthesia community, are very invested in training tomorrow’s anesthesia providers, to ensure that all patients can get the surgeries they need, when they need them. Through NAPA’s four active residencies, with more to come, and as the clinical teaching facilities for many CRNA and CAA (certified anesthesiologist assistant) programs, we aim to be part of the staffing solution by training the next generation of anesthesia clinicians.

Anesthesia’s involvement in every surgical subspecialty, from intrauterine fetal surgery to caring for centenarians, offers clinicians opportunities to experience a fascinating diversity in patient encounters and make an impact that is immensely rewarding. And because of anesthesia’s leadership in patient safety, patients today are safer having an anesthetic than they are driving their car.

At this 175th anniversary of anesthesiology, I hope everyone will reflect on how the amazing invention of anesthesia, and our specialty’s relentless pursuit of patient safety in perioperative care, has contributed to medicine, made surgeries and childbirth safer, and helped make people’s lives better.

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