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May 1996
Volume 60 |
Number 5
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TO THE MEMBERSHIP
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| Tongue in Cheek |
Erwin Lear, M.D.
Editor
The current issue addresses the role of the anesthesiologist
as the "perioperative physician." It is quite possible
that even the perioperative physician may one day disappear as
a new subspecialty, "esoanesthesiology," emerges.
Esoanesthesiology is essentially a computer-driven derivation
of current practices. The preoperative patient will have a complete
analysis via a departmental intranet. The analysis will expedite
necessary clearance medically and financially according to physical
status and impending surgery.
The anesthesia machines in the operating rooms will be linked
to the departmental computer, which now has programmed each case
in each room according to patient status and surgical procedure.
A single "esoanesthesiologist" without resident assistance
oversees the computer.
At the beginning and at the end of each procedure, there is a
short delay while an ancient figure, the clinical anesthesiologist,
inserts or removes the endotracheal tube through which a servo-controlled
respirator ventilates the patient.
During surgery, intravenous replacement therapy is handled by
a modified wheatstone bridge to sample the quality of the fluid
lost during surgery and a servo-mechanism for regulating the rate
at which replacement is carried out.
Muscle relaxation is provided by the surgeon via a foot-controlled
injection system; thus, the nervous foot-tapping surgeon who frequently
requires cadaveric relaxation is able to furnish optimal conditions.
A second foot switch automatically stands the patient on his or
her head for proper exposure during pelvic surgery.
Periodically, a specially designed tape will announce in soothing
tones, "Blood pressure 120/80, pulse 72, patient's condition
satisfactory."
Electrotissue coagulation techniques provide proper closure of
peritoneum, fascia and skin. Thus, the surgical residents and
interns are no longer required to spend endless nights laboriously
tying square knots to bed posts. They are now free to engage in
more mundane projects such as pre- and postoperative evaluation
and care of patients, perhaps as a check on the computer network.
The clinical anesthesiology residents have all gone home, and
only the dedicated, research-oriented residents are hard at work
in the departmental labs tackling the momentous task of providing
the automation necessary for intubation and extubation so that
the harassed clinical anesthesiologist can take a long-deserved
rest or, perhaps, even attend a scientific meeting.
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