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All of medicine evolves as knowledge and skills grow.
The American Board of Anesthesiology (ABA) has recently
changed the structure of its oral examination to reflect
the broadening role of the specialty. ABA has increased
its emphasis on preoperative assessment, perioperative
pain control and acute postoperative management by adding
time for these topics to each of the two oral test sessions.
Recently Simon Gelman, M.D., Ph.D., brought these concepts
to our faculty at the Brigham and Women’s Hospital
(BWH). He reminded us that the term “anesthesia”
was suggested by Oliver Wendell Holmes to evoke the
state of senselessness provided by ether. Dr. Gelman
further reminded us how our practice grew deep physiologic
roots, how we began the earliest intensive care units
as an outgrowth of our knowledge of ventilation, and
how we derived techniques of pain management from our
management in the operating rooms (O.R.s) and obstetric
suites. He suggested that our department be renamed
to conform to the reality of our current practice. Thus
we became the Department of Anesthesiology, Perioperative
and Pain Medicine.
Through the following articles, members of the BWH faculty
were invited to share their vision of the new roles
of the modern anesthesiologist outside the traditional
O.R. and delivery room. We work as preoperative physicians,
bringing patients to the most optimal state possible.
The anesthesiologist works well in the high-acuity inpatient
environment and may become the ideal “hospitalist”
physician. Anesthesiologists can best manage acute postoperative
pain by aggressive approaches because of our knowledge
of both regional techniques and the pharmacokinetics
and pharmacodynamics of potent analgesics. Even critical
care has changed, but anesthesiologists remain ideal
participants in the team approach to patient care.
I wish to thank Dr. Gelman for his vision and guidance. 
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Daniel
F. Dedrick, M.D., is Assistant Professor of Anesthesia,
Harvard Medical School, and Director of Residency
Education, Department of Anesthesiology, Perioperative
and Pain Medicine, Brigham and Women’s Hospital,
Boston, Massachusetts. |
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