James E. Cottrell, M.D.

They get the Weekly Reader in grade school, they log on in high school, and eventually, they get Modern Maturity at home. The ones in between pay the bills for their kids, themselves and, increasingly, their parents. They all want to get their money’s worth all of the time, but when they are sick or someone in their family is sick, priorities change. When they are sick enough to need surgery, nothing else matters.

They all have a sense of what surgeons do. Unfortunately if you ask the public what anesthesiologists do, they are likely to say, “They put people to sleep.” That is why we need to be in the Weekly Reader, on the Web and in Modern Maturity with some clear and important messages.

The first message is that outer space is not the last frontier. Time-lapse images of live neurons reveal that dendritic spines grow and change shape within 30 minutes of appropriate stimulation. At a microscopic level, even the brains of adults are physically dynamic hour to hour. Papers still in press suggest that a class of drugs that includes several general anesthetics (N-methyl-d-aspartate receptor blockers) have rapid and radical effects on dendritic spine morphology.¹ Within a decade, anesthesiology residents should learn not only how anesthetics affect neurophysiology but how anesthetics affect brain morphology, why those changes matter, how long they last and how any deleterious effects can be minimized.

The public take-home message for the foreseeable future is that more amazing discoveries will be made by neuroscientists here on earth than by astronauts revisiting the moon or heading for Mars. And the punch line is this: Anesthesiology is the ultimate applied neuroscience. We do not “put people to sleep”; we use powerful drugs to commandeer their central nervous systems (or for the Web generation, their personal central processing unit), and we regulate everything from their respiration to their urine output while surgeons do things that would not be possible without us. Then, when we are at our best, we return our patients’ control systems to a state that is as close to normal as the state-of-the-art will allow.

And the state-of-the-art is never static. Increasing sensitivity of measurement techniques will continue to uncover a host of problems and remedies for surgical patients. For example just as postoperative cognitive dysfunction (POCD) among elderly patients undergoing cardiac and major orthopedic procedures has only been confirmed by more sensitive psychological tests than were applied 20 years ago,² within 10 years, we may be able to measure reliable indicators of POCD in most adult patients.

Although anesthesia-related mortality is far less likely than POCD, awareness that the risk is substantial has been revitalized among anesthesiologists by Robert S. Lagasse, M.D.³ The prospect of dying grabs public attention without reference to details, and we need to make the public aware that anesthesiologists are as central to the administration of anesthesia as surgeons are to the performance of surgery.

In the long run, our best investment in the future of anesthesiology is our commitment to the science of anesthesiology. Whether we heighten awareness of problems that need to be solved or encourage solutions that linger on the horizon, everyone from kids to retirees wants the best people working on the issues, and they want the best medical specialists giving them anesthesia if they ever end up in an operating room. So the connection between the science of anesthesiology and public recognition of anesthesiologists is direct, and the connection between public respect and political power is certain. Politicians know who hires them. Unfortunately, however, the path from science to political power is not quick enough to take us where we need to go between now and March 2005. For that we need to focus on an issue that can and must be addressed more immediately.

Colleagues from Alabama, Iowa and South Dakota can stop reading here. The rest of you reprobates (including colleagues from New York!) need to check your calendars. The election of representatives, senators, a president and, perhaps most important, many governors and state representatives and senators, is only eight months away. Gaining influence through science is a noble and worthwhile endeavor, but during the next eight months, we need to remember that money talks. It does not talk in the sense of buying politicians; it talks in the sense that it can help the campaigns of candidates who appreciate the importance of progress in anesthesiology and realize that progress in anesthesiology requires support of anesthesiologists.

But who are those politicians? Fortunately the ASA Political Action Committee (ASAPAC) knows. Unfortunately ASAPAC’s ability to support supportive candidates is limited to voluntary contributions from ASA members above and beyond their ASA dues.

The state-to-state disparity in contributions to ASAPAC is disturbing.⁴ If whatever makes it work in Alabama, Iowa and South Dakota could spread to the other 47 states, if we could put our money where our mouth is, then we could put our mouth where our money is, and we could be heard!

References:

1. Matsutani S, Yamamoto N. Brain-derived neurotrophic factor induces rapid morphological changes in dendritic spines of olfactory bulb granule cells in cultured slices through the modulation of glutamatergic signaling. Neuroscience. 2004; 123(3):695-702.

2. Berry AJ. Emery A. Rovenstine Memorial Lecture: Terri G. Monk, M.D., to present postoperative cognitive dysfunction: The next challenge in geriatric anesthesia. ASA Newsl. 2003; 67(7):6,8.

3. Lagasse RS. Anesthesia safety: Model or myth? A review of the published literature and analysis of current original data. Anesthesiology. 2002; 97(6):1609-1617.

4. Bonilla ME. ASAPAC prepares for important 2004 elections. ASA Newsl. 2003; 67(12):8-10,16.



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