n the year 2050, most readers of this article are unlikely to still be practicing anesthesiology (and definitely not taking night call). Why bother then looking 50 years from now to examine the practice of anesthesiology?

Although looking forward 50 years may seem like a long time, if we look back over the last 50 years of our specialty, the legacy of accomplishments that influence our current practice becomes obvious. Indeed, 50 years hence, anesthesiology practitioners will reap the benefits of our industry and invention. Along the way, we will experience the changes that lead to that future vision. In planning the series of articles for this theme issue, it was useful to use the last 50 years to understand the magnitude of changes that can occur in half a century. From the perspective of history, it became easier to identify the problems that technology has solved and the problems that remain to be solved.

Fifty years ago, the available anesthetic agents were somewhat limited. Ether was still widely used to deliver general anesthesia, and intravenous agents consisted primarily of barbiturates and morphine. In the last 50 years, pharmacologists have refined the available anesthetic agents, progressively eliminating side effects and providing greater control over drug concentration. Although anesthetic agents are now more refined, the manner in which we deliver anesthetic agents has changed very little. Dosing is still based upon population guidelines and a clinician’s assessment of the individual patient’s response. In this issue, W. Bosseau Murray, M.D., Ph.D., describes how technology will impact the manner in which we dose anesthetic agents in the future. Empiric dosing will be replaced by methods of administration based upon pharmacokinetic models. Further, technology will be used to couple the pharmacodynamic response to the dosing method.

Fifty years ago, technology for patient monitoring consisted of intermittent measurement of blood pressure, a finger on the pulse and auscultation of breath sounds. The vacuum tubes and massive computers of the day were not suited to developing clinical electronic devices. Who would have envisioned back then the plethora of monitoring devices that populate the anesthesiology workstation today? While these monitoring devices have unquestionably made anesthesia safer, they have introduced new problems. Not only is the modern anesthesiology workspace cluttered with boxes, wires and noisy alarms, but data from these devices are subject to misinterpretation and misuse leading to errors in clinical decision making. George T. Blike, M.D., describes how the burgeoning science of human factors will shape the monitoring environment of the future where devices are highly usable and true partners in patient care.

Fifty years ago, Beecher and Todd published a landmark article assessing overall anesthesia mortality to be about 1:1,500 anesthetics.¹ This estimate was based upon a systematic review of all deaths within 24 hours of surgery at 10 university hospitals over a five-year period. Although we know that anesthesiology has become much safer, our ability to assess mortality — or in a broader sense, patient outcome — is not much better than when Dr. Beecher completed his study. We are still dependent upon a paper medical record system that makes the essential data incomplete and poorly accessible. Jeffrey M. Feldman, M.D., describes the impact that information technology will have in transforming the manner in which outcome is assessed in the future and ultimately how clinical care is rendered.

Fifty years ago, anesthesia providers were trained in much the same manner in which they are trained today. A formal medical education was followed by a period of apprenticeship where experience was gained under the guidance of an acknowledged expert. Actual case experience was governed by the procedures and events that happened to occur during the training process. In recent years, patient simulators have been developed that offer the potential to broaden the training experience beyond those cases encountered during the course of residency. David M. Gaba, M.D., shares his vision on the fundamental impact simulation technology will have on the manner in which we train and certify our credentials.

Fifty years ago, the total annual page count for Anesthesiology was 700 pages. Since then the total annual page count has grown to exceed 3,000 pages, not to mention the numerous other anesthesiology journals that have been introduced worldwide. It is no longer possible for the individual practitioner to read and assimilate all of the available information germane to clinical practice, nor is it possible to access this information when needed at the point of care. Charlotte Bell, M.D., describes how technology in the future will meet our information-seeking needs at the point of care.

The impact of technology on anesthesiology practice has been dramatic over the last 50 years. In 2004 the potential for technology to impact anesthesiology practice is limited only by our ability to identify clinical problems and our ingenuity at solving those problems. Although we cannot predict with certainty how technology will influence our practice in 2050, the articles in this issue offer a view of the exciting years ahead.

If you find these topics interesting, join the members of the Society for Technology in Anesthesia (STA) at our Annual Meeting, which will be held in Miami, Florida, from January 12-15, 2005. For more information about the meeting and STA, visit <www.anestech.org>.

Reference:

1. Beecher HK, Todd DP. A study of deaths association with anesthesia and surgery. Ann Surg. 1954; 149:2-34.

Jeffrey M. Feldman, M.D., is Associate Professor of Clinical Anesthesia, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania. He is President of the Society for Technology in Anesthesia.