adam Speaker, fellow members of the House of Delegates and guests, it is truly an honor on this unique occasion to commemorate 100 years of advancing patient safety.

Dedication to improving care and safety for our patients was evident from the outset when A. Frederick Erdmann, M.D., convened the first meeting of ASA’s predecessor, the Long Island Society of Anesthetists, consisting of eight physicians and one medical student. Incidentally, the presence of a medical student demonstrates that mentoring bright, interested students into our specialty has been a value from the beginning.

Although the records of the Long Island Society were lost in a fire, it is known that the members met quarterly to share techniques, hear papers and observe demonstrations.
“Safety First” protection for all patients receiving anesthesia was the theme of a 1923 meeting. Actions suggested to improve safety included preoperative determination of surgical risk and recording the blood pressure every five minutes during the entire operation. The goal of the “Safety First” campaign was to prevent those instances in which “the operation was a success, but the patient died.”

The World War II battlefield experience was a compelling demonstration of the excellence and value of physician involvement in anesthesia. One account mentions a 12-fold decrease in mortality in the Mediterranean Theater of Operations from one in 450 cases to one in 5,500. A specific example was the work of U.S. Army Captain Samuel L. Lieberman, who received the Legion of Merit for his exemplary work in a forward unit in the South Pacific. Under his care, patient mortality from intra-abdominal wounds decreased from 46 percent to 12.5 percent. A documentary about his career is available in the Wood Library-Museum.

The 1944 ASA meeting in Houston highlighted the value of then modern anesthesia techniques in reducing complications and improving pain control for transport in combat zones with regional nerve blocks.

As our Society moved toward its second half century, we saw our specialty begin to undertake a systematic approach toward identifying major risk factors and developing strategies to safeguard patients from them.

In the mid-50s, Henry K. Beecher, M.D., and Donald P. Todd, M.D., studied the deaths associated with anesthesia and surgery in approximately 600,000 anesthetics over a four-year period at 10 university hospitals. The significant point learned in their study was that the anesthesia death rate increased five- to six-fold when muscle relaxants were used.

In the 1980s, Ellison C. Pierce, Jr., M.D., Frederick W. Cheney, M.D., and Richard J. Ward, M.D., integrated the findings of the ASA Closed Claims Project, the work of the Anesthesia Patient Safety Foundation and a specialty-wide educational initiative so effectively that our specialty has received national acclaim for its contributions to improved patient care and safety.

Others of a past era made contributions peripheral to the practice of anesthesia that made enormous differences in the practice of medicine and in our patients’ lives:

• Virginia Apgar, M.D., the first woman at Columbia University College of Physicians and Surgeons to be named a full professor, designed and introduced the first standardized method for evaluating a newborn’s transition to life outside the womb, the Apgar Score.

• Peter Safar, M.D., who devoted his life to cheating death, was a pioneer in CPR, ICU and modern ambulance service and the only United States citizen nominated for a Nobel Prize by Russia.

At times I hear wistful or nostalgic conversations of the days when giants and heroes walked among us. These days are not gone. They are now. Giants and heroes are still in our midst. Some examples are:

• Lee A. Fleisher, M.D., is the first noncardiologist to chair the American College of Cardiology/American Heart Association committee on the update for the “Guidelines on Perioperative Evaluation for Noncardiac Surgery.”

• Debra A. Schwinn, M.D., Ph.D., has been appointed Director of Cardiovascular Genomics at Duke University’s Institute for Genome Sciences and Policy.

• John P. Kampine, M.D., Ph.D., is leading a project to establish bionanotechnology research resources at the Medical College of Wisconsin.

The work of these giants will make a difference in all of medicine and in our patients’ lives.
Also, anesthesiologists continue to serve our nation with valor and distinction, as reported in the July 2005 NEWSLETTER article regarding the service of our members in the war on terror. I quote:

“Mortality was decreased by more than 35 percent when an anesthesiologist-intensivist who was assigned in a nurse anesthetist position directed team-managed ICU patient care.”

And, closer to home, at least two anesthesiologists were among the first to volunteer to provide emergency medical care for the victims of Hurricane Katrina as members of Disaster Medical Assistance Teams, part of the National Disaster Medical System:

• Thomas H. Cromwell, M.D., of Belvedere, California, and

• Legion of Merit recipient James S. Hicks, M.D., of Portland, Oregon.

Looking back through the years, it is unmistakable that our practice today bears little resemblance to that of the pioneers in our specialty. Daily we care for patients who would not have been acceptable risks in their era. We guide them in comfort and safety though procedures that often would be unimaginably complex for our predecessors. Research, innovation and new knowledge have brought about these profound changes.

Yet, although the circumstances of our practices are ever-changing, there are two qualities that have defined us in the past, define us now and will define us in the future. They are the bonds that link our past and our future.

Our patients’ welfare has always been and will continue to be foremost in all our actions.
We are the doctors who will meet our patients at the most frightening, vulnerable times of their lives, when they are facing surgery. We calm their fears and guide them through the experience in comfort and safety. Their families call us into their midst at the two most sacred times of their lives to relieve the pains of childbirth and dying. This is who we are and what we do. It is our calling.

In closing, I apologize to the many anesthesiologists whose service and noteworthy achievements I did not mention.

It is an honor to have served as your President. I thank you for that privilege. I am also indebted to the ASA staff and to my fellow officers for their tireless dedication. I owe my family and friends an apology for having paid less attention to them than they deserved.

Lastly, my most sincere gratitude goes to my wife, Jean. Without her patient and thoughtful support, the last three years would not have been the “labor of love” that they turned out to be.

Madam Speaker, thank you for the privilege of the floor.

Eugene P. Sinclair, M.D., is Chief of Anesthesia Service, Orthopaedic Hospital of Wisconsin, Milwaukee, Wisconsin.