The Changing Face of Anesthesiology and Perioperative Medicine

he American Society of Critical Care Anesthesiologists (ASCCA) is a subspecialty organization within the umbrella of ASA. ASCCA is the only professional association exclusively devoted to critical care medicine as practiced by anesthesiologists. The mission of ASCCA is to preserve and expand the pivotal role of anesthesia intensivists in critical care and to provide educational opportunities for nonintensivists seeking to improve the perioperative care of their patients. These goals are accomplished through education and advocacy. Any anesthesiologist with an interest in the care of the critically ill patient is welcome to join the society or attend our annual meeting (which is held the Friday before the ASA Annual Meeting).

The line between inpatient operating rooms and the intensive care unit is slowly but inexorably falling away. Hospitals are, out of necessity, managing increasing numbers of critically ill patients who require ever more complex operative interventions. Anesthesiologists, as perioperative care specialists, are best suited to assume a broader role in care for these “at risk” patients. We as a specialty have the opportunity to take “ownership” of a major institutional and societal problem and lead the way to a broader reorganization of our current hierarchical, vertically siloed system of inpatient delivery of services.

The blueprint for this vision of anesthesiology was elegantly put forth by Ronald D. Miller, M.D., in the October 2005 ASA NEWSLETTER with his “Report From the Task Force on Future Paradigms of Anesthesia Practice.” For this vision to become reality, two transformations must occur in parallel. First, anesthesiology/perioperative medicine must transform as he envisioned. That topic is outside the purview of this article. The second necessary change for our specialty to not only survive but also prosper is enhancing the education of the current generation of anesthesiologists and building upon their solid foundations of physiology, pharmacology, mechanical ventilation and procedural skills.

On this second front, ASCCA and the ASA Scientific Content Subcommittee on Critical Care are providing the kind of educational opportunities to allow willing and interested current practitioners to “bridge the gap.” Bridging the gap will require anesthesiologists to simultaneously rectify their weaknesses and lead the expansion of their participation with their strengths.

With this vision in mind, ASCCA continues to reach out to residents and recruit them into the subspecialty practice of critical care medicine. We intend to repeat our resident mentor program at this year’s annual meeting and hope to expand upon our recent success. We also intend to have greater representation and recruiting efforts at the regional anesthesia resident meetings, which take place throughout the year. Consistent with its mission, ASCCA utilizes its modest resources to support its members’ growth as intensivists, investigators, educators and physician leaders. ASCCA’s Annual Meeting is widely regarded as the best one-day critical care meeting anywhere. Once again, interested members of ASA are more than welcome to attend.

ASCCA has been fully engaged in ASA’s Annual Meeting critical care track since its inception and continues to bring a full menu of intensive care topics to the broader ASA membership. It is the hope of our subspecialty society that, over time, demand for higher levels of discussion will continue to increase. This year’s critical care track will include an expanded program replete with topics that should be very interesting to ASA’s membership. While the program has not been finalized, the committee hopes to offer a slightly increased number of refresher courses, two basic science reviews, six point/counterpoint discussions, at least one clinical forum, workshops on advanced cardiac life support and echocardiography, and an expanded number of panels. Topics will span the entirety of perioperative medicine, from transfusion medicine, mechanical ventilation, hemodynamics and infection control to ethics and credentialing. The proposed program will also include discussions about getting the most out of the Internet, evidence-based medicine and clinical decision-making, all of which will be hot topics for the next few years. Be warned, many of the sessions are certain to be far more informative than their titles might suggest, and attendees’ biggest problem will be choosing from a menu of great offerings!

Michael F. O’Connor, M.D., is an Associate Professor and Section Head of Critical Care, Department of Anesthesia and Critical Care, University of Chicago.

Gerald A. Maccioli, M.D., F.C.C.M., is Director of Critical Care Medicine, Critical Health Systems of North Carolina, Raleigh Practice Center, Raleigh, North Carolina.