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Purpose:
The American Society of Anesthesiologists (ASA)
is an educational and professional association
of physicians.
Its purpose is to raise the standards of the
medical practice of anesthesiology by fostering
and encouraging education, research and scientific
progress in the specialty and to improve the
care of the anesthetized patient. |
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Anesthesiologists are physicians who, after college, have
graduated from an accredited medical school and have successfully
completed an approved residency in anesthesiology.
Anesthesiologists’ responsibilities to patients
include:
A. Preanesthetic evaluation and treatment;
B. Medical management of patients and their anesthetic
procedures;
C. Postanesthetic evaluation and treatment;
D. On-site medical direction of any nonphysician who assists
in the technical aspects of anesthesia care to the patient.
The ASA seal
depicts the role of the anesthesiologist in
patient care:
“The patient is represented as
(a ship) sailing in the troubled sea with
the clouds of doubt and waves of terror being
guided by the skillful pilot (anesthesiologist)
with constant and eternal (stars) vigilance
(motto) by the dependable (firmly based lighthouse)
knowledge of the art and science of sleep
(moon) to a safe (shield) and happy outcome
of his voyage through the realms of the unknown.
The perfect circle denotes the unity of a
closed group (the Society).”
As presented by its designer, Paul M. Wood,
M.D. (April 13, 1932). |
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Anesthesiology is the practice of medicine dedicated to
the relief of pain and total care of the surgical patient
before, during and after surgery. The medical expertise
of the anesthesiologist has caused a dramatic expansion
of the role of this specialist in health care delivery.
Although historically anesthesiologists have been known
primarily as physicians who administer anesthesia to alleviate
pain and suppress consciousness of the patient undergoing
surgery, they also provide medical care and consultations
in many other settings and situations outside of the operating
room.
Patient Safety
As evidenced by the creation in 1984 of the first foundation
dedicated to patient safety, the Anesthesia Patient Safety
Foundation, anesthesiologists are recognized leaders among
physician groups in improving patient safety. This concept
was later adopted by the American Medical Association (AMA)
when it began a similar foundation in 1998.
Anesthesia has become progressively safer over the past
50 years, and this improvement has correlated with a dramatic
increase in the number of anesthesiologists. These
improvements have occurred despite the fact that very young,
very old and sicker patients are undergoing and recovering
from major surgeries. Benefits to the sickest patients
have been shared with all patient groups such that a healthy
person’s chance of dying from anesthesia is now less
than 1 in 200,000 when an anesthesiologist is involved in
his or her care.
All of this has occurred during a time when the youngest
of premature infants in neonatal units survive intricate,
lifesaving procedures, and 100-year-old patients undergo
and recover from major surgeries that were once thought
to be impossible.
A 1999 report from the Institute of Medicine (IOM) of the
National Academy of Sciences mentioned several achievements
in the medical specialty of anesthesiology that have reduced
the risk for patients who have a medical or surgical procedure
performed under anesthesia. Here is what the IOM said about
anesthesiology:
“Anesthesiology is an example of a
local, but complex, high-risk dynamic patient care system
in which there has been notably reduced error. …
Anesthesiologists confronted the safety issues presented
by the need for continuing vigilance during long operations
but punctuated by the need for rapid problem evaluation
and action.”
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Anesthesia has become progressively
safer over the past 50 years, and this improvement
has correlated with a dramatic increase in the
number of anesthesiologists. These improvements
have occurred despite the fact that very young,
very old and sicker patients are undergoing
and recovering from major surgeries. |
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The Role of the Anesthesiologist — from Surgical
Anesthesia to Critical Care Medicine and Pain Medicine
Care of the Surgical Patient
The anesthesiologist is the perioperative
physician (“peri-” meaning “all-around”)
who provides medical care to each patient throughout his
or her surgical experience. This includes medically evaluating
the patient before surgery (preoperative), consulting with
the surgical team, providing pain control and supporting
life functions during surgery (intraoperative), supervising
care after surgery (postoperative) and medically discharging
the patient from the recovery unit.
Preoperative Evaluation
Anesthesiologists play a vital role in assessing a patient’s
medical readiness for surgery. They are unique in their
advanced knowledge of both the medical illnesses that a
patient undergoing surgery may suffer, as well as the effects
on the body of the specific operation to be performed. The
anesthesiologist’s preoperative evaluation may be
very brief (such as in the case of a surgical emergency)
or very prolonged (such as in the case of a patient with
multiple chronic medical problems who is to undergo an extensive
operation). In all cases, however, the anesthesiologist
performs a focused history and physical examination, reviews
available laboratory and special test results, and assesses
the need for additional testing prior to proceeding with
surgery.
Intraoperative Care
It is estimated that nearly 40 million anesthetics are administered
each year in this country. Anesthesiologists provide or
participate in more than 90 percent of these anesthetics.
In the operating room, they are responsible for the medical
management and anesthetic care of the patient throughout
the duration of the surgery. The anesthesiologist must carefully
match the anesthetic needs of each patient to that patient’s
medical condition, responses to anesthesia and the requirements
of the surgery.
In many surgical settings, anesthesiologists work in the
“anesthesia care team” mode, medically supervising
the work of nonphysician anesthetists such as nurse anesthetists
and anesthesiologist assistants, who, though not physicians,
have been trained in the technical administration of anesthetics.
Anesthesiologists have important functions outside of operating
room suites, such as evaluating patients prior to surgery
or conducting postoperative visits. However, the majority
of their activities, which are performed inside the operating
room, are seen by few people outside of the surgical and
nursing team. Even the patients themselves are often unable
to remember much of their involvement with this vital specialist
because much of the anesthesiologist’s critical work
may be done while the patient is anesthetized! The role
of the anesthesiologist in the operating room is to: 1)
provide continual medical assessment of the patient; 2)
monitor and control the patient’s vital life functions,
including heart rate and rhythm, breathing, blood pressure,
body temperature and body fluid balance; and 3) control
the patient’s pain and level of consciousness to make
conditions ideal for a safe and successful surgery.
The Postanesthesia Care Unit (PACU) or “Recovery Room”
After surgery, patients are transferred to the Postanesthesia
Care Unit, where they continue to emerge from the effects
of anesthesia under the watchful eyes of the peri-anesthesia
nurse with anesthesiologist consultation immediately available.
Evidence of recovery – including activity level, adequacy
of breathing, circulation, level of consciousness and oxygen
saturation – is continuously monitored. Pain control
is optimized. In most cases, the anesthesiologist decides
when the patient has recovered enough to be sent home following
outpatient surgery or has been stabilized sufficiently to
be moved to a regular room in the medical facility or transferred
to an intensive care unit.
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Critical Care and Trauma Medicine
As an outgrowth of the PACU, critical care units
are now found in all major medical facilities throughout
the country. Because of their extensive training in clinical
physiology/pharmacology and resuscitation, anesthesiologists
are uniquely qualified to coordinate the care of patients
in the intensive care unit. Some anesthesiologists pursue
advanced fellowship training to subspecialize in critical
care medicine in both adult and pediatric hospitals. In
the intensive care unit, they direct the complete medical
care for the sickest patients. The role of the anesthesiologist
in this setting includes the provision of medical assessment
and diagnosis, respiratory and cardiovascular support and
infection control.
Anesthesiologists also possess the medical knowledge and
technical expertise to deal with many emergency and trauma
situations. They provide airway management, cardiac and
pulmonary resuscitation, advanced life support and pain
control. As consultants, they play an active role in stabilizing
and preparing the patient for emergency surgery.
Anesthesia Outside the Operating Room
As medical technology has advanced, so has the need for
anesthesiologists to become involved in caring for patients
during uncomfortable or prolonged procedures in locations
remote from the confines of the traditional operating suite.
These procedures frequently include radiological imaging,
gastrointestinal endoscopy, placement and testing of cardiac
pacemakers and defibrillators, lithotripsy and electroconvulsive
therapy. In most institutions, anesthesiologists are available
during cardiac catheterizations and angioplasty procedures
should emergency airway management or resuscitation become
necessary. It would be impossible to perform many of these
tests on infants and young children without the use of anesthesia
or various sedation techniques provided by an anesthesiologist.
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Pain Medicine
Because of their specialty training and vast experience
in controlling pain during surgery, anesthesiologists are
uniquely qualified to prescribe and administer drug therapies
or perform special techniques for acute, chronic and cancer
pain.
Acute Pain Management
In addition to relief of patients’ pain during a surgical
procedure, it is equally important for the patient’s
comfort and well-being to receive adequate pain relief postoperatively.
Anesthesiologists are responsible for ensuring that a patient’s
pain is under control before they are discharged from the
PACU. An anesthesiologist may prescribe specific pain medications
or perform specialized procedures to maximize patient comfort,
which helps to minimize stress on the patient’s heart
and blood pressure. The techniques that are best suited
for each individual patient are chosen to allow for proper
rest and healing.
Chronic and Cancer Pain Management
Anesthesiologists are the vanguard of those who are developing
new therapies for chronic pain syndromes and cancer-related
pain. Anesthesiologists who specialize in the treatment
of chronic pain often dedicate their practices exclusively
to a multidisciplinary approach to pain medicine, working
collaboratively with other medical specialists in a pain
clinic.
Obstetric Anesthesia
It has become very common for anesthesiologists to provide
expectant mothers with pain relief during labor and delivery.
While many mothers choose to use natural childbirth techniques,
the demand for epidural anesthesia for labor and delivery
has increased dramatically over the last several years due
to the proven safety and benefits of this resource. During
childbirth, the anesthesiologist manages the care of two
patients, providing effective pain relief for the mother
while maintaining a high degree of safety for her unborn
infant. In most cases, this involves administration of local
anesthetics and/or narcotics via spinal or epidural routes.
In the event of an emergency cesarean section, the anesthesiologist
provides surgical anesthesia while managing the life functions
of both the mother and the baby.
Ambulatory and Office-Based Anesthesia
The number of operations performed in ambulatory surgical
centers and doctors’ offices continues to rise. Many
of the patients being treated in these facilities are from
an increasingly elderly population with more complex medical
problems. Patients deserve the same high standard of care
in these facilities that they receive in the hospital setting.
Anesthesiologists are working with federal and state legislators
and agencies and collaborating with other physicians and
accrediting bodies to establish safety standards for such
facilities.
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Operating Room Management
In addition to providing patient care, the anesthesiologist
is often responsible for managing the resources of the operating
suite, including the efficient use of operating rooms, supplies,
equipment and personnel. Unlike most surgeons, who spend
much of their time seeing patients in private offices, anesthesiologists
work in the operating suite every day. Their continuous
presence, along with their wide-based appreciation for the
needs of surgeons and other physicians who perform procedures
requiring anesthesia, uniquely qualifies anesthesiologists
for leadership positions in operating room administration
and management.
Basic Science and Clinical Research
Some of the most significant strides in medicine and surgery
have been directly attributable to anesthesiology’s
advances in patient monitoring, improved anesthetic agents
and new drug therapy. Anesthesia research at the clinical
and basic science levels has been completed almost exclusively
by anesthesiologists or Ph.D. scientists with the goal of
continually improving patient care and safety. Research
is conducted in each of the subspecialties of pediatric,
geriatric, obstetric, critical care, cardiovascular, neurosurgical
and ambulatory anesthesia. Other areas of active study include
blood transfusions and fluid therapy, infection control,
difficult airway management, cardiopulmonary resuscitation,
complications, new devices and methods of monitoring, pharmacology,
patient safety, pain therapy and organ transplantation.
Education and Training
The education of today’s anesthesiologists has kept
pace with their expanding role in offering the highest quality
health care available anywhere in the world. After completing
a four-year college program and four years of medical school,
they enter a four-year anesthesiology residency training
program. Fellowships in an anesthesia subspecialty, education
or research also may be taken for an additional year. Almost
90 percent of the active members of the American Society
of Anesthesiologists have been certified as diplomates of
the American Board of Anesthesiology.
Educational and Legislative Activities
Through their national professional organization, the American
Society of Anesthesiologists (ASA), anesthesiologists participate
in many continuing medical education programs, legislative
activities and public education. These include:
• The world’s largest international educational
program for anesthesiologists — the five-day ASA
Annual Meeting with an average attendance of more than
18,000.
• Comprehensive refresher courses for continuing
medical education during the ASA Annual Meeting and regional
courses and workshops throughout the year.
• Education and training in applications of new
knowledge in the areas of patient safety, standards of
care, practice guidelines and quality improvement.
• Web-based continuing education programs.
• Practice management seminars and publications
for anesthesia practitioners and groups.
• Legislative and regulatory activities at the state
and national levels through the ASA Washington Office.
• Public education programs, events and materials
about the current and emerging technologies in anesthesiology
that help patients to make educated choices about their
anesthesia or pain management care.
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The American Society of Anesthesiologists
History
Unlike most other medical specialties, anesthesiology’s
heritage is rooted in the United States, where
ether was first used for surgery in the mid-19th
century.
In 1905, nine medical colleagues from Long Island,
New York, organized the first professional anesthesia
society. The Society expanded to 23 members
in 1911 and renamed itself the New York Society
of Anesthetists.
As its purpose and scope of involvement in anesthesia-related
issues grew and attracted other interested physicians
nationwide, the Society changed its name to
the American Society of Anesthetists in 1935
and then to the American Society of
Anesthesiologists (ASA) in 1945. ASA
moved its offices from New York to Chicago in
1947 and then to the Chicago suburb of Park
Ridge, Illinois, in 1960, where today it serves
a membership of more than 40,000.
Membership
ASA’s highest decision-making power is
vested in its House of Delegates, composed of
about 350 delegates who represent the interests
of members in the United States and Puerto Rico.
Active members of ASA must be Doctors of Medicine
(M.D.) or Osteopathy (D.O.) who are licensed
physicians and have successfully completed a
training program in anesthesiology approved
by the Accreditation Council for Graduate Medical
Education (ACGME) or the American Osteopathic
Association (AOA).
ASA has a special category for residents in
anesthesiology training. Resident members must
be physicians in a full-time anesthesiology
residency program accredited by ACGME or AOA.
There also is a category for medical students
with an interest in the specialty.
Other categories of membership include retired
members, life members (past presidents), honorary
members and affiliate members (physicians or
scientists not in the clinical practice of anesthesiology
but who maintain an interest in the specialty).
In October 2001, ASA’s House of Delegates
overwhelmingly approved a new category of educational
membership. Educational membership is available
for anesthesiologist assistants and certified
registered nurse anesthetists.
Publications & Resources
• Anesthesiology, ASA’s internationally
recognized, scientific peer-reviewed journal,
is published monthly.
• ASA has developed and adopted more than
30 standards, guidelines, advisories and practice
parameters for optimal patient care.
• ASA Refresher Courses in Anesthesiology book, containing selected scientific Refresher
Course presentations, is published annually.
• ASA has produced more than 30 patient
safety videotapes and CD-ROM programs for the
continuing medical education of its members.
• ASA produces and publishes a variety
of publications and provides informational services
on various aspects of anesthetic care for both
medical personnel and the general public. Many
of ASA’s publications and resources can
be accessed on its Web site at <www.ASAhq.org>. |
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8/24/06
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