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 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 and in education or research may also be taken for an additional year.

More than 90 percent of the active membership of the American Society of Anesthesiologists have been certified as diplomates of the American Board of 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.

SCOPE OF PRACTICE

The medical expertise of this specialist has caused a dramatic expansion of the role of the anesthesiologist. 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 in addition to the operating room. In recent years, many anesthesiologists have dedicated their careers to the treatment of acute, chronic or cancer pain.

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 support of life functions during surgery (intraoperative), supervising care after surgery (postoperative) and medically discharging the patient from the recovery unit.

Anesthesia Care Team Approach

AAFL has the reputation for delivering the highest quality of anesthesia services for all types: elective and emergency surgery. The main purpose for the establishment of AAFL was that this level of service be provided at any time. The implementation of the team care concept, we feel, is the means of providing each patient with the best coordinated, idividual care. We then can concentrate particular resources, both personnel and equipment, wherever and whenever necessary. The members of AAFL consist of both Anesthesiologists and Certified Nurse Anesthetists.

In the operating room:

An estimated 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.

Within the confines of the operating room suite, which is often comprised of several separate operating rooms, the activities of the anesthesiologist are seen by few people outside of the surgical and nursing team. Even the patients themselves are unable to recall much of their involvement with this vital specialist because most of the anesthesiologist's critical work is 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 -- heart rate and rhythm, breathing, blood pressure, body temperature and body fluid balance; and

3) control the patient's pain and level of unconsciousness to make conditions ideal for a safe and successful surgery.

In addition to direct 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.

In the postanesthesia care unit (recovery room):

This is where patients are transferred after surgery, allowing them to emerge fully from the effects of the anesthesia under the watchful eyes of skilled nursing personnel with anesthesiologist consultation immediately available. While safety is of course the foremost priority during surgery, it is also of utmost concern that the patient be monitored and continually assessed while fully recovering from the anesthesia. In most cases, the anesthesiologist decides when the patient has recovered enough to be sent home following outpatient surgery, has been stabilized sufficiently to be moved to a regular room in the medical facility or should be transferred to an intensive care unit.

For pain management:

In addition to the patient's pain being relieved or blocked entirely during a surgical procedure, it is equally important to provide adequate pain relief postoperatively for the patient's comfort and well-being. After surgery, the anesthesiologist is involved in prescribing pain-relieving medication and techniques that are best for each individual patient to maintain a level of comfort and to allow proper rest.

Because of their specialty training, anesthesiologists are uniquely qualified to prescribe and administer drug therapies for acute, chronic, cancer and childbirth pain. In childbirth, the anesthesiologist manages the care of two people, providing pain relief with epidural or spinal blocks for the mother while managing the life functions of both the mother and the baby. Anesthesiologists also have been in the vanguard of those developing new therapies for chronic and cancer pain.

In critical care and trauma medicine:

As an outgrowth of the postanesthesia care unit, critical care units are now found in all major medical facilities throughout the country. The role of the anesthesiologist in this setting is to provide medical assessment and diagnosis, respiratory and cardiovascular support, and infection control.

Anesthesiologists also have the medical background to deal with many emergency 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.
During cardiac laboratory procedures:
In most institutions, anesthesiologists are available during cardiac catheterizations and angioplasty procedures for emergency airway management or resuscitation if necessary.

For diagnostic procedures and nonsurgical treatments:

As medical technologies have advanced, so has the need for anesthesiologists to become involved in caring for patients during radiological imaging or scanning procedures, endoscopies, in vitro fertilization, lithotripsy procedures, electroshock treatment, nutritional support and respiratory therapy.

RESEARCH AND CLINICAL STUDIES

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 done 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 study include: blood transfusions and fluid therapy, infection control, difficult airway management, cardiopulmonary resuscitation, complications, new devices and methods of monitoring, pharmacology, pain therapy and organ transplant.

Complications from anesthesia have declined dramatically over the last 25 years. Since 1970, the number of anesthesiologists has more than doubled and, at the same time and at virtually the same rate, patient outcomes have improved. In just the last decade, estimates for the number of deaths attributed to anesthesia have dropped 25-fold from 1 in 10,000 anesthetics to less than 1 in 250,000 today.

All this has occurred during a time when the youngest of premature infants in neonatal units survives intricate, lifesaving procedures and 100-year-old patients undergo and recover from major surgeries that were once thought to be impossible.

EDUCATIONAL AND LEGISLATIVE ACTIVITIES

Anesthesiologists, through their national professional organization, the American Society of Anesthesiologists (ASA), participate in many continuing medical education programs and legislative activities. These include:

The world's largest international educational program for anesthesiologists -- a five-day ASA Annual Meeting with an 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, training and applications of new knowledge in the areas of patient safety, standards of care, practice guidelines and quality improvement.

Patient education programs and materials about the current and emerging technologies in anesthesiology to help the public make educated choices about their anesthesia or pain management care.

Legislative and regulatory activities at the state and national levels through the ASA Washington Office.