Perioperative Medicine: Innovations and Challenges


With this issue, the Mount Sinai Journal of Medicine celebrates 2 anniversaries: the 4th anniversary of its relaunch as a center for the dissemination of excellent scientific information from around the world, and the 60th anniversary of the Mount Sinai Department of Anesthesiology, whose faculty members are dedicated to providing patients with excellent clinical care and conducting innovative programs in education, research, and quality improvement.

To commemorate its 60th anniversary, the Department of Anesthesiology has compiled scientific articles by outstanding faculty from both inside and outside Mount Sinai. The articles focus on the expansion of the anesthesiologist's role, from anesthetist in the operating room to that of perioperative physician who manages the patient pre-, intra-, and postoperatively in the ever-increasing number and types of procedural locations.

The first interaction of the perioperative physician with a patient is usually during the preanesthesia assessment. This topic is reviewed in general by Dr Elizabeth Frost and more specifically by Drs Flynn and Silvay with regard to the ever-increasing numbers of patients scheduled for cardiovascular surgery. Many of these patients have an implanted cardiac pacing and/or defibrillating device, the perioperative management of which is often poorly understood. Dr Castillo and his coauthors demystify this subject.

When evaluating the airway, it is not uncommon to discover problems with dentition that require a referral to a dentist or oral surgeon. Drs Yasny and Herlich, who are both dentists and anesthesiologists, address this important subject.

Most patients and their families are anxious about the risks of anesthesia. The preanesthesia evaluation includes an assessment of the patient's physical status according to the classification of the American Society of Anesthesiologists (ASA). Drs Lagasse and Saubermann discuss whether ASA physical status can be used to predict adverse perioperative outcome.

Patients are very often worried about the risks associated with blood transfusion and may request bloodless surgery. Drs Shander and his colleagues and Dr Bennett-Guerrero are experts in this area and have contributed insightful reviews.

Parents whose children require anesthesia are naturally concerned about potential effects on the developing brain. Similarly, adult children of parents (or another elderly relative) who require anesthesia are concerned because “grandma was never the same after her last anesthesia.” These two timely topics are addressed respectively by Drs Cottrell and Hartung and by Drs Deiner and Silverstein.

An ever-increasing number of procedures that require sedation or anesthesia are now being performed in physicians' offices. Office-based anesthesia (OBA) is a rapidly growing field. The office is a very different environment from the fully equipped and supported hospital operating room. Education in this area is essential, and a number of training programs now include an OBA rotation. Dr Hausman and coauthors are experienced OBA experts and educators.

Inevitably, some patients will find themselves in a critical care unit, with their lungs being mechanically ventilated. Much has been written about new ventilatory strategies and weaning from ventilation. Dr Papadakos, a well-published authority on critical care medicine, and his colleagues provide a timely update.

Postoperative pain and other pain syndromes (e.g., failed back surgery syndrome) are of great concern for most patients. Pain management is now a subspecialty of anesthesiology, using both invasive and noninvasive techniques to prevent or alleviate pain. Dr Epstein describes spinal cord stimulators, and Drs Khelemsky and Noto review post-thoracotomy pain and its management.

Human patient simulators are increasingly being used to educate medical personnel at all levels. In addition, certifying bodies are beginning to use these devices for evaluating anesthesiologists for maintenance of their specialty certification. Dr Levine, a pioneer in this field, and his colleagues review the current status of simulation in medical education, certification, and licensure.

Anesthesiologists have always considered patient safety to be their primary consideration and are constantly seeking ways to improve it. Learning from past experiences requires that accurate data be available for analysis, but handwritten records do not facilitate this. The introduction of anesthesia information management systems provides the means to capture huge amounts of data and therefore facilitate outcomes research. Dr Bassam and colleagues have contributed an overview of these systems and discuss applications that have the potential to further improve the safety of our patients.

We hope that our readers find these articles of interest and help when one of their patients needs anesthesia.


Potential conflict of interest: Nothing to report.