OPERATING ROOM

The OR continues to be the principal focus of the anesthetic practice (see Chapter 86 ). Whereas the anesthesiologist is comfortable in the OR setting, it can be a hostile environment, both to patients and to other medical personnel. The use of volatile anesthetics and the possible contamination of the environment by those gases are concerns that must be recognized by the anesthesiologist and appropriately monitored. Because anesthesiologists use needles and constantly risk exposing themselves and others to blood and other body fluids, appropriate consideration and thought must be given to how to prevent injury, both to the anesthesia personnel and to others who work in the OR.^[19] Unfortunately, not only are physicians and nurses in the OR subject to needlestick injuries, but housekeeping personnel also are at risk because of potential inattention by the medical staff. Certainly, it is in the best interest of the anesthesiologist to exploit creative new ways to administer drugs and monitor patients that will decrease the incidence of contamination of personnel in the OR by body fluids from patients.

It is well recognized that the OR is a major consumer of hospital, physician, and patient resources. It is equally apparent that efficient management of the OR can minimize costs and at the same time maximize patient through-put, contributing to enhanced institutional performance, although not without extraordinary effort and continuing education.^[20] Whereas few doubt the wisdom of these observations, fewer still have developed the ideal administrative and operational structure to effect the efficiencies needed in today's cost-constrained environment.^[21] Nevertheless, the effort continues, and anesthesiologists, by their temperament, availability, and interest, will be some of the principal players in the game (see Chapter 86 ). The application of managerial science to the improvement of OR efficiency has already become a scholarly focus in our specialty.^{[22] [23] [24]}

Triage is an important aspect of the anesthesiologist's role in the OR. Urgent or emergent cases need to be inserted into operative schedules during normal working hours, and often emergent cases vie for available resources during off-hours. The anesthesiologist must have the broad medical and surgical knowledge to allocate resources and facilitate appropriate treatment of patients in an orderly progression. If this triage responsibility is abdicated, patient care suffers. The anesthesiologist usually has the best overview of the surgical, nursing, and anesthesia personnel necessary to care for the patient.