The Evolution of Anesthesiology
Health care is in an active state of transformation and reform.
The next decade will be a transition-rich environment for consolidations, affiliations,
and improving quality of care. The anesthesiologist-directed preoperative evaluation
clinic represents a successful partnership between hospital and physician and a framework
for growth in our specialty and improvement in outcome for patients.
Anesthesiologists are being asked to provide optimal, efficient
patient care within the limitation of finite resources. Current dynamic changes
in the field of anesthesiology require a fundamental reassessment and restructuring
of the manner in which clinical anesthesia care is provided.
The anesthesia preoperative assessment is a medical evaluation
of the patient's current condition, integrated with the anesthesiologist's unique
knowledge of the potential clinical and operative events that may occur. Is it time
to use this resource to improve patient outcome? Clear data now indicate the outcome
benefits (and cost savings to the patient and to society) of instituting the following
measures:
- β-Adrenergic receptor blockade for 2 weeks for all patients over 60
years of age without contraindications who are scheduled for type B and C procedures
(see Chapter 27
)
- Statins for 2 weeks for all patients not already receiving such who are
scheduled for type B and C procedures
- Aspirin for all patients over 40 years of age who are scheduled for type
B and C procedures that do not involve a closed space lesion, plastic surgery, or
retinal surgery (although retinal surgery has shown outcome benefits from perioperative
aspirin in at least one study)
- Physical activity regimen and smoking cessation programs for all patients
who are scheduled for type B and C procedures.[31]
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Will anesthesiology adopt these changes and be a more vibrant
specialty in the future, or will these changes become the responsibility of the primary
care physician, making preoperative evaluation part of another specialty? And will
acceptance or abandonment of such changes determine the viability of the specialty
of anesthesiology and its value to society in the future?
I believe the answers are obvious! You, the reader of this chapter,
have the ability to make anesthesiology a specialty of the future or a dinosaur of
the past. The expanding role of the anesthesiologist beyond the OR has redefined
our specialty for the hospital, our colleagues, and the community regarding our clinical
expertise, effectiveness, and contribution to quality patient care.
A successful anesthesia PPAC provides the foundation for preparation
of the patient for surgery. It results in considerable advantages for the anesthesiologist,
improves the quality of care and value for our patients, and provides visible hospital
leadership in responding to rapidly changing health care demands.
