Impact Versus Impact Factor

Opportunities Beyond the Anesthesiology Department: Broader Impact Through Broader Thinking

“…Anesthesiologists with notable research contributions extending beyond the specialty have included Dr Elmer McKesson who was able to achieve transformational advances in patient safety by advocating for quantitative assessments of pulse, respirations, and blood pressure. 34 Additionally, Drs Max Kelz and Emery Brown, whose work have advanced the understanding of neurobiologic mechanisms of unconsciousness, 35,36 exemplified how anesthesiologists can play key roles in cross-disciplinary research initiatives aimed at revolutionizing the understanding of the human brain.…”

Preoperative Blood Pressures and the Physician Anesthesiologist

“…In 1920, and standing on Cushing’s metaphorical shoulders, the famed anesthesiologist and founder of the International Anesthesia Research Society (San Francisco, California), Elmer McKesson, broke new ground with his insistence on recording quantitative blood pressures rather than relying merely on qualitative assessments of so-called “pulse quality,” a change that had been made possible with the introduction of a new device known as the sphygmomanometer. 5…”

“…In 1920, and standing on Cushing's Robert B. schonberger Editorial metaphorical shoulders, the famed anesthesiologist and founder of the International Anesthesia Research Society (San Francisco, California), Elmer McKesson, broke new ground with his insistence on recording quantitative blood pressures rather than relying merely on qualitative assessments of so-called "pulse quality," a change that had been made possible with the introduction of a new device known as the sphygmomanometer. 5 In more than a century since such foundational work, physicians have naturally sought to bring a normative understanding to the systemic blood pressure. That is, we anesthesiologists do not simply want to know what the blood pressure is, but rather we want to know what it should be-and of equal importance for our day-to-day practice, what should it not be during our preoperative evaluations as we assess our patients' fitness for, and likelihood of, safe passage through the fraught period of a pending surgery and anesthetic.…”

Ideal Blood Pressure Management and our Specialty

“…As an echo of this tradition of poorly grounded pronouncements, McKesson’s original 1923 article itself remained entirely unreferenced until 2012. 4 In addition to the phenomenon of white-coat hypertension, our specialty should also be aware of the increasingly recognized inverse phenomenon of “masked hypertension.” Masked hypertension is present when otherwise hypertensive people (as determined by a gold-standard ambulatory blood pressure monitoring device) repeatedly demonstrate blood pressures in the normal range specifically within healthcare contexts. 5 It may be projection that leads anesthesiologists to be more anxious to assume our hypertensive patients are “just nervous” than we are to ask which of our apparently normotensive patients are in fact masked hypertensives who should also be treated differently while under our care.…”

“…As an echo of this tradition of poorly grounded pronouncements, McKesson’s original 1923 article itself remained entirely unreferenced until 2012. 4 …”