The future of anesthesiology

Prielipp, Richard C.; Cohen, Neal H.

doi:10.1097/aco.0000000000000301

Cited by 19 publications

(7 citation statements)

References 13 publications

(12 reference statements)

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“…7 Anesthesia training has subsequently evolved to involve more advanced hemodynamic monitoring, point of care ultrasound training, advanced regional techniques, and enhanced recovery modalities. 8 It can be argued that anesthesia training has also normalized high-risk patient populations, and thus, the average anesthesiologist, regardless of fellowship training, may practice similarly when such high-risk patients are encountered. This study specifically looked at pre-emptive vasopressor use as well as pre-emptive arterial line placement, and both the CTA group and the non-CTA group made similar choices in practice patterns and had similar incidences of post-induction hypotension.…”

Section: Discussionmentioning

confidence: 99%

Should All Patients With Pulmonary Hypertension Undergoing Non-Cardiac Surgery Be Managed by Cardiothoracic Fellowship-Trained Anesthesiologists?

Bhatia,

Scheiber,

Arora

et al. 2023

Semin Cardiothorac Vasc Anesth

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Objectives To identify differences in practice patterns and outcomes related to the induction of general anesthesia for patients with pulmonary hypertension (PH) performed by anesthesiologists who have completed a cardiothoracic fellowship (CTA group) vs those who have not (non-CTA group). Design Retrospective study with propensity score matching. Setting Operating room. Participants All adult patients with PH undergoing general anesthesia requiring intubation at a single academic center over 5 years. Interventions Patient baseline characteristics, peri-induction management variables, post-induction mean arterial pressure (MAP), and other outcomes were compared between CTA and non-CTA groups. Methods and main results: Following propensity scoring matching, 402 patients were included in the final model, 100 in the CTA group and 302 in the non-CTA group. Also following matching, only cases of mild to moderate PH without right ventricular dysfunction remained in the analysis. Matched groups were overall statistically similar with respect to baseline characteristics; however, there was a greater incidence of higher ASA class ( P = .025) and cardiology and thoracic procedures ( P < .001) being managed by the CTA group. No statistical differences were identified in practice patterns or outcomes related to the induction of anesthesia between groups, except for longer hospital length of stay in the CTA group ( P = .008). Conclusions These results provide early evidence to suggest the induction of general anesthesia of patients with non-severe PH disease can be comparably managed by either anesthesiologists with or without a cardiothoracic fellowship. However, these findings should be confirmed in a prospective study.

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Section: Discussionmentioning

confidence: 99%

Should All Patients With Pulmonary Hypertension Undergoing Non-Cardiac Surgery Be Managed by Cardiothoracic Fellowship-Trained Anesthesiologists?

Bhatia,

Scheiber,

Arora

et al. 2023

Semin Cardiothorac Vasc Anesth

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“…A shift in attitude is therefore required to make the hospital-wide implementation of anaesthesiological safety qualities a reality. Various opinion papers simultaneously highlight the multitude of possibilities and the hesitancy to proactively pursue them [29]. It is unfortunate, given that during the COVID-19 pandemic we showcased how this disruptive moment successfully placed us in the lead.…”

Section: Yes We Canmentioning

confidence: 99%

Broadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again)

Buhre,

Maas

2024

Current Opinion in Anaesthesiology

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Purpose of review The landscape of healthcare is characterized by high demands and scarce human and financial resources. This calls for action in improving healthcare quality. This review shows how anaesthesiologists are the designated medical specialist to share their affinity and knowledge in quality and safety, throughout the hospital and across the care continuum. Recent findings Recent studies show excellent frameworks and examples of anaesthesiologist leading the way in patient safety and quality of care. Summary Anaesthesiologist are early adapters of patient safety. In the last decades anaesthesia has become linked with patient safety and the quality of care. With the recent transition from peroperative to perioperative care; new opportunities are emerging, expanding our professional scope. Unfortunately, the anaesthesiologist is not often positioned in a leading role in quality of care and patient safety. After a brief rise during the COVID-19 pandemic, in which anaesthesiologists were visible in the frontline in many countries, we have unfortunately disappeared from the spotlight. This review shows numerous ideas, examples, and a framework how a leading position can be realized.

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“…16 Adding to the lack of academic time is the limited bandwidth of senior academic physicians to mentor and support aspiring physician scientists. 17 Anesthesiologists continue to assume a broader role in the perioperative care of patients, 18 which threatens to exacerbate the concern for protected academic time if interpreted narrowly. Health care organizations increasingly seek anesthesiology expertise to improve care beyond the operating room, and the public rightfully demands that expert practices continue to evolve superior anesthetic delivery, improve safety margins, and enhance perioperative outcomes.…”

Section: Research Productivity Across Anesthesiology Departmentsmentioning

confidence: 99%

A Call to Action: A Specialty-Specific Course to Support the Next Generation of Clinician Scientists in Anesthesiology

Cavallone

Duggan

Berger

2022

Anesthesia &Amp; Analgesia

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Clinical production pressure is a significant problem for faculty of anesthesiology departments who seek to remain involved in research. Lack of protected time to dedicate to research and insufficient external funding add to this long-standing issue.Recent trends in funding to the departments of anesthesiology and their academic output validate these concerns. A 2022 study examining National Institutes of Health (NIH) grant recipients associated with anesthesiology departments across 10 years (2011-2020) outlines total awarded funds at $1,676,482,440, with most of the funds awarded to only 10 departments in the United States. Of note, the total 1-year NIH funding in 2021 for academic internal medicine departments was 3 times higher than the 10-year funding of anesthesiology departments. Additionally, American Board of Anesthesiology (ABA) diplomats represent a minority (37%) of the anesthesiology researchers obtaining grant funding, with a small number of faculty members receiving a prevalence of monies. Overall, the number of publications per academic anesthesiologist across the United States remains modest as does the impact of the scholarly work.Improving environments in which academic anesthesiologists thrive may be paramount to successful academic productivity. In fact, adding to the lack of academic time is the limited bandwidth of senior academic physicians to mentor and support aspiring physician scientists. Given then the challenges for individual departments and notable successes of specialty-specific collaborative efforts (eg, Foundation for Anesthesia Education and Research [FAER]), additional pooled-resource approaches may be necessary to successfully support and develop clinician scientists. It is in this spirit that the leadership of Anesthesia & Analgesia and The Journal of Education in Perioperative Medicine, unified with the Association of University Anesthesiologists, aim to sponsor the Introduction to Clinical Research for Academic Anesthesiologists (ICRAA) Course. Directed toward early career academic anesthesiologists who wish to gain competency specifically in the fundamentals of clinical research and receive mentorship to develop an investigative project, the yearlong course will provide participants with the skills necessary to design research initiatives, ethically direct research teams, successfully communicate ideas with data analysts, and write and submit scientific articles. Additionally, the course, articulated in a series of interactive lectures, mentored activities, and workshops, will teach participants to review articles submitted for publication to medical journals and to critically appraise evidence in published research. It is our hope that this initiative will be of interest to junior faculty of academic anesthesiology departments nationally and internationally.

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The future of anesthesiology

Abstract: The scope of anesthesia practice has expanded globally, providing anesthesiologists, particularly those in the USA, with unique new opportunities to assume a broader role in perioperative care of surgical patients.

Cited by 19 publications

References 13 publications

Should All Patients With Pulmonary Hypertension Undergoing Non-Cardiac Surgery Be Managed by Cardiothoracic Fellowship-Trained Anesthesiologists?

Should All Patients With Pulmonary Hypertension Undergoing Non-Cardiac Surgery Be Managed by Cardiothoracic Fellowship-Trained Anesthesiologists?

Broadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again)

A Call to Action: A Specialty-Specific Course to Support the Next Generation of Clinician Scientists in Anesthesiology

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