Responsibility Beyond Surgery

In the 12 million operations performed in the U.S. each year, from charity patient to President, one feature is uniform and unchanging. The last in dividual the patient sees and hears be fore he "goes under" is the person who gives the anesthetic.

Today that person is often a physician. Nearly gone is the nurse-technician who dates back to the early days of ether and chloroform and whose only function was to render the patient in sensible to pain. Today's anesthesiologist is responsible for the whole man--his breathing and his circulation. In the past dozen years, the growth of knowledge and skills among anesthesia specialists has been greater than in practically any other branch of medicine. When the American Society of Anesthesiologists held its annual meeting in Denver last week, the trade talk of members made it clear that while their operating-room techniques continue to improve at a remarkable pace, their responsibility is beginning to extend beyond the bounds of surgery.

Advance Planning. Individual drugs are being developed to do the job better than old prescriptions compounded of many ingredients, said Dr. Perry Volpitto, the A.S.A.'s retiring president. "Only a few years ago we were giving patients what some doctors called 'the garbage anesthetic'--a little of this, a little of that and a little of something else. Today we have better equipment including vastly improved vaporizers, and better drugs."

As his materials have changed, the anesthesiologist's equipment has become as complex as the cockpit of a space capsule. Behind the screen that isolates the patient's head from the rest of his body, the anesthesiologist is surrounded by cylinders of oxygen and anesthetic gases, dials and valves to indicate and control their flow rates, electronic equipment to give continuous readings of the patient's pulse, breathing rate, blood pressure, and the oxygen concentration in his blood. One recent addition to the anesthesiologist's kit is an oscilloscope screen across which as many as half a dozen of these vital indices parade in ever-changing squiggly yellow lines.

New Role. "People used to think of the anesthetist as a faceless person who suddenly appears in the surgery, does his little assignment, and then disappears," said Dr. Volpitto. "It's different today. Anesthesiologists see the patients in advance, and we play a role with the surgeon in preparing them for what is to come." The A.S.A.'s incoming president, Dr. John J. Bonica, drew attention to another vital role of the anesthesiologist--where surgery is not involved or at least not scheduled. "Suppose," he said, "a patient comes in with barbiturate poisoning. All his automatic nervous system reactions, including those of his breathing center, are depressed. He may die because he is not getting enough oxygen, or he may be getting enough to keep him alive but so little as to leave him with a damaged brain. Or the respiratory depression may damage his lungs so that pneumonia and death follow. The anesthesiologist goes to work with the same equipment that he uses in surgery to maintain this patient's breathing and circulation until the drug is eliminated. We do the same for victims of drowning or accidental electrocution. This development is only five or six years old, but it is already saving many lives."

Justifiably Proud. Dr. Jay Jacoby, head of anesthesia at Marquette University School of Medicine, explained that the management of intractable pain promises to become an increasingly important part of anesthesiologists' work, as the aged population increases and, with it, the incidence of cancer. Dr. Bonica reported that he is concentrating on the relief of intractable pain from arthritis and neuralgia as well as cancer. The approach is usually by "permanently anesthetizing" nerves with injections of alcohol or phenol.

No anesthesia is without its dangers, but the answer to the patient's perennial question, "Will I wake up?", is becoming more assuredly affirmative each year. The number of deaths directly caused by anesthesia is impossible to determine because all the patients are sick to begin with. Though the total number of deaths that occur under general anesthesia is still significant, it is steadily declining even with more--and more radical--operations, a fact that makes anesthesiologists justifiably proud.

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