Vital Times 2020 - 102

percent. Vomiting during anesthesia was a serious
complication that usually led to aspiration of gastric
contents and fatal respiratory failure within 24 hours.
In the early 20th century, a small group of physicians
devoted their careers to the advancement of
anesthesia as a scientific discipline. Arthur E. Guedel,
MD, prompted the use of tracheal intubation with
cuffed tubes that protected the airway. Ralph Waters,
MD, and Brian Sword, MD, discovered methods to
remove carbon dioxide from the breathing circuit. Safe
techniques of epidural anesthesia were advanced and
accepted by practicing anesthesiologists. Training
programs in anesthesia for physicians were begun in
1928, and the practice of anesthesia was accepted
as a legitimate specialty by the American Medical
Association (AMA) in 1940.
Since those early days when physicians such as
Guedel, Waters, Lundy, and Beecher limited their
practice to the academic study of anesthesiology, the
major advances in the specialty have always been
made by physicians. Within a few decades, surgeons
and hospital administrators recognized the value
of physician-led departments of anesthesia. These
departments delivered a clinical service, a teaching
service for medical students and residents, and
innovative research.
Some of the advancements made by physician
investigators who are also anesthesiologists include
the development of nonflammable anesthetics,
epidural anesthesia, blood gas analysis, anesthetic
gas measurements, acute pain services, neonatal
resuscitation, ultrasound-directed nerve blocks,
patient-controlled analgesia, muscle relaxants,
induced coma for traumatic brain injury, and pulse
oximetry. These innovations have spread beyond
the discipline of anesthesia into other branches of
medical practice such as neurosurgery, nursing,
emergency medicine, and pain medicine.

102 |

CSA Vital Times

No major hospital in the U.S. today could function
without a physician-led director of anesthesia
services. These highly trained physicians are called
upon to direct intensive care units, operating rooms,
code blue teams, acute pain services, preoperative
clinics, ambulatory surgery units, and patient safety
committees. Anesthesiologists are always involved
in the most difficult surgical procedures such as
heart and lung transplants, liver transplants, neonatal
surgery, high-risk deliveries, and fetal intrapartum
surgery.
Clearly, there is nothing to be gained by less-trained
anesthesia practitioners understating the preeminent
role that physician anesthesiologists have played in
the modern practice of anesthesia. Today, the death
rate during anesthesia is so low that it is nearly
impossible to measure. These advances have been
accomplished by the steady guidance of the physician
anesthesiologist, who always has been and continues
to be the leader of the anesthesia care team.



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