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The Scope of Anesthetic Practice:

The scope of anesthesia practice has expanded beyond our primary function in the operating room into a broad spectrum of roles both inside and outside the operating room. The uniqueness of the specialty of anesthesia is the fact that anesthesiologists provide care for all surgical specialties and at all ages of a patient’s life twenty-four hours a day.

The scope of anesthesia practice today may include work in the following areas:

 Pre-admission unit

 Operating room (OR)

 Obstetrical suites

 Post anesthetic care unit (PACU)

 Intensive care units (ICU)

 Surgical step down units

 Acute pain service

 Procedural sedation (endoscopy units,interventional radiology, surgical outpatient clinics)

 Chronic pain clinic

 Surgical/anesthesia care coordinator/facilitator/scheduler

 Teaching

 Administration

 Research

 Simulation centre (instructor, manager, coordinator, research)

Surgical procedures may be performed on an elective, urgent or emergent basis. Elective procedures are scheduled to permit an assessment of the patient’s fitness for the surgery prior to the surgical date (see Chapter 3 Preoperative Assessment). On occasion, time limitations do not permit a complete assessment and optimization of a patient’s condition prior to urgent or emergent surgery. Fig. 2.3 is an overview of the typical flow of a patient to and from the operating room.

Anesthesiology is a fascinating specialty where principles of applied pharmacology, physiology, and anatomy are used to provide care for patients of all ages. It has experienced exponential growth from the humble beginnings of Dr. W.G. Morton’s experience with inhalational anesthetics to our current practice. Like a painter’s brush, no two anesthesiologists have the same practice, and there are subtle nuances that continue to allow for the art as well as the science of medicine. We hope this primer serves as a useful guide during your introduction to our specialty.

References:

1 Marcucci, L. (2010). Inside Surgery. Origin of the Word “Anesthesia”.

1 Astyrakaki E, Papioannou A, Askitopoulou H. (2010). References to anesthesia, pain, and analgesia in the Hippocratic Collection. Anesth Analg 2010; 110(1):188-94.

2 Sullivan J. Surgery before anesthesia. Excerpt from the ASA Newsletter 1966;60(9):8-10.

3 Shepard DAE, Turner KE. (2004). Preserving the Heritage of Canadian Anesthesiology: A panorama of People, Ideas, Techniques and Events.