Anesthesiology

Anesthesiology is widely regarded as the preeminent scientific journal in the specialty. This is evidenced not just by its size and circulation, but by its "Impact Factor", a number which estimates the number of times the average journal article is quoted by other authors.

While surgery has been practiced for many thousands of years, only the introduction of antisepsis and anesthesia during the 19th century made it possible to perform all but the simplest procedures. Before this time, many relatively unsuccessful attempts to control surgical pain had been made, including the use of alcohol, opium or laudanum, but the first truly successful general anesthetic (with ether) was performed in 1842, by Dr. Crawford Long of Georgia. Unfortunately, Dr. Long did not publicize his activities. The first public demonstration of anesthesia took place 150 years ago, when a dentist, William T.G. Morton, anesthetized a young man (Gilbert Abbott) with ether for removal of a neck tumor by the surgeon John. C. Warren M.D. This monumental event took place on October 16, 1846 at the Massachusetts General Hospital, in the operating suite now known as "The Ether Dome". The news that pain free surgery was finally possible spread around the world almost instantly, and ether anesthetics were being performed around the world within weeks. 

Modern Anesthesiology has come a long way from Drs. Long and Morton. At its core, it remains the art and science of relieving pain and of keeping patients safe and stable during surgery. This is now done using an armamentarium of medications and techniques that would astound the specialty's founders. For example, ether is now obsolete (and because of it's flammability, is never used). Instead, general anesthesia is now performed with multiple medications, including "volatile agents" (halothane, enflurane, isoflurane, desflurane, sevoflurane), nitrous oxide ("laughing gas"), intravenous agents (pentothal, propofol, etomidate, midazolam etc.), opioids (morphine - and its synthetic and shorter acting cousins, fentanyl, sufentanil, alfentanil and remifentanil) and drugs that can relax muscles (like curare - although this drug has now been replaced with synthetic agents with more controllable properties). In situations were general anesthesia is not desired or considered inadvisable, a wide range of "regional anesthetic techniques" and local anesthetics are available, including spinal and epidural anesthesia, and selective blockade of nerves to various areas of the body. This increase in the number of medications and techniques has permitted curative surgery to be performed on patients who, even 30 years ago, would have been deemed "too sick" to survive an operation. To aid in the safe performance of procedures in such patients (and to make even routine surgery in healthy patients safer), anesthesiologists and engineers have developed a broad range of new devices to monitor the function of vital organ systems. Where once the clinician could do no more than simply watch the patient and perhaps feel the pulse, he now can use electrocardiographs, automated blood pressure cuffs, finger tip devices to measure blood oxygen, arterial and cardiac catheters - as well as echocardiographs - to assess the function of the heart, electroencephalographs to measure brain function - and more. Where once anesthesia was delivered by dripping drugs on gauze pads over the nose, anesthesiologists now use elaborate and complex devices to precisely control anesthetic delivery and breathing.