Development Of Anesthesiology Research Articles

Clinical features of patients with cancer of thoracic esophagus and results of their surgical treatment

Esophageal cancer takes one of the first places in the structure of morbidity and mortality among malignant diseases. The development of anesthesiology and thoracic resuscitation provided the evolution of the surgical method. Resections of the esophagus with locally-disseminated and complicated forms of cancer have become possible. But even today, the long-term results of surgical treatment don’t satisfy clinicians. Often this is due to the dissemination of the tumor process in most patients at the time of treatment. For this purpose, an analysis of clinical material was carried out, including 89 patients with cancer of thoracic part of esophagus, who underwent reconstructive surgeries (extirpation of the thoracic part of esophagus with simultaneous retromediastinal plasty by stomach tube) in the surgical unit of Republican Clinical Hospital (RCH), n.a. academic M.A.Mir-Gasimov, Baku city. Interventions on the esophagus were performed either of two approaches – upper median laparotomy and left-sided cervicotomy (76 patients – 85,4%) or from three-with the addition of a right sided lateral thoracotomy in the fifth intercostal space (13 patients – 14,6%). There were no deaths due to surgical complications. The fundamental possibility and reasonableness of performing expanded radical interventions has been detected, taking into account the technical resectability of the tumor, which is especially important in working with a group of patients with “late” esophageal cancer criteria, such as the age of the patient, the size of the primary tumors, its local dissemination are not a contraindication to radical surgery.

Review on the monograph of Doctor of Medical Sciences Professor V.I. Strashnova «Development of the anesthesiology and intensive care at the Pavlov First Saint Petersburg State Medical University, Saint Petersburg, 2021

The monograph is devoted to the history of anesthesiology at the Pavlov First Saint Petersburg State Medical University. In the first chapter titled The beginning of the epoch of anesthesia, the author emphasized the role of coryphaeus. Russian world surgeon and anesthesiologist, Nikolay I Pirogov, enumerated the merits of Vasily von Anrep, the first rector of the womens medical institute who discovered the local anesthetic property of cocaine. The second chapter, Development of anesthesia: from 1918 to 1950, shows the role of Professors V.A. Shaak, L.A. Andreev, K.K. Skrobansky, and A.A. Zykov. The third chapter, Development of Anesthesiology: from 1945 till 1970, describes the beginning of the application of the apparatus method of general anesthesia and the first dissertations in anesthesiology. The fourth chapter, Development of Anesthesiology and Intensive Care since 1971, describes the establishment of the Department of Anesthesiology and Intensive Care in 1974 and the results of its scientific work, particularly the role of epidural anesthesia in the anesthesiological support of lung surgery, the development of combined spinalepidural anesthesia, and the establishment of a new direction - adrenergic analgesia. The fifth chapter, Development of Anesthesiology and Intensive Care since 2001, includes data about monographs and is written by the department staff. The sixth chapter, Development of Anesthesiology since 2013, shows the changes in the educational activities of the department and the challenges of providing emergency care to individuals with various qualifications. The monograph will be useful for students, clinical residents, practical physicians, and historians of medicine.

Anesthesia and World War II: When the Battlefield Becomes a Research Field-A Bibliometric Analysis of the Influence of World War II on the Development of Anesthesiology.

At the outbreak of World War II (WWII), anesthesiology was struggling to establish itself as a medical specialty. The battlefield abruptly exposed this young specialty to the formidable challenge of mass casualties, with an urgent need to provide proper fluid resuscitation, airway management, mechanical ventilation, and analgesia to thousands. But while Europe was suffering under the Nazi boot, anesthesia was preparing to rise to the challenge posed by the impending war. While war brings death and destruction, it also opens the way to medical advances. The aim of this study is to measure the evolution of anesthesia owing to WWII. We conducted a retrospective observational bibliometric study involving a quantitative and statistical analysis of publications. The following 7 journals were selected to cover European and North American anesthesia-related publications: Anesthesia & Analgesia, the British Journal of Anaesthesia, Anesthesiology, Schmerz-Narkose-Anaesthesie, Surgery, La Presse Médicale, and The Military Surgeon (later Military Medicine). Attention was focused on journal volumes published between 1920 and 1965. After reviewing the literature, we selected 12 keywords representing important advances in anesthesiology since 1920: "anesthesia," "balanced anesthesia," "barbiturates," "d-tubocurarine," "endotracheal intubation," "ether," "lidocaine," "morphine," "spinal anesthesia," "thiopental," "transfusion," and "trichloroethylene." Titles of original articles from all selected journals editions between 1920 and 1965 were screened for the occurrence of 1 of the 12 keywords. A total of 26,132 original article titles were screened for the occurrence of the keywords. A total of 1815 keywords were found. Whereas Anesthesia & Analgesia had the highest keyword occurrence (493 citations), Schmerz-Narkose-Anaesthesie had the lowest (38 citations). The number of publications of the 12 keywords was significantly higher in the postwar than in the prewar period (65% and 35%, respectively; P < .001). Not surprisingly, the anesthesiology journals have a higher occurrence of keywords than those journals covering other specialties. The overall occurrence of keywords also showed peaks during other major conflicts, namely the Spanish Civil War (1936-1939), the Korean War (1950-1953), and the Vietnam War (1955-1975). For the first time, this study demonstrates statistically the impact of WWII on the progress of anesthesiology. It also offers an objective record of the chronology of the major advances in anesthesiology before and after the conflict. While the war arguably helped to enhance anesthesiology as a specialty, in return anesthesiology helped to heal the wounds of war.

On anesthesia and race

Racial tensions continue to ignite social unrest in the United States. Structural racism is increasingly recognized as a public health issue. It is therefore necessary to continue addressing the interaction of race and medicine, including anesthesiology. While many may overlook the impact that racial discrimination has had on the development of anesthesiology, understanding pain through a racialized lens has always been entwined with this medical specialty since its origins. Considering the first public demonstration of ether anesthesia in 1846 occurred 15 years before the American Civil War (1861-1865), it is naïve to pretend that anesthesia has been insulated from racial prejudice.We increasingly recognize the effects of variables, such as housing and education, which are important as social determinants of health. Across ethnic and racial lines, statistically significant differences persist in pain assessment and analgesia delivery. To understand these irregularities without relying on unsupported theories, we must challenge our current understanding of race in medicine. By reviewing the history of anesthesia through a racialized lens, we may better explore our biases and develop strategies towards racially equitable care. This article focuses on anesthesia's roots on the plantation in the American South, the medical perpetuation of racial disparities, and the challenges we face in healthcare today.

The bright diamond in the crown of Professor Gruzdev scientific school for 100th anniversary of Kazan State Medical Academy and obstetrical-gynecological hospital

Because of the 100th anniversary of Kazan State Medical Academy and obstetrical-gynecological hospital, this article present outstanding scientific achievements of the first head of the department, Professor A.I. Timofeev, who was an apprentice to professor V.S. Gruzdev. Historical and literature study of primary materials was used as the method of research. In April 2020, Kazan State Medical Academy (formerly the State Institute of Advanced Medical Training) celebrated its 100th anniversary. Organization of work of the gynecology-obstetrics department and hospital fell on the shoulders of Professor Alexander Ignatievich Timofeev, who was an apprentice to Professor V.S. Gruzdev. The article reflects three shining moments from his working life, which made the Kazan school of obstetricians and gynecologists famous. Throughout the 19th century, scientists were seeking to answer the question of corpus luteum originating: from the connective or epithelial tissues. Professor Gruzdev has suggested that the source needs to be granulosa cells. His student, Professor Timofeev, carefully performed histological preparations finally established in 1913 that granular cells are the genesis of the human corpus luteum originated, and bring these centennial scientific disputes to an end. In 1925, Professor Timofeev was the first in the USSR to perform surgery under local infiltration anesthesia in Kazan. His publication of the results of observation in 1928 was the beginning of the further study and implementation of local infiltration anesthesia by the method of Professor A.V. Vishnevsky (creeping infiltration method) in obstetrics and gynecology. For 30 years, this method of analgesia was dominant and gave way only with the development of anesthesiology and resuscitation. In 1928, he, together with professor Gruzdev, report on cesarean section at the 8th All-Union Congress of Obstetricians and Gynecologists laid the foundation for a wider study of Caesarean section in the USSR, the result of which was generalized in 1979. International recognition of the epithelial nature of the corpus luteum alone deserves a monument; the school of Kazan doctors of obstetrician-gynecologists honors the memory of the outstanding apprentice to professor V.S. Gruzdev A.I. Timofeev.

Extreme blood loss in cancer surgery: is it a verdict to the patient or a challenge to the staff?

Background. The development of anesthesiology allows performing combined operations in patients with locally advanced malignant tumors. A logical companion of aggressive cancer surgery is a massive blood loss, which can be so pronounced that it poses a threat to the life of the patient.&#x0D; Objective. The presented experience is an example of transformation of a nearly fatal situation into a curable one and can be useful in choosing an active treatment strategy in most desperate situations.&#x0D; Methods. This research includes 25 patients with the blood loss of 20 liters or more during surgery.&#x0D; Results. The median ratio of infusion to blood loss was 133%, and the ratio of the infusion to all fluid losses amounted to 118%. In 100% of cases, catecholamines were used to support the blood circulation: one drug used in 12% of observations and two to five drugs used in 88% of observations. 2 patients died during the operation. 5 patients died in the early postoperative period from multiple organ failure. The cause of death of another 5 patients was septic complications before the 28th post-op day.&#x0D; Discussion. Performing operations accompanied by acute massive blood loss requires an effective anesthetic support.&#x0D; Conclusions. Enforcement of certain diagnostic and therapeutic conditions (stage construction of anesthesia, hemodynamic and laboratory monitoring, adequate venous access, rational infusion, timely use of catecholamines, using cell-saver device) in the majority of cases allows completing the operation with the surgical control of hemostasis and successfully enduring traumatic and complicated surgery in half of cases.

Road to Perioperative Medicine: A Perspective From China.

With the development of anesthesiology, patient safety has been remarkably improved, but the postoperative mortality rate at 30 days is still as high as 0.56%-4%, and the morbidity is even higher. Three years ago, the Chinese Society of Anesthesiology proposed that the direction of the anesthesiology development should be changed to perioperative medicine in China. Anesthesiologists should pay more attention to the long-term outcome. In this article, we introduced what we have done, what the challenges are, and what we should do in the future with regard to the practice of perioperative medicine in China.

To the issues of history and formalization of the concept of anesthesia

Anesthesiology as a science has passed a long way of development. The empirical period begins with the moment when people realize that they can reduce pain and get rid of it. Real prerequisites for the development of effective methods of anesthesia began to take shape at the end of the 18th century. It conditioned the emergence of a second (pre-scientific) period of development of anesthesiology. The active use of anesthesia in surgery led to special training for anesthesia. Improved methods of general anesthesia, developed methods for replacing and managing the functions of vital organs and the organism as a whole, scientific discoveries and systematization of the results of scientific research formed the basis for the formation of anesthesiology and intensive therapy as a separate scientific and practical discipline.&#x0D; The concept of “anesthesia” was introduced in the scientific professional language – a physiologically based, combined and multicomponent, selectively directed and balanced set of therapeutic and prophylactic measures aimed at optimizing the algorithm for performing physiological functions of the human body during the perioperative period of the surgical method of treatment or in the procedure followed by the formation and development of the phenomenon of pain. Its components:&#x0D; 1) modulation of the psychoemotional state;&#x0D; 2) modulation of the neurovegetative state;&#x0D; 3) analgesia;&#x0D; 4) anesthesia;&#x0D; 5) miorelaxation.

Professionalism in Anesthesiology training

En el presente artículo de reflexión se busca definir y establecer los componentes fundamentales del profesionalismo requerido para el óptimo ejercicio de la anestesiología. De este modo, se identifican algunos ejemplos de comportamiento no profesional y de las posibles herramientas positivas que se pueden aprovechar. Se propone, entonces, el profesionalismo como eje fundamental para el desarrollo de la anestesiología como especialidad médica y se evalúa el impacto benéfico derivado de su inclusión en los programas curriculares.

American Influences on the Development of Anesthesiology in the Federal Republic of Germany Between 1949 and 1960

American Influences on the Development of Anesthesiology in the Federal Republic of Germany Between 1949 and 1960

Contribuciones de enfermería a la anestesiología en Costa Rica

Introducción. En el presente artículo se presentan los resultados de un estudio que cuyo objetivo fue identificar la participación de la enfermería en el desarrollo de la anestesiología en Costa Rica.Método. Se aplicó la metodología de la investigación histórica para determinar los sucesos ocurridos en el pasado relacionados con el desarrollo de la anestesia, así como las contribuciones de enfermería. Se analizó fuentes primarias y secundarias que fueron sistematizadas, valoradas, ordenadas y sintetizadas. Se aplicó la técnica de grupo focal y entrevistas en profundidad a 23 enfermeras (os) técnicos en anestesia que laboran actualmente y a las enfermeras (os) pensionados.Resultados. Durante más de 90 años la administración de anestesia a las personas fue llevada a cabo por enfermeras (os), no obstante, la formación de enfermería en anestesia fue suspendida en 1981.Conclusión. El estudio determinó que este personal tenía una preparación formal dada por el doctor Sotela que luego fue ampliada a año y medio por la Escuela de Medicina de la Universidad de Costa Rica, institución de la que egresaban como técnicos en anestesia.

Outcome and Complications in Surgical Treatment of Lumbar Stenosis or Spondylolisthesis in Geriatric Patients.

Development of anesthesiology and improvement of surgical instruments enabled aggressive surgical treatment even in elderly patients, who require more active physical activities than they were in the past. However, there are controversies about the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. The purpose of this study is to review the clinical outcome of spinal surgery in elderly patients with spinal stenosis or spondylolisthesis. MEDLINE search on English-language articles was performed. There were 39685 articles from 1967 to 2013 regarding spinal disease, among which 70 dealt with geriatric lumbar surgery. Eighteen out of 70 articles dealt with geriatric lumbar surgery under the diagnosis of spinal stenosis or spondylolisthesis. One was non-randomized prospective, and other seventeen reports were retrospective. One non-randomized prospective and twelve out of seventeen retrospective studies showed that old ages did not affect the clinical outcomes. One non-randomized prospective and ten of seventeen retrospective studies elucidated postoperative complications: some reports showed that postoperative complications increased in elderly patients, whereas the other reports showed that they did not increase. Nevertheless, most complications were minor. There were two retrospective studies regarding the mortality. Mortality which was unrelated to surgical procedure increased, but surgical procedure-related mortality did not increase. Surgery as a treatment option in the elderly patients with the spinal stenosis or spondylolisthesis may be reasonable. However, there is insufficient evidence to make strong recommendations regarding spinal surgery for geriatric patients with spinal stenosis and spondylolisthesis.

Current Trends in the Development of Anesthesiology

The topic of anesthesia is constantly touched upon in the treatises of the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences. The Institute's researchers have studied and perfected general and regional anesthesia, intraoperative protection modes during ambulatory surgical interventions. In 2010, a perioperative critical care laboratory was set up for further investigations of the issues and problems of anesthesiology. The laboratory's main scientific areas are to investigate the negative effects of mechanical ventilation during general anesthesia and ways of their overcome; to study the mechanisms of hypoxic preconditioning, and to attempt to put the discovered phenomenon into clinical practice. Progress and prospects in the selected areas are discussed

The early steps of chloroform anaesthesia in Turkey during the Ottoman Empire in the 19th century

Objective. – The aim of this study was to research the pioneering steps for the employment of chloroform in Turkey in comparison with the developments in the West i.e. in the United States and in Europe. The development of anaesthesiology in the West started in the first half of the 19th century. As an anaesthetic substance, ether was first employed in a medical operation by R. Liston in December 1846. But taking into consideration of its bronchially irritant effect, British gynaecologist Dr. J.Y. Simpson preferred to utilize chloroform in obstetrical operations in 1847. The paper aims at shedding light on the earlier steps for modern anaesthesiology in Turkey in that sense. Methods. – The survey used evaluation of archival documents, first hand-original sources such as the annual medical reports of the Medical School, books, official journals, and newspapers of the time, and also secondary sources concerned with the subject. Results. – In view of the findings of the survey, chloroform, as an anaesthetic material, began to be administered surgically in Turkey much earlier than it was already known. It was experienced and used in operations at the surgical clinic of the Imperial School of Medicine at the Capital city, Istanbul in 1848. The Crimean War (1853–1855) induced to the prevalent surgical use of chloroform in Istanbul on the soldiers back from the front. In other words, it was evidenced that surgeons started to make use of this anaesthetic substance in the Ottoman Empire, shortly after it was put into medical practice in Europe. Conclusion. – This study deals with that phenomenal progress of chloroform anaesthesia in the medical history in Turkey during the second half of the 19th century.

Careers in Anesthesiology: Autobiographical Memoirs. Vol. 6 (review)

Reviewed by: Careers in Anesthesiology: Autobiographical Memoirs. Vol.6 Selma Harrison Calmes Kathryn E. McGoldrick , ed. Careers in Anesthesiology: Autobiographical Memoirs. Vol. 6: B. Raymond Fink, Luke Masahiko Kitahata, J. Roger Maltby, and Thomas T. McGranahan. Park Ridge, Ill.: Wood Library-Museum of Anesthesiology, 2001. xii + 189 pp. Ill. $45.00 (1-889595-07-1). The Wood Library-Museum of Anesthesiology's series of autobiographies of notable anesthesiologists began in 1996 to commemorate the sesquicentennial of the first public demonstration of surgical anesthesia; its purpose is to document the development of modern anesthesiology through personal stories. The participants in this volume are B. Raymond Fink (University of Washington), Luke Kitahata (previously chair of anesthesiology at Yale), J. Roger Maltby (University of Calgary), and Thomas T. McGranahan, a private practitioner in Oregon. In many ways, this is the best volume to date. The geographic range of the book is extraordinary, moving from England, Belgium, South Africa, Japan, Nepal, and Canada through North Carolina, New York City, and the rural U.S. Northwest. The profound effect of World War II on everyday lives and on the development of anesthesiology, even as late as the mid-1960s, is a common theme. The topics covered in the individual stories are wide-ranging also, including the evolution of the larynx, the American bombing of Tokyo at the end of World War II, the joys of playing the violin, the development of modern medicine in Nepal, Sherlock Holmes and anesthesia, the rise of outpatient surgery, and "surgeon-bashing." As was the case in previous volumes, chance events led the authors into anesthesia. Two of them entered the field after experiencing problem cases: While working at a mission hospital in South Africa, Dr. Fink operated on a young girl who died of airway obstruction postoperatively; her mother's scream when she learned of the death remained with him throughout his life, and led him to anesthesiology to try to prevent such deaths. A brilliant research career followed, often focused on the airway. Dr. Kitahata was a neurosurgeon in Japan who experienced difficulty with his patients' anesthesia, due to the primitive state of Japanese anesthesia post-World War II. An incident with a very demanding and very obese visitor from Germany led him to an anesthesiology residency in New York, with the plan to return to Japan to improve anesthesia there; American licensing laws led to a delay in his return to his home country, and others were working to improve Japanese anesthesia by then, so the Japanese [End Page 921] came for training in the outstanding department he chaired at Yale. Dr. McGranahan saw a movie short on a famous anesthesiologist as a child, and remembered it when an incident took place during a student rotation on urology; he then decided on anesthesia. Dr. Maltby left general practice seeking to specialize, and chose anesthesiology because it required a wide range of medical knowledge. This volume documents very well the personal lives of these anesthesiologists and the complex systems in which they worked. As an anesthesiologist myself, I greatly appreciated these stories by very dedicated physicians who all worked in a wide variety of very difficult situations and who strove to advance anesthesia through education and research. Dr. Fink's chapter is especially enjoyable. He was a true intellectual and one of the most brilliant researchers in anesthesia, but he was extremely modest and hardly ever talked about his many accomplishments; but because he died before his chapter was complete, it was finished by his wife and daughters, who gave us a full accounting of those accomplishments. Dr. Fink, who began this series and who served as its editor until his death, leaves us an important legacy in these personal stories by those who made anesthesiology the vigorous and scientifically based specialty it is today. Selma Harrison Calmes Olive View-UCLA Medical Center Copyright © 2004 The Johns Hopkins University Press

The American Society of Anesthesiologist's efforts in developing guidelines for sedation and analgesia for nonanesthesiologists: the 40th Rovenstine Lecture.

I am honored to have been selected to deliver the 40th Annual Emery A. Rovenstine Memorial Lecture. At previous Rovenstine lectures, I learned about his pioneering efforts as the Director of the Anesthesia Service at Bellevue Hospital (New York City, New York) where he served from 1935 to 1960; his Presidency of the American Society of Anesthesiologists (ASA), 1943–1944; and as the recipient of the ASA’s Distinguished Service Award in 1957. In the past year, however, two outstanding articles have been written that present material I was unaware of. Lucien Morris, M.D. (Professor Emeritus, Medical College of Ohio, Toledo, Ohio) authored the fascinating article “Ralph M. Waters’ Legacy: The Establishment of Academic Anesthesia Centers by the ‘Aqualumni’.” The ’aqualumni,’ is defined as Waters’ own trainees. The article was written to commemorate the 75th Anniversary of Waters accepting an academic appointment to the medical faculty of the University of Wisconsin (Madison, Wisconsin). I found particularly interesting the section describing Professor Waters’ concern that when Dr. Rovenstine, one of his aqualumni, went to Bellevue Hospital, New York University (NYU, New York City, New York), he might not have sufficient staff to establish a new academic training center for anesthesia. As a result, Waters split his Wisconsin group, sending both staff and residents to New York City to ensure the success of Dr. Rovenstine at NYU. Waters had enough confidence in Dr. Rovenstine to predict that he would succeed. He would not disappoint Dr. Waters. David Waisel, M.D. (Department of Anesthesia, Children’s Hospital, Boston, Massachusetts) provided a comprehensive review of “The Role of World War II and The European Theater of Operations in the Development of Anesthesiology as a Physician Specialty in the USA.” In 1942, Waters and Rovenstine and others teamed up to train “90-day wonders” in 12-week courses “to prepare medical officers to take charge of the anesthesia sections of the various types of hospitals of the U.S. Army.” Courses were given at several institutions, including Bellevue, and were developed by the Subcommittee on Anesthesia of the National Research Council. The latter was chaired by Dr. Waters. Dr. Rovenstine was the Secretary. Many future anesthesiologists were attracted to the specialty as a result of their initial exposure to the field in World War II and the influence of role models such as Dr. Rovenstine. Although I did not know Dr. Rovenstine personally, I was trained by another aqualumnus of Dr. Waters, Robert D. Dripps, M.D. (Professor and Chair, Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania). Dr. Dripps was interested in attracting medical students into the field of Anesthesiology. One of his efforts led to the establishment of the ASA Preceptorship Program and the Committee on which I first served the ASA. In the 36 yr in which I have been involved in the activities of the ASA, 20 yr have been spent on developing guidelines for sedation for nonanesthesiologists. It has been the most challenging, frustrating, and contentious issue I have had to address. Even though ASA’s efforts have been exemplary, the results have been misunderstood by not only the groups we have attempted to educate but also by our own members. I have decided to set the record straight by discussing the history of “ASA’s Efforts in Developing Guidelines for Sedation and Analgesia for Nonanesthesiologists.” Some of the comments that follow are my own thoughts and interpretations; however, most of the statements are documented in the literature or are part of my own collection of documents. The latter will be donated to the Wood Library Museum (Park Ridge, Illinois) together with the script of this lecture. The formal process of ASA’s evidence-based guideline development for members did not begin until 1990, and for nonanesthesiologists, in 1993. Other specialty groups began setting guidelines earlier and their efforts must be acknowledged before proceeding with ASA’s efforts. It is not intended to provide a comprehensive or complete review of these accomplishments but rather to attempt Professor Emeritus in Pediatrics and Anesthesiology. Received from the Department of Pediatrics and Anesthesiology, The George Washington University Medical Center, Washington, District of Columbia.

Education in anesthesiology for the twenty-first century

The growth and development of anesthesiology in the twenty-first century will likely depend on two major factors: our vision for the specialty in the future and our ability to implement an anesthesia education plan that will foster the achievement of that vision. The foundation of effective anesthesia education must be built on an understanding of the past and an analysis of the present but, most importantly, it must be shaped by our vision for the future. Focus on the future is essential, for it is remarkably easy to teach others as we were taught, or as we practice today. Unfortunately, the easy path will not foster the advancement of the specialty or develop the leaders for the future. The comments that follow are not a prescription for success. Rather, they are intended to stimulate discussion and planning regarding the future of anesthesiology, leading to a course of action that will enhance the development of the specialty. Long-term success for the specialty will depend on our efforts in undergraduate and graduate medical education, whereas short-term success will depend on our efforts in the continuing medical education of current practitioners.

The role of World War II and the European theater of operations in the development of anesthesiology as a physician specialty in the USA.

World War II was a time of growth and development of anesthesia as a physician specialty. Wartime training exposed neophyte physician-anesthetists to role models who showed the potential of anesthesiology and to the richness of practicing anesthesia. Wartime anesthesia required dexterity, imagination, and pluck, and surgeons and other physicians were suitably impressed. Drawing historical conclusions about cause and effect is hazardous. Recognized and unrecognized biases, preconceived notions, and the quality and type of resources available affect writers. With this in mind, consider how the effects of World War II on the growth of physician anesthesia loosely parallel the growth of anesthesia in Great Britain during the 19th century. Anesthesia became a medical profession in Great Britain because of the interest and support of physicians and the complexity of administering chloroform anesthesia. Similarly, World War II physician-anesthetists showed they could provide complex anesthesia care, such as pentothal administration, regional anesthesia, and tracheal intubation, with aplomb and gained the support of surgical colleagues who facilitated their growth within a medical profession. They returned to a medium ready to support their growth and helped to establish the medical profession of anesthesiology in the United States.

Cardiac massage: a method rescued from oblivion.

Cardiac massage: a method rescued from oblivion.

Careers in Anesthesiology

Department of Anesthesiology; Wake Forest University School of Medicine; Winston-Salem, North Carolina 27103–1009James C. Eisenach, M.D., EditorCareers in Anesthesiology: Autobiographical Memoirs. Edited by B. Raymond Fink. Volume I: William K. Hamilton, “No Time at All”; Eli M. Brown, “An Autobiographical Essay”; E.M. Papper, “The Palate of My Mind.” Park Ridge, Illinois, Wood Library Museum of Anesthesiology, 1997. Pages: 217. Price:$35.00 (hard cover);$25.00 (paperback).Anesthesiologists at all points in their careers will enjoy and benefit from reading this book. Following the stories of three distinguished anesthesiologists provides the reader with history, perspective, admiration, and wonder for the specialty. Three different lives cover more than 50 years of the trials, tribulations, success, and development of anesthesiology. The reader learns of a time when anesthesia was administered by mask for correction of tracheoesophageal fistulas in the newborn, when it was the norm for anesthesiology to be part of the Department of Surgery in university medical centers, when anesthesiology suffered from a dearth of well-educated anesthesiologists, financial resources, times, and space for research, and when anesthesiologists commanded little respect in the medical community. We follow the evolution of the specialty to one held in high regard and which has reduced the patient mortality rate from 1:6,000 to 1:400,000 anesthetics.The stories of these three men help us to know them as real people. They are told with charm, honesty, and in places humor. The important roles these physicians filled in the American Society of Anesthesiologists, the Association of University Anesthesiologists, the American Board of Anesthesiology, and the National Institutes of Health provide unique insight into these organizations.Although several typographic errors appear throughout the text, the book reads easily, and the 35 dollar cost for the hardback version represents a fair price. An index would enhance the value of the book as a source of information about our specialty.I highly recommend this book for all anesthesiologists. Reading it will help to understand our heritage. The Wood Library deserves commendation for capturing and preserving our history in such a delightful manner. I look forward to volume II with great anticipation.Francis M. James, III, M.D.Department of Anesthesiology; Wake Forest University School of Medicine; Winston-Salem, North Carolina 27103–1009