of ether - Todays
Today the discipline
has expanded far beyond the operating room, as reflected in this
change of the MGH departments name to Anesthesia and Critical
Care. In the core area of general anesthesia, better drugs, improved
monitoring and specialized training have been responsible for great
improvements in patient safety and comfort during and after surgery.
is probably the doctor you know least, says Warren Zapol,
MD, chief of Anesthesia and Critical Care. But while you are
in the operating room, he or she is responsible for keeping you
safe during surgery.
Depending on the requirements
of the particular operation, the anesthesiologist may need to paralyze
the body with muscle relaxants, help maintain circulation and oxygenation
of blood while the heart or lungs are stopped, determine the need
to replenish blood components, or chill the brain or spinal cord
to avoid nerve damage.
Ether has long been supplanted by newer
and safer agents that allow more precise control of consciousness
and result in fewer side effects like nausea. Anesthetic drugs that
quickly disappear from the bloodstream allow many patients to go
home within hours of certain surgical procedures.
A nationwide movement to improve anesthesia
patient safety has been led by several MGH staff members
including Richard Kitz, MD, former chief of Anesthesia, and Jeffrey
Cooper, PhD, director of Anesthesia Technology and Biomedical Engineering.
Safer drugs and ever-improving equipment to monitor patient vital
signs and control the flow of medication have recently been joined
by a specialized training tool: an anesthesia simulator that allows
anesthesiologists to experience handling major crises in a computer-controlled
The anesthesiologists expertise
in keeping patients alive during surgery logically spilled over
into helping patients through the critical post-surgical period
as well. Intensive care units at the MGH and elsewhere were established,
and many are directed, by anesthesiologists. During the 1950s, the
use of mechanical ventilators to avoid lung complications in patients
recovering from major surgery was pioneered by Henning Pontoppidan,
MD, an MGH anesthesiologist.
Several techniques to relieve pain
are offered through the hospitals Pain Center, a collaborative
program involving anesthesiologists, neurologists and other specialists.
Many patients use patient-controlled analgesia to self-administer
pain-killing drugs through special intravenous pumps. The technique,
which even children can use safely, allows for steady relief with
less grogginess. Pain control also is key in helping patients resume
activity after injury or surgery and, it now appears, in preventing
nerve damage that can lead to chronic, ever-increasing pain.
Specialized research by members of
the MGH Anesthesia and Critical Care Department is leading to ways
to reduce the amount of blood lost during surgery, and probing the
molecular basis of pain itself. Zapol and several colleagues have
pioneered the use of the gas nitric oxide to improve lung function
in several life-threatening conditions of infants and adults.
The changes we see in hospital
care today more outpatient care, more serious illness in
those patients who are hospitalized means that the need for
the specialized care delivered by anesthesiologists is actually
increasing, Zapol says. In collaboration with our colleagues
in surgery, medicine, nursing, and other disciplines, well
continue advancing ways to keep patients as safe, healthy and comfortable