Chapter 1

• An anesthetic plan should be formulated that will optimally accommodate the patient’s baseline physiological state, including any medical conditions, previous operations, the planned procedure, drug sensitivities, previous anesthetic experiences, and psychological makeup.
• Inadequate preoperative planning and errors in patient preparation are the most common causes of anesthetic complications.
• Anesthesia and elective operations should not proceed until the patient is in optimal medical condition.
• To be valuable, performing a preoperative test implies that an increased perioperative risk exists when the results are abnormal and a reduced risk exists when the abnormality is corrected.
• The usefulness of a screening test depends on its sensitivity and specificity. Sensitive tests have a low rate of false-negative results, whereas specific tests have a low rate of false-positive results.
• If any procedure is performed without the patient’s consent, the physician may be liable for assault and battery.
• The intraoperative anesthesia record serves many purposes. It functions as a useful intraoperative monitor, a reference for future anesthetics for that patient, and a tool for quality assurance.

The Greek philosopher Dioscorides first used the term anesthesia in the first century ad to describe the narcotic-like effects of the plant mandragora. The term subsequently was defined in Bailey’s An Universal Etymological English Dictionary (1721) as “a defect of sensation” and again in the Encyclopedia Britannica (1771) as “privation of the senses.” The present use of the term to denote the sleeplike state that makes painless surgery possible is credited to Oliver Wendell Holmes in 1846. In the United States, use of the term anesthesiology to denote the practice or study of anesthesia was first proposed in the second decade of the twentieth century to emphasize the growing scientific basis of the specialty. Although the specialty now rests on a scientific foundation that rivals any other, anesthesia remains very much a mixture of both science and art. Moreover, the practice of anesthesiology has expanded well beyond rendering patients insensible to pain during surgery or obstetric delivery (Table 1–1). The specialty is unique in that it requires a working familiarity with most other specialties, including surgery and its subspecialties, internal medicine, pediatrics, and obstetrics as well as clinical pharmacology, applied physiology, and biomedical technology. The application of recent advances in biomedical technology in clinical anesthesia continues to make anesthesia an exciting and rapidly evolving specialty. A significant number of physicians applying for residency positions in anesthesiology already have training and certification in other specialties.

Table 1–1. Definition of the Practice of Anesthesiology, Which Is the Practice of Medicine.1

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