Perioperative Medicine: Innovations and Challenges

MOUNT SINAI JOURNAL OF MEDICINE 79:1–2, 2012 1

THEME INTRODUCTION

Perioperative Medicine:Innovations and Challenges

James B. Eisenkraft, MD, George Silvay, MD, PhD, and David L. Reich, MD

Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY

With this issue, the Mount Sinai Journal of Medicinecelebrates 2 anniversaries: the 4th anniversary of itsrelaunch as a center for the dissemination of excellentscientific information from around the world, andthe 60th anniversary of the Mount Sinai Departmentof Anesthesiology, whose faculty members arededicated to providing patients with excellentclinical care and conducting innovative programs ineducation, research, and quality improvement.

To commemorate its 60th anniversary, theDepartment of Anesthesiology has compiled scien-tific articles by outstanding faculty from both insideand outside Mount Sinai. The articles focus on theexpansion of the anesthesiologist’s role, from anes-thetist in the operating room to that of perioperativephysician who manages the patient pre-, intra-, andpostoperatively in the ever-increasing number andtypes of procedural locations.

The first interaction of the perioperative physi-cian with a patient is usually during the preanesthesiaassessment. This topic is reviewed in general byDr Elizabeth Frost and more specifically by Drs Flynnand Silvay with regard to the ever-increasing num-bers of patients scheduled for cardiovascular surgery.Many of these patients have an implanted cardiacpacing and/or defibrillating device, the perioperativemanagement of which is often poorly understood.Dr Castillo and his coauthors demystify this subject.

When evaluating the airway, it is not uncommonto discover problems with dentition that require areferral to a dentist or oral surgeon. Drs Yasny and

Address Correspondence to:

James B. EisenkraftDepartment of AnesthesiologyMount Sinai School of Medicine

New York, NYEmail: james.eisenkraft@mountsinai.org

Herlich, who are both dentists and anesthesiologists,address this important subject.

Most patients and their families are anxiousabout the risks of anesthesia. The preanesthesiaevaluation includes an assessment of the patient’sphysical status according to the classification ofthe American Society of Anesthesiologists (ASA).Drs Lagasse and Saubermann discuss whether ASAphysical status can be used to predict adverseperioperative outcome.

Patients are very often worried about the risksassociated with blood transfusion and may requestbloodless surgery. Drs Shander and his colleaguesand Dr Bennett-Guerrero are experts in this area andhave contributed insightful reviews.

Parents whose children require anesthesia arenaturally concerned about potential effects on thedeveloping brain. Similarly, adult children of parents(or another elderly relative) who require anesthesiaare concerned because ‘‘grandma was never the sameafter her last anesthesia.’’ These two timely topics areaddressed respectively by Drs Cottrell and Hartungand by Drs Deiner and Silverstein.

An ever-increasing number of proceduresthat require sedation or anesthesia are nowbeing performed in physicians’ offices. Office-basedanesthesia (OBA) is a rapidly growing field. Theoffice is a very different environment from the fullyequipped and supported hospital operating room.Education in this area is essential, and a numberof training programs now include an OBA rotation.Dr Hausman and coauthors are experienced OBAexperts and educators.

Inevitably, some patients will find themselvesin a critical care unit, with their lungs beingmechanically ventilated. Much has been writtenabout new ventilatory strategies and weaning fromventilation. Dr Papadakos, a well-published authorityon critical care medicine, and his colleagues providea timely update.

Published online in Wiley Online Library (wileyonlinelibrary.com).DOI:10.1002/msj.21296

© 2012 Mount Sinai School of Medicine

2 J. B. EISENKRAFT ET AL.: PERIOPERATIVE MEDICINE

Postoperative pain and other pain syndromes(e.g., failed back surgery syndrome) are of greatconcern for most patients. Pain management isnow a subspecialty of anesthesiology, using bothinvasive and noninvasive techniques to prevent oralleviate pain. Dr Epstein describes spinal cordstimulators, and Drs Khelemsky and Noto reviewpost-thoracotomy pain and its management.

Human patient simulators are increasingly beingused to educate medical personnel at all levels.In addition, certifying bodies are beginning to usethese devices for evaluating anesthesiologists formaintenance of their specialty certification. Dr Levine,a pioneer in this field, and his colleagues review thecurrent status of simulation in medical education,certification, and licensure.

Anesthesiologists have always considered patientsafety to be their primary consideration and are

constantly seeking ways to improve it. Learning frompast experiences requires that accurate data be avail-able for analysis, but handwritten records do notfacilitate this. The introduction of anesthesia infor-mation management systems provides the means tocapture huge amounts of data and therefore facili-tate outcomes research. Dr Bassam and colleagueshave contributed an overview of these systems anddiscuss applications that have the potential to furtherimprove the safety of our patients.

We hope that our readers find these articles ofinterest and help when one of their patients needsanesthesia.

DISCLOSURES

Potential conflict of interest: Nothing to report.

DOI:10.1002/MSJ