also spelled Anaesthesiology, medical specialty dealing with
anaesthesia and related matters, including resuscitation and
pain. The development of anaesthesiology as a specialized field
came about because of the dangers of anaesthesia, which involves
the use of carefully graduated doses of strong poisons to deaden
pain. (See anaesthetic.) In the 19th century, anaesthesia in the
operating room, where the surgeon was in command, was relegated
to a minor role. Yet gradually physicians and surgeons
recognized the need for anaesthesiologists, well-trained
specialist physicians dedicated full-time to anaesthesia, who
could extend surgical horizons by permitting operations
previously scarcely conceivable and by allowing applications of
surgical principles to patients previously considered too ill to
withstand either anaesthesia or operation. A few physicians were
attracted by this opportunity early in the 20th century, but it
was not until the mid-1930s that the specialty was officially
recognized with the establishment of such medical societies as
the American Board of Anaesthesiology for certifying
appropriately trained physician anaesthetists. Today, in
virtually every medical school, anaesthesiology functions either
as an autonomous academic department or as a division of
surgery.
Anaesthesiology was originally concerned entirely with the
administration of general anaesthetics, and the
anaesthesiologist's activities were confined to the operating
room. The advent of local anaesthetics injected into the fluid
surrounding the spinal cord broadened the methods available to
provide relief of pain during an operation. The introduction
into clinical anaesthesia of drugs aimed specifically at
relaxing muscles may have facilitated the surgeon's tasks but
deprived patients of the ability to breathe spontaneously, thus
creating a need for artificial respiratory support during the
operation. As a result, anaesthesiologists became specialists in
respiratory and circulatory physiology, as well as in devices
used to support and monitor these systems and in drugs that act
upon them. Increasingly complex operations were undertaken, and
more critically ill patients, including the very young and the
very old, were treated surgically. Because the individualized
attention provided to patients in the operating room could not
be terminated abruptly upon completion of an operation, recovery
rooms, intensive care units, and respiratory care units became
necessities. The anaesthesiologist came to be a central figure
in all these areas.
In general, anaesthesiology may now be defined as a practice of
medicine dealing with but not limited to: (1) the management of
procedures for rendering a patient insensible to pain and
emotional stress during surgical, obstetrical, and certain other
medical procedures; (2) the support of life functions under the
stress of anesthetic and surgical manipulations; (3) the
clinical management of the unconscious patient, whatever the
cause; (4) the management of problems in pain relief; (5) the
management of problems in cardiac and respiratory resuscitation;
(6) the application of specific methods of respiratory therapy;
and (7) the clinical management of various fluid, electrolyte,
and metabolic disturbances. Knowledge of physiology,
biochemistry, pharmacology, and clinical medicine are absolutely
necessary to the anaesthesiologist.
