Laughing and Crying about Anesthesia - Gerald Zeitlin M D

Each working day at least 40,000 Americans undergoing surgery require general anesthesia: an anesthesiologist renders them oblivious. Fifty years ago when the author Dr. Zeitlin began giving anesthesia in the United Kingdom one patient in 1500 died as a direct consequence of the anesthetic. That number was sadly true all over the world. In 2011 mortality and morbidity from anesthesia is too rare to count accurately. Nevertheless the increasing average age of patients coming to surgery and the inventiveness of surgeons require the same or greater vigilance and sophistication that has led to this desirable change. In this book Dr. Zeitlin gives us a view of the difficulties and struggles that have led to this improvement. He recounts his own untutored, frightened early days in the operating room for six years in hospitals in and around London. He continues with illuminating and powerful stories about the remainder of his career both in academic and private practice in Boston, Massachusetts. The patient in the hands of nearly all other specialists is able to see what his or her physician struggles with in making an accurate diagnosis and planning treatment. Obviously the surgeon's patient in the care of the anesthesiologist knows nothing about what actually occurs in the operating room. We believe this is the first book that gives the reader an inside view of the actors on this stage. It is not for nothing that operating rooms are called operating theatres in the United Kingdom. Although he does not aspire to such literary heights the author would like to think that to a small extent he does for anesthesia what Dr. Atul Gawande achieved for surgery with his illuminating book 'Complications'. Dr. Zeitlin tackles difficult matters such as possible awareness during anesthesia, drug addiction, violence related to anesthesia, his own and others' mishaps and the struggle for recognition that anesthesia is the practice of medicine. The author believes that anesthesiology is the use of intensive care and monitoring in the operating room, the recovery room and in the pain clinic. Some of the stories are so harrowing that the author includes three 'Intermissions' to provide the reader with some intriguing speculations about anesthesia. The most important story Dr. Zeitlin tells is that about the Anesthesia Patient Safety movement. Many of the principal movers of this success story worked in Boston and the author was privileged to have known them all. The disciplines of safe patient care began with anesthesiologists and have now spread to all of medicine. Anesthesiologists introduced the use of simulators in accident prevention. The author does not dismiss the very important roles played in all this by cardiologists, surgeons, pre-and postoperative nurses, our medical industry colleagues and most of all our close collaborators, nurse- anesthetists.