Canadian Journal of Anesthesia, Vol 4, 131-142, Copyright © 1957 by Canadian Anesthesiologists' Society

Promotion de l'anesthésiste

¹ Chef de la section des maladies vasculaires, service de Chirurgie, Hôtel-Dieu de Montréal

In the past twenty years, anaesthesia in surgery has proceeded from the rank of servant to that of partner. This has been achieved through the improvement in our knowledge of haemodynamics, cardiopulmonary physiology and autonomic drugs, and through the discovery of antibiotics and widespread use of blood transfusions.

Because of its tremendous new potentialities, anaesthesia now permits operations which are more diversified and risky as well as much longer. Progress in both surgery and anaesthesia has required a complex armamentarium of various pressor, depressor, sedative, narcotic and muscle-paralyzing drugs, tracheal intubation, cardiac resuscitation, hibernation and postoperative recovery rooms. But mastery of such broad knowledge could not be accomplished by the "amateur" who formerly practised anaesthesia. Today, the doctor who intends to meet the enormous exigencies of modern surgery adequately needs a full four-year course of theoretical studies and practical training: he must be a professional.

Using information gathered in a large private and teaching hospital, the author exemplifies the economic consequences of that promotion of anaesthesia in a graph in which (1) the rising cost for anaesthesia, (2) increasing use of the operating room, and (3) the greater duration of operations are compared with (4) the increase of the cost-of-living index (94 per cent from 1935 to 1955).

Even if the reasons for the discrepancies in the graph curves of the above can be readily understood, one should still try to find some means that might help in alleviating the so often prohibitive cost of operations that bears heavily on the middle class.

The following are suggested:

1. One might take a hint from the Mayo Clinic system of rating fees for different kinds of diseases and for different classes of people.

2. The anaesthetists should aim principally at securing the services of specialized technicians.

3. Everyone in the hospital, medical men as well as administrative personnel, should try to prevent the misunderstandings which often arise between the patient or his relatives and the hospital with its many departments.

Note:

Conférence donnée à la Convention de la Société canadienne des Anesthésistes de la province de Québec, Hôtel-Dieu de Montréal, 3 mars 1956.