The Origins, Evolution, and Spread of Anesthesia Monitoring Standards: From Boston to Across the World.

In the mid-1980s, the anesthesia departments at hospitals affiliated with Harvard Medical School were faced with a challenge: mounting medical malpractice costs. Malpractice insurance was provided by the Controlled Risk Insurance Company (CRICO), a patient safety and medical malpractice insurance company owned by and providing service to the Harvard medical community. CRICO spearheaded an effort to reduce these costs and ultimately found a way to decrease the risks associated with anesthesia. Here, we chronicle events that led to the dramatic changes in medical practice that resulted from the activities of a small group of concerned anesthesiologists at Harvard-affiliated hospitals. We place these events in a historical perspective and explore how other specialties followed this example, and end with current strategies that minimize the risk associated with anesthesia. We conducted interviews with principals who formulated original standards of patient monitoring. In addition, we consulted documents in the public domain and primary source material. Efforts of these pioneers resulted in the establishment of the seminal Harvard-based anesthesia monitoring standards for minimal monitoring. What followed was an unprecedented transformation of the entire field. After the implementation of these standards at Harvard-affiliated hospitals, the American Society of Anesthesiologists (ASA) adopted "Standards for Basic Anesthetic Monitoring" for use during the administration of all anesthetics in the United States. Other nations have since adopted similar guidelines and these practices have resulted in significant improvements in patient safety. Currently, we estimate mortality due to anesthesia in healthy patients to be 1:400,000-perhaps as much as 10 times lower since the early 1980s. What began as an attempt to lower medical malpractice costs in a group of university hospitals became a worldwide effort that resulted in improvements in patient safety. Other specialties have adopted similar measures. Currently, an attitude and appreciation of safety are exemplified by several practices that include among others-the adherence to these patient safety guidelines, simulator training, the promulgation of standards and guidelines by ASA, and the use of a safety checklist before induction of anesthesia.

Ochsner Health System Department of Anesthesiology: the first thirty years.

The Department of Anesthesiology at Ochsner Clinic Foundation was founded in 1947 at the original Ochsner Hospital at Camp Plauche in New Orleans. An anesthesiology residency training program was accredited in 1953, making Ochsner one of the early and leading producers of anesthesiologists for the Gulf South region. Staff members over the years have held prominent national leadership positions, including two American Society of Anesthesiology presidents, the founder of the Society of Cardiovascular Anesthesiology, and the president of the Society for Obstetric Anesthesiology and Perinatology.

The Sister Anaesthetists of Norwich.

The administration of general anaesthesia in the UK has generally been carried out by medically qualified staff but there have been instances where this has not been the case. This article describes the role of the "Sister Anaesthetists" who made a significant contribution to the delivery of anaesthesia services at the Norfolk and Norwich Hospital from the end of the First World War until the introduction of the National Health Service in 1948.

[The creation of the first anesthesiology service in Spain (Hospital de la Santa Cruz y San Pablo, Barcelona 1941)]. / En torno a la creación del primer Servicio de Anestesiología en España (Hospital de la Santa Cruz y San Pablo, Barcelona 1941).

On the sixtieth anniversary of the founding of the first Spanish anesthesia department, we review factors that led to its creation and its early development. Hospital de la Santa Cruz y San Pablo in Barcelona was the place where the service was established for several reasons. The first was the growing need for anesthesia to be administered by specialized physicians able to handle problems developing during and after surgery. The second was the presence of a prestigious surgeon, Dr. Juan Soler Juliá, who perceived the need, alongside the only physician in Spain who was completely dedicated to anesthesiology, Dr. José Miguel Martínez. Finally, the fact that professional anesthesiology allowed a physician to earn a decent income triggered interest in the specialty among physicians.

The evolution of intraoperative transesophageal echocardiography.

In this article, the development of intraoperative transesophageal echocardiography (TEE) is reviewed. It took two decades to develop the present clinical applications of TEE. This modality will continue to serve as a monitor and diagnostic tool to ensure better care of patients in the operating room and the intensive care units.

Anesthesiologists and surgeons at Mount Sinai: a partnership in excellence.

Although anesthesia was available to patients when the doors of The Jews Hospital opened in 1855, "professional anesthetists" were not appointed to the staff until 1902. This article traces the history of the anesthesiology staff and department, and documents their accomplishments over the past century.

Neuroanesthesia at The Mount Sinai Hospital.

The practice of neuroanesthesia at the Mount Sinai Medical Center focused initially on clinical practice, followed by specialization. This article presents a brief history of the division and a description of the areas of interest, presentations, and publications that have originated there.

The Mount Sinai Hospital's role in the development of anesthesia safety standards.

The Department of Anesthesiology of The Mount Sinai Hospital was closely involved in introducing anesthesia safety standards for anesthesia breathing systems, the introduction of the first disposable plastic anesthesia breathing system, the layout of the controls on gas machines, nontoxic airways, safe ethylene oxide sterilization and safe obstetrical anesthesia.