Pain Medicine Education in the United States: Success, Threats, and Opportunities.

The year 2022 marked the 30th anniversary of the first Accreditation Council for Graduate Medical Education (ACGME) accreditation of pain medicine training programs. Before this, the education of pain medicine practitioners was through primarily an apprenticeship model. Since accreditation, pain medicine education has grown under the national leadership of pain medicine physicians and educational experts from the ACGME, exemplified by the release of Pain Milestones 2.0 in 2022. The rapid growth of knowledge in pain medicine, along with its multidisciplinary nature, poses challenges of fragmentation, standardization of curriculum, and adaptation to societal needs. However, these same challenges present opportunities for pain medicine educators to shape the future of the specialty.

Thomas Dent Mütter, M.D. (1811 to 1859): Exemplar of Expertise.

Thomas Dent Mütter, a Philadelphia plastic surgeon in the 1840s, boldly championed anesthesia when few physicians were convinced of its virtues. He was an early advocate of handwashing and hygienic wound care and helped pioneer the concept of postoperative recovery units. A leader in education, Mütter used a highly interactive style of teaching and restructured medical school classes to raise the caliber of clinical training. He supplemented his lectures with a myriad of specimens that he amassed over 24 yr. In 1863, this vast collection would serve as the basis for the Mütter Museum, which remains active today. Mütter exemplified expertise by tirelessly pursuing new knowledge and methods for the benefit of his patients and students.

The Bupivacaine Story: A Tribute to George A. Albright, MD (1931-2020).

In 1979, George A. Albright, MD (1931-2020) published a controversial editorial in Anesthesiology that raised the question of bupivacaine cardiotoxicity. In it, he presented several cases of rapid cardiovascular collapse after administration of the highly lipophilic local anesthetic and called for further investigation. Although the scientific community initially resisted Dr Albright's idea, his editorial would ultimately lead to several important advancements in anesthesiology. In 1983, the US Food and Drug Administration issued a black box warning that recommended against the use of 0.75% bupivacaine in obstetric anesthesia. This warning would remain in place until 1999. In addition, Dr Albright's article led to the following changes: laboratory research that proved the cardiotoxicity of bupivacaine; the development of safer, stereoselective agents like ropivacaine; and the acceptance of lipid emulsion as a treatment for local anesthetic toxicity. In this article, C. Philip Larson, Jr, MDCM, Editor-in-Chief of Anesthesiology at the time of publication of Albright's manuscript, provides a unique perspective on the bupivacaine story.

Origins of the International Anesthesia Research Society, Anesthesia & Analgesia, and the World Federation of Societies of Anaesthesiologists: Lasting Legacies of Francis McMechan, MD.

Francis McMechan, MD, founded the National Anesthesia Research Society (NARS), which was the precursor to the International Anesthesia Research Society (IARS) and the first physician anesthesia organization in the United States that was devoted to the research goals of the specialty. NARS initially sponsored Current Researches in Anesthesia and Analgesia, and IARS remains the main parent organization of the journal to this day. Dr McMechan originally hoped to coordinate the scientific efforts of NARS/IARS with the political activities of several other organizations he had founded to achieve his ultimate goal of building a powerful and well-connected anesthesia community across the nation, and eventually around the world. About a decade after his death, Dr McMechan's sweeping global vision would be fulfilled by the creation of the World Federation of Societies of Anesthesiologists (WFSA). Although Dr McMechan's political organizations would eventually lose ground to the newer American Society of Anesthetists (ASA), his scientific organization and his inspiring international interest-embodied by IARS, Anesthesia & Analgesia, and WFSA-continue to thrive today.

A Century of Technology in Anesthesia & Analgesia.

Technological innovation has been closely intertwined with the growth of modern anesthesiology as a medical and scientific discipline. Anesthesia & Analgesia, the longest-running physician anesthesiology journal in the world, has documented key technological developments in the specialty over the past 100 years. What began as a focus on the fundamental tools needed for effective anesthetic delivery has evolved over the century into an increasing emphasis on automation, portability, and machine intelligence to improve the quality, safety, and efficiency of patient care.

The Editors-in-Chief of Anesthesia & Analgesia Over 100 Years: Creating the Voice of the Global Anesthesiology Community.

The year 2022 marks the 100th anniversary of Anesthesia & Analgesia, the longest-running anesthesiology publication in the world. Founded in 1922 as Current Researches in Anesthesia & Analgesia by the visionary and charismatic Francis McMechan, MD, the journal served as a reliable mirror for the key scientific and political issues facing the nascent specialty of anesthesiology. Under the leadership of 6 subsequent Editors-in-Chief over the ensuing century-Howard Dittrick, MD; T. Harry Seldon, MD; Nicholas M. Greene, MD; Ronald D. Miller, MD; Steven L. Shafer, MD; and Jean-Francois Pittet, MD-Anesthesia & Analgesia has grown in size, circulation, and impact. Today, it remains a formidable voice in the global anesthesia community.

Ambition for Self and for Specialty: Emery A. Rovenstine and the Politics of Organized Anesthesia, 1937-1947.

The letters between Emery Andrew Rovenstine, MD (1895-1960), and Arthur Ernest Guedel, MD (1883-1956), are a window into the personalities and politics of the creation of American anesthesiology. The ambition of these men, both personal and professional, lay at the heart of their sacrifices and successes. Their correspondence unmasked common struggles and foibles, humanizing these giants of our field. Notably throughout the letters, Rovenstine, as the junior partner, wrestled with Guedel's advice to temper personal ambition for the collective good. Over time, their relationship matured, and the junior eclipsed the senior. Still, at various points in his career, Rovenstine was censured for self-promotion by leaders in anesthesiology and the general medical community. These moments brought to light issues of continued relevance today: inner tension between individual and group ambition, and professional friction between academic and political priorities in anesthesiology. In the end, it was an unapologetic blend of ambition for self and ambition for the specialty that allowed Emery Rovenstine to make his unique imprint on American anesthesiology.

William James, Nitrous Oxide, and the Anaesthetic Revelation.

William James greatly influenced the fields of psychology, philosophy, and religion during the late 19th and early 20th centuries. This was the era of Modernism, a time when many writers rejected the certainty of Enlightenment ideals. Positivism, which rose to prominence in the early 19th century, had emphasized physical phenomena, empirical evidence, and the scientific method. Darwin's On the Origin of Species (1859), with its theory of natural selection, provided an explanation for the evolution of species apart from a divine Creator. Within this context, William James served as a "mediator between scientific agnosticism and the religious view of the world." James' own experience inhaling nitrous oxide played an important role in shaping his views. For James, the use of nitrous oxide served a key role in elucidating some of his most central ideas: 1) the value of religion, and the emphasis on mysticism and revelation (as opposed to theology and doctrine) as religion's foundation; 2) the universe as pluralistic (as opposed to absolutist, constant, eternal), driven by chance, experience, and change.

An unusual case of small bowel obstruction in a child caused by ingestion of water-storing gel beads.

Foreign body ingestion occurs most commonly in the pediatric population. Small bowel obstruction is a rare complication that can occur, and surgical intervention is required. We present the first report of a case of an 18-month-old child with a jejunal obstruction caused by ingestion of water-storing gel beads used for botanical arrangements. The child presented with obstipation and nonbloody, nonbilious emesis. Symptoms resolved after a large bead 3 cm in diameter was retrieved via laparoscopic-assisted excision. This case suggests that water-storing gel beads are particularly dangerous foreign bodies and should be kept out of the reach of children.