Before anesthesia, the best surgeons were the fastest. Four Herculean men would hold a patient on a gurney and surgery would proceed. Quick and simple procedures such as amputations were the majority of surgeries and most patients would just faint from the unbearable pain. With the advent of anesthesia, surgeons could proceed safely and carefully allowing delicate procedures to be performed without pain.

It has been over 150 years since the first anesthetic was performed, and even today, there are many questions that remain unanswered. It was William Thomas Morton who on October 16, 1846 performed the first public display of anesthesia in what is now called the Ether Dome at the Massachusetts General Hospital in Boston. A prominent surgeon at the time realized the implications and declared to his colleagues, "Gentlemen, this is no humbug!" A few months later in 1847, anesthesia was used to relieve labor pain and in 1853, Queen Victoria of England had anesthesia for the birth of her son Prince Leopold. Since that time the specialty of anesthesia has developed in many ways. Cocaine was first used to achieve topical anesthesia in 1884. Spinal and epidural anesthesia were discovered soon after and a combination of drugs was being used to allow optimal conditions for physicians to perform surgery.

The practice of anesthesia has developed into a specialty devoted to patient care before, during and after surgery. In 1935, the first anesthesia department was formed and today there are nearly 140 accredited training programs in the United States alone. Anesthesiologists complete four years of undergraduate training, four years of medical school followed by another four years of residency training in anesthesiology. Some go on even further to specialize within a field of anesthesia whether it be cardiac anesthesia, pediatric anesthesia, intensive care etc. During the residency, the physician completes several months of subspecialty training in all areas of anesthesia. Several months are also devoted to post-surgical intensive care units or ICUs. Many ICUs are run by surgical and medical departments but more and more are being run by anesthesiologists.

The anesthesiologist may be the person you know the least, but is the person who takes care of you during and after your surgery. There are generally two people whom you will encounter in the operating room (OR) performing your anesthetic. A CRNA or certified registered nurse anesthetist and an anesthesiologist. A CRNA is a registered nurse who has completed an additional two years in the practice of anesthesia. CRNAs are supervised by a physician who is usually an attending anesthesiologist.

The anesthesiologist you see may be an attending anesthesiologist, who has completed all the formal training in anesthesia, or a resident in training. Once the training period is complete, the physician has the opportunity to become board certified in anesthesiology. The American Board of Anesthesiology (ABA), which was founded in 1938, was formed to guarantee that an anesthesiologist meets a minimum requirement and has passed a standardized written examination as well as an oral exam before 4 representatives of the ABA. Once these exams are passed, the physician becomes a board-certified anesthesiologist and is free to practice and supervise residents and CRNAs. There are also several subspecialties within anesthesia such as pediatric, cardiac, neuroanesthesia, obstetric, critical care and pain management. The latter two subspecialties require an additional year of training and offer board certification as well.

Over the years there have been dramatic improvements in the medications we use for anesthesia. Ether is no longer used and drugs are shorter acting with fewer side effects. Patients awaken from anesthesia more rapidly, feeling less drowsy than in the past, allowing for earlier discharge from the recovery room.

There have also been tremendous advances in patient monitoring including pulse oximetry and carbon dioxide detection. Pulse oximetry uses infrared technology to measure the amount of oxygen in your blood by placing a clip on your finger. As blood perfuses the finger, the infrared signal 'reads' the color of your blood and can estimate the percent of oxygen in it. Carbon dioxide detection informs anesthesiologists that anesthetic gases and oxygen are delivered to the lungs. Both of these advances and others, have made the practice of anesthesia extremely safe. This monitoring has allowed for better patient care and safety in the perioperative period. Despite all these fancy and expensive monitors, the average anesthesia bill amounts to only 5% of the total hospital cost. Efforts are always being made to lessen the cost of anesthesia without compromising the quality of patient care. (SEE CHART WITH MONITORS AND WHAT THEY DO).