Anesthesiology

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Anesthesiology
Anaesthesiology
Anaesthesia
Anaesthetics
Physician anesthesiologist.jpg
An anesthesiologist controlling a patient's airway while inducing anesthesia
Focus Anesthesia, perioperative medicine
Subdivisions Intensive care medicine
Pain medicine
Critical emergency medicine
SpecialistAnesthesiologist
Anaesthesiologist
Anaesthetist

Anesthesiology, anaesthesiology, anaesthesia or anaesthetics (see Terminology ) is a branch of medical and nursing science dealing with anesthesia and anesthetics. [1] This medical speciality concerned with the total perioperative care of patients before, during and after surgery. [2] It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. [3] A physician specialised in this field of medicine and nursing is called an Physician or Nurse Anesthesiologist, anaesthesiologist or anaesthetist, depending on the country (see Terminology ). [4] [5] [6] [7] A nurse who undergoes training, education, and certification in anesthesia practice is referred to as a Nurse Anesthesiologist, or CRNA. [8]

Perioperative medicine is the medical care of patients from the time of contemplation of surgery through the operative period to full recovery, but excludes the operation or procedure itself. Perioperative care may be provided by an anesthesiologist, Intensivist, an internal medicine generalist or hospitalist working with surgical colleagues.

Surgery Medical specialty

Surgery is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.

Anesthesia State of medically-controlled temporary loss of sensation or awareness

Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include analgesia, paralysis, amnesia, or unconsciousness. A patient under the effects of anesthetic drugs is referred to as being anesthetized.

Contents

The core element of the specialty is the study and use of anesthesia and anesthetics to safely support a patient's vital functions through the perioperative period. Since the 19th century, anesthesiology has developed from an experimental area with non-specialist practitioners using novel, untested drugs and techniques into what is now a highly refined, safe and effective field of medicine. In some countries anesthesiologists comprise the largest single cohort of physicians in hospitals, [9] [10] and their role can extend far beyond the traditional role of anesthesia care in the operating room, including fields such as providing pre-hospital emergency medicine, running intensive care units, transporting critically ill patients between facilities, and prehabilitation programs to optimize patients for surgery. [9]

Anesthetic drug that causes anesthesia

An anesthetic or anaesthetic is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two broad classes: general anesthetics, which result in a reversible loss of consciousness, and local anesthetics, which cause a reversible loss of sensation for a limited region of the body without necessarily affecting consciousness.

Pre-hospital emergency medicine medical speciality in which physicians care for seriously ill or injured patients before they arrive at hospital

Pre-hospital emergency medicine, also referred to as pre-hospital care, immediate care, or emergency medical services medicine, is a medical subspecialty which focuses on caring for seriously ill or injured patients before they reach hospital, and during emergency transfer to hospital or between hospitals. It may be practised by physicians from various backgrounds such as anaesthesiology, emergency medicine, intensive care medicine and acute medicine, after they have completed initial training in their base specialty.

Prehabilitation, or prehab, a form of strength training, aims to prevent injuries before the actual occurrence. Since rotator cuff and elbow injuries, among other things, are common among athletes in a wide range of sports, training the muscles surrounding these vulnerable joints can prevent injuries sustained from repeated wear and exertion.

Terminology

International standards for the safe practice of anesthesia, jointly endorsed by the World Health Organization and the World Federation of Societies of Anaesthesiologists, define "anesthesiologist" as a graduate of a medical school who has completed a nationally recognized specialist anesthesia training program. [11] However, various names are used for the specialty and those doctors who practise it in different parts of the world:

World Health Organization Specialized agency of the United Nations

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.

The World Federation of Societies of Anaesthesiologists (WFSA) is an international federation of independent national professional associations of anaesthesiologists. The WFSA’s Secretariat is based in London, UK.

A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians and surgeons. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery, Doctor of Medicine (MD), or Doctor of Osteopathic Medicine (DO). Many medical schools offer additional degrees, such as a Doctor of Philosophy (Ph.D), Master's degree (M.Sc), a physician assistant program, or other post-secondary education.

In the United States, anesthesiologist assistants - known in full as certified anesthesiologist assistants - are healthcare workers who work under the direction of licensed anesthesiologists to implement anesthesia care plans for a patient undergoing surgery. CAAs work exclusively within the anesthesia care team environment as described by the American Society of Anesthesiologists (ASA). All CAAs possess a premedical background, a baccalaureate degree, and also complete a comprehensive didactic and clinical program at postgraduate level. CAAs are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques. The goal of CAA education is to guide the transformation of qualified student applicants into competent health care practitioners who aspire to practice in the anesthesia care team.

A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. Nurse anesthetists are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy. A 2002 survey reported that there were 107 countries where nurse anesthetists practice anesthesia and nine countries where nurses assist in the administration of anesthesia.

Commonwealth of Nations Intergovernmental organisation

The Commonwealth of Nations, generally known simply as the Commonwealth, is a political association of 53 member states, nearly all of them former territories of the British Empire. The chief institutions of the organisation are the Commonwealth Secretariat, which focuses on intergovernmental aspects, and the Commonwealth Foundation, which focuses on non-governmental relations between member states.

The name derives from the Ancient Greek roots ἀν- an- , "not", αἴσθησις aísthēsis , “sensation”, and -λογία -logia , "study".

Ancient Greek Version of the Greek language used from roughly the 9th century BC to the 6th century AD

The ancient Greek language includes the forms of Greek used in Ancient Greece and the ancient world from around the 9th century BC to the 6th century AD. It is often roughly divided into the Archaic period, Classical period, and Hellenistic period. It is antedated in the second millennium BC by Mycenaean Greek and succeeded by Medieval Greek.

Scope

As a specialty, the core element of anesthesiology is the practice of anesthesia. This comprises the use of various injected and inhaled medications to produce a loss of sensation in patients, making it possible to carry out procedures that would otherwise cause intolerable pain or be technically unfeasible. Safe anesthesia requires in-depth knowledge of various invasive and non-invasive organ support techniques that are used to control patients' vital functions while under the effects of anaesthetic drugs; these include advanced airway management, invasive and non-invasive hemodynamic monitors, and diagnostic techniques like ultrasonography and echocardiography. Anesthesiologists are expected to have expert knowledge of human physiology, medical physics, and pharmacology, as well as a broad general knowledge of all areas of medicine and surgery in all ages of patients, with a particular focus on those aspects which may impact on a surgical procedure. In recent decades, the role of anesthesiologists has broadened to focus not just on administering anesthetics during the surgical procedure itself, but also beforehand in order to identify high-risk patients and optimize their fitness, during the procedure to maintain situational awareness of the surgery itself so as to improve safety, as well as afterwards in order to promote and enhance recovery. This has been termed "perioperative medicine".

Injection (medicine) infusion method of putting fluid into the body

Injection is the act of putting a liquid, especially a drug, into a person's body using a needle and a syringe. Injection is a technique for delivering drugs by parenteral administration, that is, administration via a route other than through the digestive tract. Parenteral injection includes subcutaneous, intramuscular, intravenous, intraperitoneal, intracardiac, intraarticular, and intracavernous injection.

Inhalation flow of the respiratory current into an organism

Inhalation happens when air or other gases enter the lungs.

Airway management medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

The concept of intensive care medicine arose in the 1950s and 1960s, with anesthesiologists taking organ support techniques that had traditionally been used only for short periods during surgical procedures (such as positive pressure ventilation), and applying these therapies to patients with organ failure, who might require vital function support for extended periods until the effects of the illness could be reversed. The first intensive care unit was opened by Bjørn Aage Ibsen in Copenhagen in 1953, prompted by a polio epidemic during which many patients required prolonged artificial ventilation. In many countries, intensive care medicine is considered to be a subspecialty of anesthesiology, and anesthesiologists often rotate between duties in the operating room and the intensive care unit. This allows continuity of care when patients are admitted to the ICU after their surgery, and it also means that anesthesiologists can maintain their expertise at invasive procedures and vital function support in the controlled setting of the operating room, while then applying those skills in the more dangerous setting of the critically ill patient. In other countries, intensive care medicine has evolved further to become a separate medical specialty in its own right, or has become a "supra-specialty" which may be practiced by doctors from various base specialties such as anesthesiology, emergency medicine, general medicine, surgery or neurology.

Anesthesiologists have key roles in major trauma, resuscitation, airway management, and caring for other patients outside the operating theatre who have critical emergencies that pose an immediate threat to life, again reflecting transferable skills from the operating room, and allowing continuity of care when patients are brought for surgery or intensive care. This branch of anesthesiology is collectively termed critical emergency medicine, and includes provision of pre-hospital emergency medicine as part of air ambulance or emergency medical services, as well as safe transfer of critically ill patients from one part of a hospital to another, or between healthcare facilities. Anesthesiologists commonly form part of cardiac arrest teams and rapid response teams composed of senior clinicians that are immediately summoned when a patient's heart stops beating, or when they deteriorate acutely while in hospital. Different models for emergency medicine exist internationally: in the Anglo-American model, the patient is rapidly transported by non-physician providers to definitive care such as an emergency department in a hospital. Conversely, the Franco-German approach has a physician, often an anesthesiologist, come to the patient and provide stabilizing care in the field. The patient is then triaged directly to the appropriate department of a hospital.

The role of anesthesiologists in ensuring adequate pain relief for patients in the immediate postoperative period, as well as their expertise in regional anesthesia and nerve blocks, has led to the development of pain medicine as a subspecialty in its own right. The field comprises individualized strategies for all forms of analgesia, including pain management during childbirth, neuromodulatory technological methods such as transcutaneous electrical nerve stimulation or implanted spinal cord stimulators, and specialized pharmacological regimens.

History

Over the past 100 years, the study and administration of anesthesia has become more complex. Historically anesthesia providers were almost solely utilized during surgery to administer general anesthesia in which a person is placed in a pharmacologic coma. This is performed to permit surgery without the individual responding to pain (analgesia) during surgery or remembering (amnesia) the surgery.

In the nineteenth century the beginnings of general anesthesia started with the introduction of ether in Boston and chloroform in the United Kingdom to bring about a state of unawareness and unresponsiveness to the pain of surgical insult. With the isolation of cocaine in the mid-nineteenth century there began to be drugs available for local anesthesia. By the end of the nineteenth century the number of pharmacological options increased and they began to be applied both peripherally and neuraxially. Then in the twentieth century neuromuscular blockade allowed the anesthesiologist to completely paralyze the patient pharmacologically and breath for him or her via mechanical ventilation. With these new tools the anesthetist could intensively manage the patient's physiology bringing about critical care medicine, which, in many countries, is intimately connected to anesthesiology.

Investigations

Effective practice of anesthesiology requires several areas of knowledge by the practitioner, some of which are:

Treatments

Many procedures or diagnostic tests do not require "general anesthesia" and can be performed using various forms of sedation or regional anesthesia, which can be performed to induce analgesia in a region of the body. For example, epidural administration of a local anesthetic is commonly performed on the mother during childbirth to reduce labor pain while permitting the mother to be awake and active in labor and delivery.

In the United States, anesthesiologists may also perform non-surgical pain management (termed pain medicine) and provide care for patients in intensive care units (termed critical care medicine).

Training

The length and format of anesthesiology training programs varies from country to country. A candidate must first have completed medical school training to be awarded a medical degree, before embarking on a programme of postgraduate specialist training or residency which can range from four to nine years. [18] Anesthesiologists in training spend this time gaining experience in various different subspecialties of anesthesiology and undertake various advanced postgraduate examinations and skill assessments. These lead to the award of a specialist qualification at the end of their training indicating that they are an expert in the field and may be licensed to practice independently.

Argentina

In Argentina, residency programs are five years long.

Australia and New Zealand

In Australia and New Zealand, training is supervised by the Australian and New Zealand College of Anaesthetists, while anaesthetists are represented by the Australian Society of Anaesthetists and the New Zealand Society of Anaesthetists. The ANZCA-approved training course encompasses an initial two-year long Pre-vocational Medical Education and Training (PMET) and five years of supervised clinical training at approved training sites. Thus the total training following graduation from medical school is seven years long. Trainees must pass both the primary and final examinations which consist of both written (multiple choice questions and short-answer questions) and, if successful in the written exams, oral examinations (viva voce).

In the final written examination, there are many questions of clinical scenarios (including interpretation of radiological exams, EKGs and other special investigations). There are also two cases of real patients with complex medical conditions - for clinical examination and a following discussion. The course has a program of 12 modules such as obstetric anaesthesia, pediatric anaesthesia, cardiothoracic and vascular anaesthesia, neurosurgical anaesthesia and pain management. Trainees also have to complete an advanced project, such as a research publication or paper. They also undergo an EMAC (Effective Management of Anaesthetic Crises) or EMST (Early Management of Severe Trauma) course. On completion of training, the trainees are awarded the Diploma of Fellowship and are entitled to use the qualification of FANZCA – Fellow of the Australian and New Zealand College of Anaesthetists.

Brazil

In Brazil, approximately 650 physicians are admitted yearly to a three-year specialization program. The residency programs can take place at training centers in university hospitals. These training centres are accredited by the Brazilian Society of Anesthesiology (SBA), or other referral hospitals accredited by the ministry of health. Most of the residents are trained in different areas, including ICU, pain management, and anesthesiology sub-specialties, including transplants and pediatrics. In order to be a certified anesthesiologist in Brazil, the residents must undergo exams throughout the residency program and at the end of the program. The SBA conducts these examinations. In order to be an instructor of a residency program certified by the SBA, the anesthesiologists must have the superior title in anaesthesia, in which the specialist undergoes a multiple choice test followed by an oral examination conducted by a board assigned by the national society.

Canada

In Canada, training is supervised by 17 universities approved by the Royal College of Physicians and Surgeons of Canada. [19] Upon completion of a residency program (typically five years long), the candidate is required to pass a comprehensive objective examination consisting of a written component (two three-hour papers: one featuring 'multiple choice' questions, and the other featuring 'short-answer' questions) and an oral component (a two-hour session relating to topics on the clinical aspects of anesthesiology). The examination of a patient is not required. Upon completion of training, the anaesthesia graduate is then entitled to become a "Fellow of the Royal College of Physicians of Canada" and to use the post-nominal letters "FRCPC".

Germany

In Germany, after earning the right to practice medicine (German: Approbation), [20] German physicians who want to become anaesthesiologists must undergo 5 years of training, consisting of anaesthesiology, ECG and pulmonary function testing, critical care and pain medicine, and also palliative care medicine. The training includes rotations serving in the operation theatres to perform anaesthesia on a variety of patients being treated by various surgical sub-specialties (e.g. general surgery, neurosurgery, invasive urological and gynecological procedures), followed by a rotation through various intensive-care units. [21] Many German anaesthesiologists choose to complete a curriculum in emergency medicine, which once completed, enables them to be referred to as Notarzt  [ de ], an emergency physician working pre-clinically with the emergency medical service. In pre-clinical settings the emergency physician is assisted by paramedics. [22]

Netherlands

In the Netherlands, anaesthesiologists must complete medical school training, which takes six years. After successfully completing medical school training, they start a five-year residency training in anaesthesiology. In their fifth year they can choose to spend the year doing research, or to specialize in a certain area, including general anaesthesiology, critical care medicine, pain and palliative medicine, paediatric anaesthesiology, cardiothoracic anaesthesiology, neuro-anaesthesiology or obstetric anaesthesiology.

Guatemala

In Guatemala, a student with a medical degree (he or she must have surgery and general medicine skills by law) has to complete a residency of six years (five years in residency and one year of practice with an expert anaesthetist).

After residency, students take a board examination conducted by the college of medicine of Guatemala, the Universidade De San Carlos De Guatemala (Medicine Faculty Examination Board), and a chief physician who represents the health care ministry of the government of Guatemala. The examination includes a written section, an oral section, and a special examination of skills and knowledge relating to anaesthetic instruments, emergency treatment, pre-operative care, post-operative care, intensive care units, and pain medicine. After passing the examination, the college of medicine of Guatemala, Universidad De San Carlos De Guatemala and the health care ministry of the government of Guatemala grants the candidate a special license to practice anaesthesia as well as a diploma issued by the Universidad De San Carlos De Guatemala granting the degree of physician with specialization in anaesthesia. Anaesthetists in Guatemala are also subject to yearly examinations and mandatory participation in yearly seminars on the latest developments in anaesthetic practice.

Hong Kong

To be qualified as an anesthesiologist in Hong Kong, medical practitioners must undergo a minimum of six years of postgraduate training and pass three professional examinations. Upon completion of training, the Fellowship of Hong Kong College of Anesthesiologists and subsequently the Fellowship of Hong Kong Academy of Medicine is awarded. Practicing anesthesiologists are required to register in the Specialist register of the Medical Council of Hong Kong and hence are under the regulation of the Medical Council. [23]

Italy

In Italy, a medical school graduate must complete an accredited five-year residency in anesthesiology.

The Nordic countries

In Denmark, Finland, Iceland, Norway, and Sweden, anesthesiologists' training is supervised by the respective national societies of anesthesiology as well as the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. In the Nordic countries, anesthesiology is the medical specialty that is engaged in the fields of anesthesia, intensive care medicine, pain control medicine, pre-hospital and in-hospital emergency medicine. Medical school graduates must complete a twelve-month internship, followed by a five-year residency program. SSAI currently hosts six training programs for anesthesiologists in the Nordics. These are Intensive care, Pediatric anesthesiology and intensive care, Advanced pain medicine, Critical care medicine, Critical emergency medicine, and Advanced obstetric anesthesiology.

United Kingdom

In England, Northern Ireland, Scotland, and Wales, training is supervised by the Royal College of Anaesthetists. Following the completion of medical school training, physicians enter a two-year foundation program which consists of at least six, four-month rotations in various medical specialties. It is mandatory for all physicians to complete a minimum of three months of general medicine and general surgery training during this time. Following the foundation program, physicians compete for specialist training.

The training program in the United Kingdom currently consists of two years of core training and five years of higher training. Before the end of core training, all trainees must have passed the primary examination for the diploma of Fellowship of the Royal College of Anaesthetists (FRCA). Trainees wishing to hold dual accreditation in anaesthesia and intensive care medicine may enter anaesthesia training via the Acute Care Common Stem (ACCS) program which lasts three years and consists of experience in anaesthesia, emergency medicine, acute medicine and intensive care. Trainees in anaesthesia are called Specialty Registrars (StR) or Specialist Registrars (SpR).

The Certificate of Completion of Training (CCT) in anaesthesia is divided into three levels: Basic, intermediate and advanced. During this time, physicians learn anaesthesia as applicable to all surgical specialties. The curriculum focuses on a modular format, with trainees primarily working in one special area during one module, for example: cardiac anaesthesia, neuro-anaesthesia, ENT, maxillofacial, pain medicine, intensive care, and trauma. Traditionally (before the advent of the foundation program), trainees entered anaesthesia from other specialties, such as medicine or accidents and emergencies. Specialist training takes at least seven years. On completion of specialist training, physicians are awarded CCT and are eligible for entry on the GMC Specialist register and are also able to work as consultant anaesthetist. A new consultant in anaesthetics must have completed a minimum of 14 years of training (including: five to six years of medical school training, two years of foundation training, and seven years of anaesthesia training).

Those wishing for dual accreditation (in Intensive care and anaesthesia) are required to undergo an additional year of training and also complete the Diploma in Intensive Care Medicine (DICM). Pain specialists give the Fellowship of the Faculty of Pain Medicine of the Royal College of Anaesthetists (FFPMRCA) examination.

United States

Photo of prebriefing for mixed modality simulation being used for anesthesia resident training Anesthesia Resident Simulation.jpg
Photo of prebriefing for mixed modality simulation being used for anesthesia resident training

Following medical school training, anesthesiology residency programs in the United States require successful completion of four years of residency training at an ACGME approved program for board certification eligibility in the specialty of anesthesiology. [24] Anesthesiology residents face multiple examinations during their residency, including exams encompassing physiology, pathophysiology, pharmacology, and other medical sciences addressed in medical school, along with multiple anesthesia knowledge tests which assess progress during residency. Successful completion of a board exam after completion of residency is required for board certification.

Residency training in the U.S. encompasses the full scope of perioperative medicine, including pre-operative medical evaluation, management of pre-existing disease in the surgical patient, intraoperative life support, intraoperative pain control, intraoperative ventilation, post-operative recovery, intensive care medicine, and chronic and acute pain management. After residency, many anesthesiologists complete an additional fellowship year of sub-specialty training in areas such as pain management, sleep medicine, cardiothoracic anesthesiology, pediatric anesthesiology, neuroanesthesiology, regional anesthesiology/ambulatory anesthesiology, obstetric anesthesiology, or critical care medicine. [25]

Dental anesthesiology is an emerging field for some dentists in the United States, who must have completed an undergraduate college program (that includes pre-medical requirements) and four years of dental school training. Dentist anesthesiology residency programs in the United States require successful completion of two years of residency training. [26] [27]

The average salary for a full-time anesthesiologist is roughly $269,600, according to US News. [28] The number of jobs are rounding to about 170,400 according to statistics in 2014. [29]

The majority of anesthesiologists in the United States are board-certified, either by the American Board of Anesthesiology (ABA) or the American Osteopathic Board of Anesthesiology (AOBA). D.O. anesthesiologists can be certified by the ABA. The ABA is a member of the American Board of Medical Specialties, while the AOBA falls under the American Osteopathic Association. Both Boards are recognized by the major insurance underwriters in the U.S. as well as by all branches of the U.S. Uniformed Services. Board certification by the ABA involves both a written and an oral examination. AOBA certification requires the same exams, in addition to a practical examination with examining physicians observing the applicant actually administering anesthetics in the operating room. [ citation needed ]

Related Research Articles

Emergency medicine medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for unscheduled and undifferentiated patients of all ages. As first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians generally practise in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units, but may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, ultrasonography, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine.

General anaesthesia

General anaesthesia or general anesthesia is a medically induced coma with loss of protective reflexes, resulting from the administration of one or more general anaesthetic agents. It is carried out to allow medical procedures that would otherwise be intolerably painful for the patient; or where the nature of the procedure itself precludes the patient being awake.

Anaesthetic machine medical device used to generate a fresh gas flow for anaesthesia

An anaesthetic machine or anesthesia machine is a medical device used to generate and mix a fresh gas flow of medical gases and inhalational anaesthetic agents for the purpose of inducing and maintaining anaesthesia.

Awareness under anesthesia, also referred to as intraoperative awareness or accidental awareness during general anesthesia (AAGA), is a rare complication of general anesthesia when patients regain varying levels of consciousness during their surgical procedures. While it's possible to regain consciousness during surgery without any memory of it, the more clinically significant entity is awareness with explicit recall, where patients can remember the events related to their surgery. This article focuses on intraoperative awareness with explicit recall.

Oral and maxillofacial surgery medical specialty

Oral and maxillofacial surgery specializes in surgery of the face, mouth, and jaws. It is an internationally recognized surgical specialty. OMFS is a specialty of dentistry in North America, Central America, South America, Australia, New Zealand, Russia, Asia, and Scandinavia. After a full degree in dentistry, the dental specialty residency of oral and maxillofacial surgery may or may not include a full degree in medicine. In countries such as the UK and most of Europe, it is recognized as a specialty of medicine and a degree in medicine or both degrees in dentistry and medicine are compulsory.

A medical speciality is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include children (pediatrics), cancer (oncology), laboratory medicine (pathology), or primary care. After completing medical school, physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a medical specialist.

The American Society of Anesthesiologists (ASA) is an educational, research and scientific association of physicians organized to raise the standards of the medical practice of anesthesiology and to improve patient care.

In the United States, anesthesia can be administered by nurse anesthetists, physician anesthesiologists, Anesthesiologist Assistants Anesthesiologist Assistants

Harold Randall Griffith was a Canadian anesthesiologist and a leader in the fields of anesthesiology.

<i>British Journal of Anaesthesia</i> journal

The British Journal of Anaesthesia (BJA) is a monthly peer-reviewed international medical journal published by Elsevier on behalf of the Royal College of Anaesthetists ; the College of Anaesthesiologists of Ireland; and the Hong Kong College of Anaesthesiologists, for all of which it serves as their official journal. The journal covers all aspects of anaesthesia, perioperative medicine, intensive care medicine and pain management. The current editor-in-chief is Hugh C. Hemmings . The BJA was founded in 1923, one year after the first anaesthetic journal was published by the International Anaesthesia Research Society. The first Editor-in-Chief of the journal was H. M. Cohen. He was based in Manchester, UK, but born in New York City, and he edited the journal from 1923 to 1928. Recent Editors-in-Chief include Ravi Mahajan, Charles Reilly and Jennifer Hunter.

Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures.

Geriatric anesthesia is the branch of medicine that studies anesthesia approach in elderly.

The International Anesthesia Research Society (IARS) is an international, professional medical society dedicated to improving clinical care, education and research in anesthesia, pain management, and perioperative medicine.

The following outline is provided as an overview of and topical guide to anesthesia:

The College of Anaesthesiologists of Ireland is the professional association and educational institution responsible for the medical specialty of anaesthesiology throughout Ireland. It sets standards in anaesthesiology, critical care, and pain medicine, and for the training of anaesthesiologists, critical care physicians and pain medicine physicians. It also holds examinations for anaesthesiologists in training, jointly publishes the British Journal of Anaesthesia and BJA Education, and informs and educates the public about anaesthesiology. Its headquarters are in Dublin, Ireland.

Obstetric anesthesia or obstetric anesthesiology, also known as ob-gyn anesthesia or ob-gyn anesthesiology is a sub-specialty of anesthesiology that provides peripartum pain relief (analgesia) for labor and anesthesia for cesarean deliveries ('C-sections').

Critical emergency medicine subspecialty of anaesthesiology concerned with immediately life threating emergencies

Critical emergency medicine (CREM) refers to the acute medical care of patients who have medical emergencies that pose an immediate threat to life, irrespective of location. In particular, the term is used to describe the role of anaesthesiologists in providing such care.

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