American Society of Anesthesiologists (ASA)

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American Society of Anesthesiologists

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 2012, the organization claimed a membership of 48,000 national and international members and has more than 100 full-time employees.

Contents

History of ASA [edit]

Anesthesiology’s roots are closely tied to an event in the mid-19th century. On March 30, 1842, Crawford Long, M.D. administered the first ether anesthetic for surgery and operated to remove a tumor from a patient’s neck. After the surgery, the patient revealed that he felt nothing and was not aware the surgery was over until he awoke. This was the start of a specialty critical to modern medicine, anesthesiology.

In 1905, nine physicians (from Long Island, N.Y.) organized the first professional anesthesia society. In 1911, the Society expanded to 23 members and became the New York Society of Anesthetists. Over the next 25 years, involvement in anesthesia-related issues grew and attracted other interested physicians nationwide. Thought leaders, such as Dr. Virginia Apgar who created the Apgar score used to assess newborn children, migrated into this exciting and rapidly developing medical specialty. In 1936, the Society changed its name to the American Society of Anesthetists. In 1945, the organization moved to become the American Society of Anesthesiologists (ASA). In 1960, the ASA established an Executive Office in Park Ridge, Ill to meet growing membership and patient-care demands. Learn more details about ASA’s exciting history here.

Each year, on March 30, Doctors Day celebrates Dr. Long’s historic achievement, as well as the continued efforts of all physicians to alleviate human suffering and improve patient safety. The contribution of anesthesiology’s early pioneers, such as Drs. Long and Apgar, has been recognized worldwide to include commemorative postage stamps in their names.

Membership in ASA [edit]

Membership is open to holders of Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degrees who are licensed practitioners and have successfully completed a training program in anesthesiology approved by the Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA).

Members must maintain the high standards required by the Society throughout their careers. Within the membership, the Society has a special section for residents in training in anesthesiology, as well as medical students. Resident members must be physicians in a full-time anesthesiology residency program accredited by ACGME or AOA.

Following completion of their residency, an anesthesiologist is eligible for board certification through the American Board of Anesthesiology (ABA). Board certification consists of a written and then an oral exam. To learn more about the board certification process, visit the ABA website. Board-certified anesthesiologists must maintain their certification with continuing medical education specifically approved by the ABA for Maintenance of Certification in Anesthesiology (MOCA®). Learn more about MOCA®requirements here.

The ASA also maintains an active resident component as well as medical student component.

Governance [edit]

ASA is governed by its House of Delegates. The House of Delegates is composed of ASA delegates and directors (designated by geographic distribution), ASA officers, all past presidents, the Editor-in-Chief of the journal, the chairs of all sections, the chair of the ASA delegation to the American Medical Association House of Delegates and each member of the Resident Component Governing Council not to exceed five members and a non-voting member of the Medical Student component. The House of Delegates meets each year during the Society's Annual Meeting.

During the interim between the meetings of the House of Delegates, the ASA Board of Directors exercises authority to manage the business and financial affairs of the Society, and superintends and directs the publication and distribution of all official documents, journals and reports consistent with policies of the House of Delegates. The Board of Directors meet three times each year. The Society also has many special committees. In addition, 55 component societies work to implement and complement the Society's goals at the community level.

The current President is John M. Zerwas, M.D., the President-Elect is Jane C.K. Fitch, M.D., the First Vice President is John P. Abenstein, M.D., the Secretary is Linda J. Mason, M.D. and the Treasurer is James D. Grant, M.D.

The current President of the Resident Component is Nicole A. Weiss, M.D., the President-Elect is Mark Bickett, M.D. and the Secretary is Gina L. Haeussner, M.D.

The current President of the Medical Student Component is Daniel A. Hansen, the President-Elect is Chad R. Greene and the Secretary is Rachel Wood.

ASA designated the ASA's Division of Scientific Affairs as the major continuing educational component of the Society, and the Committee on Professional Education Oversight has overall responsibility for the programs. To achieve its goal of raising standards of the medical practice of anesthesiology, ASA sponsors the world's largest annual educational program for anesthesiologists, to provide anesthesiologists with information on the newest developments in anesthesiology and other related medical fields. ASA also offers formal refresher courses of continuing education for the practicing anesthesiologist at the Annual Meeting and in regional courses throughout the year.

Educational Products Include:

Meetings [edit]

Meetings are held annually and are based on scientific progress in the anesthesiology fields.

Publications [edit]

The Society publishes multiple academic resources within the following categories:

Anesthesiologist Education and Training [edit]

In the United States, physicians train extensively to become specialists in anesthesiology. Following high school, young scholars undergo a four-year undergraduate college degree. Although the specific degree will vary, all students must complete requisite pre-med science requirements. Following completion of their undergraduate studies, potential anesthesiologists then undergo four years of medical school followed by four years of post-doctoral training.

Following completion of their residency, an anesthesiologist is eligible for board certification through the American Board of Anesthesiology (ABA) or the American Osteopathic Board of Anesthesiology (AOBA). Board certification consists of a written and then an oral exam. Board-certified anesthesiologists must maintain their certification with continuing medical education specifically approved by the ABA for Maintenance of Certification in Anesthesiology (MOCA®).

Anesthesia Subspecialties [edit]

While all anesthesiologists complete a minimum of eight years of medical training after college, some anesthesiologists have additional training (called a fellowship) in a specific area of anesthesiology. The ABA offers specific certifications in some of these areas. Anesthesiologists are not required to subspecialize, but many do focus on one area of care to further hone their expertise. These specialty areas include, but are not limited to:

  • Pediatric Anesthesia
  • Cardiac Anesthesia
  • Pain Medicine
  • Obstetric Anesthesia
  • Ambulatory Anesthesia
  • Neurosurgical Anesthesia
  • Critical Care Medicine
  • Hospice and Palliative Medicine
  • Research

Additional details regarding the anesthesiologist’s role in operative and specialty care is provided in the upcoming sections titled “Anesthesiology for the Surgical Patient” and “Anesthesiology Beyond Surgery.”

For more information on anesthesiologists’ training, visit ASA’s patient website.

Anesthesia Care, Practice and Safety [edit]

Care and Practice

Anesthesiologists serve a central role in the operating room, making decisions to protect and regulate critical life functions. They typically are the first to diagnose and treat any medical problems that may arise during surgery or the recovery period. The practice of anesthesiology is broad and transcends the operating room as well. Anesthesiologists are experts in pain medicine. They help patients with chronic disease live better lives through pain management treatments. Additionally, their work in critical care units saves countless lives. Anesthesiologists treat patients with multiple complications, from pulmonary and cardiac issue to infection control and advanced life support.

Safety

Complications from anesthesia have declined dramatically over the last 50 years. Since the 1970s, the number of anesthesiologists has more than doubled and at the same time patient outcomes have improved. While perioperative deaths attributed to anesthesia were approximately 1 in 1,500 some 50 years ago, today that number has improved nearly 10-fold. Despite older and sicker patients being treated in operating rooms nationwide, this is a dramatic increase in patient safety. At present, the chances of a healthy patient suffering an intraoperative death attributable to anesthesia is less than 1 in 200,000 when an anesthesiologist is involved in patient care. (Committee on Quality of Healthcare in America, Institute of Medicine, To Err Is Human, Building a Safer Health System. Edited by Kohn L., Corrigan J, Donaldson M. Washington, National Academy Press, 1999, p 241).

Anesthesiology for the Surgical Patient [edit]

Preoperative Clinic

Anesthesiologists play a vital role in assessing a patient’s medical readiness for surgery. They are unique in their advanced knowledge of both the medical illnesses and the potential effects of surgery on the human body. The anesthesiologist’s preoperative evaluation may be very brief (such as in the case of a surgical emergency) or very prolonged (as in the case of a patient with multiple chronic medical problems who is to undergo an extensive operation). In all cases, however, the anesthesiologist performs a focused history and physical examination, reviews available laboratory and special test results and assesses the need for additional testing prior to proceeding with surgery.

Intraoperative Care

It is estimated that nearly 40 million anesthetics are administered each year in the United States. Anesthesiologists provide or participate in more than 90 percent of these anesthetics. In the operating room, they are responsible for the medical management and anesthetic care of the patient throughout the duration of the surgery. The anesthesiologist must carefully match the anesthetic needs of each patient to that patient’s medical condition, responses to anesthesia and the requirements of the surgery. Anesthesiologists practice in either a “solo” or “Anesthesia Care Team” model. “Solo” practice involves the physician anesthesiologist directly caring for a single patient throughout an entire surgical episode. The “care team model” involves the physician anesthesiologist medically supervising and directing the work of non-physician anesthetists, such as nurse anesthetists (NA) or anesthesiologist assistants (AA). Although NAs and AAs are not physicians, theses providers have been trained in the technical aspects of administering anesthesia. Regardless of the provider, however, the anesthesiologist is the director of the Anesthesia Care Team. Anesthesiologists have important functions outside of the operating room, but the majority of their vital work takes place in the surgical suite. Their main roles during surgery are:

  • Provide continual medical assessment of the patient.
  • Monitor and control the patient’s vital life functions, including heart rate and rhythm, breathing, blood pressure, body temperature and body fluid balance.
  • Control the patient’s pain and level of consciousness to make conditions ideal for a safe and successful surgery.

Most of the time, the patient won’t even realize the anesthesiologist is providing these critical functions during surgery, but rest assured you have a physician by your side making sure your health and safety is protected at all times. For more information on the Anesthesia Care Team, visit ASA’s patient website.

Postanesthesia Care Unit, or 'Recovery Room'

After surgery, patients are transferred to the PACU, where they continue to emerge from the effects of anesthesia under the watchful eyes of the peri-anesthesia nurse with anesthesiologist consultation immediately available. Evidence of recovery – including activity level, adequacy of breathing, circulation, level of consciousness and oxygen saturation – is continuously monitored. Pain control is optimized. In most cases, the anesthesiologist decides when the patient has recovered enough to be sent home following outpatient surgery or has been stabilized sufficiently to be moved to a regular room in the medical facility or transferred to an intensive care unit.

Anesthesiology Beyond Surgery [edit]

As medical technology has advanced, so has the need for anesthesiologists to become involved in caring for patients during uncomfortable or prolonged procedures in locations outside the traditional operating suite. These procedures include radiological imaging, gastrointestinal endoscopy, placement and testing of cardiac pacemakers and defibrillators, lithotripsy and electroconvulsive therapy. In most institutions, anesthesiologists are available during cardiac catheterizations and angioplasty procedures should emergency airway management or resuscitation become necessary.

Basic Science and Clinical Research

Some of the most significant strides in medicine and surgery are directly attributable to anesthesiology’s advances in patient monitoring, improved anesthetic agents and new drug therapy. Anesthesia research at the clinical and basic science levels has been completed almost exclusively by anesthesiologists or Ph.D. scientists with the goal of continually improving patient care and safety.

Ambulatory and Office-Based Anesthesia

The number of operations performed in ambulatory surgical centers and doctors’ offices continues to increase. Many of the patients being treated in these facilities are from an increasingly elderly population with more complex medical problems. Patients deserve the same high standard of care in these facilities that they receive in the hospital setting. Anesthesiologists are working with federal and state legislators and agencies, and collaborating with other physicians and accrediting bodies to establish safety standards for such facilities. Further information about ambulatory surgery can be found here.

Operating Room Management

In addition to providing patient care, the anesthesiologist often is responsible for managing the resources of the operating suite, including the efficient use of operating rooms, supplies, equipment and personnel.

Critical Care and Trauma Medicine

Critical care units are now found in most major medical facilities throughout the United States. Anesthesiologists are uniquely qualified to coordinate the care of patients in the intensive care unit because of their extensive training in clinical physiology/pharmacology and resuscitation. Some anesthesiologists pursue advanced fellowship training to subspecialize in critical care medicine in both adult and pediatric hospitals. In the intensive care unit, they direct the complete medical care for the sickest patients. The role of the anesthesiologist in this setting includes the provision of medical assessment and diagnosis, respiratory and cardiovascular support, and infection control. Anesthesiologists also possess the medical knowledge and technical expertise to deal with many emergency and trauma situations. They provide airway management, cardiac and pulmonary resuscitation, advanced life support and pain control. As consultants, they play an active role in stabilizing and preparing the patient for emergency surgery.

Pain Medicine

The field of pain medicine focuses on managing all types of pain - studying what causes it, how the body reacts to it, how different medications dull or eliminate pain, and how other treatments can be used to relieve many painful conditions. Anesthesiologists frequently are the pain managers for their patients. They make sure patients are safe, that their pain is managed and that they are comfortable during and following surgery. They also provide their services in other areas of the hospital and in physicians' offices where painful medical tests or procedures are performed.

Obstetrics

These physician anesthesiology specialists help women manage their pain during labor and delivery both during natural vaginal births as well as cesarean births. Some women need little or no pain relief, and others find that pain relief gives better control over their labor and delivery.

Notable Anesthesiologists [edit]

Related Organizations [edit]

ASA Journal and Other Publications [edit]

  • Anesthesiology is the official journal of the American Society of Anesthesiologists.
  • The ASA NEWSLETTER is published monthly for members by the ASA and is also available online.
  • ASAP is ASA’s weekly e-newsletter sent to members via email.

External links [edit]
Types
Techniques
Measurements
Instruments
Drugs
Complications
Fields of study
Professions
History
Organizations
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