The evolution of the anesthesiologist: novel perioperative roles and beyond

Delivery of the spectrum of anesthesia from sedation to general anesthesia for patients undergoing procedures outside of the operating room (OR) poses several problems not encountered in the OR. These include limited time to assess the patient and often no time to obtain consultations for medical conditions that may be outside of the usual purview of an anesthesiologist, such as initial management of infections, diabetic ketoacidosis or hyperosmotic hyperglycemic state, inadequately managed cardiovascular disease, and toxic ingestions. Anesthesiologists trained in critical care usually have more experience with the initial assessment and management of patients with such conditions. It can be argued that because procedures performed outside of the OR are becoming more common, the curriculum for anesthesia residencies should be modified to provide more training in conditions typically assessed and managed by internists or medical subspecialists.