Monitoring, past, present, future. A personal journey

A little over 40 years ago, anesthesiology in the United States became recognized as a specialty. At that time, its practice was largely that of an art, the science of which was yet to come. A finger on the pulse, observation of color, skin turgor, perspiration, and perhaps a blood pressure cuff in adults, and an estimation of the reflex signs of anesthesia were the standards for the assessment of the patient status and 'the depth of anesthesia'. How far have we come in the intervening years? The journey, as reflected in the experience of one physician, will be held up to the looking-glass; easily as astounding as that through which Alice passed. Caught as we are in the socio-economic climate of the present, how shall we react? Has the gadgetry and electronics of this day given us a meaningful cost-effective handle on a decreased morbidity and mortality? What impact is there on decision-making and outcome? What indeed is the contribution of the machine versus the newer agents, techniques, and the advanced educational milieu. The first attempts at monitoring were clearly directed toward the cardiovascular system. The devices developed were simple and non-invasive. The Riva-rocci method of measuring blood pressure was first applied in anesthesia by Harvey Cushing at the turn of the century. But it was 40 years before the electrocardiogram was introduced as an instrument of potential importance. It took another 25 years for it to have general acceptance, and even later for the anesthesiologist to become comfortable with it as a diagnostic tool.(ABSTRACT TRUNCATED AT 250 WORDS)