The Challenge of our Specialty

Letter to Editor

Austin J Anesthesia and Analgesia. 2014;2(4): 1025.

The Challenge of our Specialty

Essam M Manaa*

Department of Anesthesiology, Assiut University, Egypt

*Corresponding author: Essam M Manaa, Department of Anesthesiology, Assiut University, Egypt.

Received: May 01, 2014; Accepted: May 05, 2014; Published: May 06, 2014

Letter to Editor

We are specialists in a medical branch that has evolved and grown exponentially in just time; having had a circumscribed activity in the surgical area managing the perioperative period. Many changes started to be applied to our professional activities that have revolutionized us. We have seen the need to incorporate new knowledge and technologies in line with development of specialty which have led to the change of postgraduate study plan, to suit the needs of the new profile of the anesthesiologist [1,2].

The cornerstone of the specialty of anesthesiologists is the basic sciences: anatomy, physiology and pharmacology; we must apply knowledge of medicine; know the diseases and their complications in anesthesia. We must be trained to handle as global each patient, not organs or systems, and our competence is integral in the perioperative period [3,4].

We must accurately diagnose and treat because our complications require prompt and accurate resolution. Undoubtedly we have in our hands one of the most complete medical specialty, which forces us to be with updated constant information’s. Currently, we meet patients in the pre anesthetic consultation where a committed attitude team carrying this work to detect and resolve possible causes of delays and avoid suspensions in the operating room; can anticipate possible difficulties and preparing for them. Definitely we are taking care of patient during intra and postoperative period [3].

Other important areas of our competition are emergency management (trauma, burns), medical intensive care and pain. It is accepted by all that the management of acute postoperative pain period is an integral part of anesthetic practice. For ethical, humanitarian and physiological reasons pain should be anticipated, prevented and controlled effectively in all age groups and is considered a pro– public health problem [5]. It is not permissible to give an excellent anesthesia and neglect postoperative analgesia. According to the Declaration of Montreal, access to pain management is such a fundamental human right [6]. The various committees, corporations and humanitarian agencies (World Health Organization) promotes and support the analgesia [7–9].

At the beginning of this century, the Congress of the United States declared that it was a national purpose consider first decade as “10 years of research and control of pain” [10]. We know that there is no single way to relieve pain so the current trend of treating this vital sign is using a multimodal management. [11–14]. Un–Fortunately 73%–80% of patients continue experiencing moderate to severe pain after surgery. It is well known that perioperative analgesia effectively facilitates the rehabilitation process, improves satisfaction and reduces patient length of hospital stay [15–18].

At the present time the use of epidural catheters and nerve blocks have been shown to be superior against systemic analgesia[19,20]. Postoperatively 10 to 80% of patients may have chronic pain persistent in the surgical site [8]. Thus, experts recommend the use of techniques regional analgesia to prevent the development of persistent postsurgical pain. Hence the concern of anesthetic andanalgesic technique protocol begins intra operatively.

This edition will deal with themes that express concerns of our community to improve intra–and postoperative analgesia. Opioid drugs are considered gold standard for the management of postoperative pain despite its adverse effects. They have good effect on moderate and severe pain. Remifentanil is an ideal opioid for the anesthesiologist for its pharmacokinetic properties. Many authors compared their experience with the use of remifentanil either manually by means of perfusion vs TCI effect [21]. If we have the possibility of having infusion pumps in all our operating rooms it will be a valid alternative to manual infusion, so we can provide adequate anesthesia and avoid consuming more medication.


Essam M Manaa


  1. Hartrick CT, Rozek RJ, Conroy S, Dobritt D, Felten D. Pain education: getting an early start. Pain Pract. 2012; 12: 593-594.
  2. Neal JM. Education in regional anesthesia: caseloads, simulation, journals, and politics: 2011 Carl Koller Lecture. Reg Anesth Pain Med. 2012; 37: 647- 651.
  3. Van Gessel E, Mellin-Olsen J, østergaard HT, Niemi-Murola L. Education and Training Standing Committee, European Board of Anaesthesiology, Reanimation and Intensive Care. Postgraduate training in anaesthesiology, pain and intensive care: the new European competence- based guidelines. Eur J Anaesthesiol. 2012; 29: 165-168.
  4. Section and Board of Anaesthesiology, European Union of Medical specialists1, Carlsson C, Keld D, van Gessel E, Fee JP, van Aken H . Education and training in anaesthesia--revised guidelines by the European Board of Anaesthesiology, Reanimation and Intensive Care. Eur J Anaesthesiol. 2008; 25: 528-530.
  5. Loeser JD. Relieving pain in America. Clin J Pain. 2012; 28: 185-186.
  6. Cousins MJ, Lynch ME. The Declaration Montreal: access to pain management is a fundamental human right. Pain. 2011; 152: 2673-2674.
  7. Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth Analg. 2007; 105: 205-221.
  8. Liu SS. Regional analgesia for postoperative pain: then & now. Anesth Analg. 2012; 114: 255-256.
  9. Institute of Medicine (U.S.) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Educationtion, and Research. Washington (DC): National Academies Press (U.S.). 2011.
  10. Elvir-Lazo OL, White PF. The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol. 2010; 23: 697-703.
  11. White PF, Kehlet H, Neal JM, Schricker T, Carr DB, Carli F. Fast-Track Surgery Study Group. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg. 2007; 104: 1380-1396.
  12. White PF. Multimodal pain management. The future is now! Curr Opin Investig Drugs. 2007; 8: 517-518.
  13. Kehlet H. Multimodal approach to postoperative monitoring pathophysiology and rehabilitation. Br J Anaesth. 1997; 78: 606-617.
  14. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain Continues to be undermanaged. Anesth Analg. 2003; 97: 534-540.
  15. White PF, Raeder J, Kehlet H. Ketorolac: Its role as part of a multimodal analgesic regimen. Anesth Analg. 2012; 114: 250-254.
  16. Romundstad L, Breivik H. Accelerated recovery programmes should complement, not replace, the acute pain services. Acta Anaesthesiol Scand. 2012; 56: 672-674.
  17. White PF, Kehlet H. Improving postoperative pain management: what are the unresolved issues Anesthesiology?. 2010; 112: 220-225.
  18. Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg. 2007; 104: 689-702.
  19. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011; 113: 904-925.
  20. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006; 367: 1618-1625.
  21. Ritchey RM. Optimizing postoperative pain management. Cleve Clin J Med. 2006; 73: S72-76.

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Citation: Manaa EM. The Challenge of our Specialty. Austin J Anesthesia and Analgesia. 2014;2(4): 1025. ISSN: 2381-893X

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