Volume 4, No. 3 • Fall 1989

Anesthesia Care Team Concept Questioned; Aviation Analogy Faulted

Benjamin H. Gorsky, M.D

To the Editor

Dr. Rauscher employed the aviation/anesthesia analogy in a recent letter (March 1989 Newsletter) to argue in favor of the Care Team approach in anesthesia. As an active anesthesiologist, pilot and flight instructor I believe that I see the limits of this analogy more clearly than others.

It is difficult to argue against the potential utility of another’s help with the performance of complex tasks in either aviation or anesthesia. However, a few points should be kept in mind. first, no airline captain endeavors simultaneously to fly two aircraft with the assistance of two co-pilots. Second, those involved in human factor analysis for aviation have recognized that new technology can so ease the cockpit workload that performance and vigilance may actually suffer due to boredom induced fatigue. Crew reductions have been considered so that each crew member will have enough work to do to keep busy, engaged and alert. This type of problem may exist in anesthesia as well.

Finally, the “crew” concept in aviation is not without its problems. Some airlines have recently introduced new training programs to help crews team to work together more efficiently. These “cockpit resource management” programs specifically deal with the dichotomy of the captain as pilot-in-command with absolute authority and the need for input, suggestions and assistance from subordinates. Such programs do not exist for the anesthesia care team.

If the anesthesia care team implies that two professionals will work together in a well thought out fashion, with appropriate duties and responsibilites for each, while providing anesthesia for a single patient, then the airline analogy may hold; in common anesthesia practice, it does not.

Benjamin H. Gorsky, M.D. Chief Anesthesiologist

Shriners Hospital for Crippled Children Honolulu, Hawaii