“Art” of Anesthesia Requires Vigilance

David J. Cohen M.D.

To the Editor

In response to the letter from C. Carl Bostek in the Winter APSF Newsletter, I must weigh in with an emphatic “NO!” to the practice of reading during cases. One of the very first lessons I learned as a resident was that reading in the OR was not permitted. The basis for this prohibition (which I have followed now for six years) was simple: patient safety may be jeopardized by an inattentive anesthesia provider. While we in anesthesia have embraced the impressive advances in monitoring technology, I believe we may well be on a slippery slope and should beware of over reliance on bells and whistles. Subtle changes in a patients condition, which may signify an actual or impending problem, can often fall well within the alarm parameters of our monitors. This is the essence of the ‘art” of anesthesia.

Beyond this, however, is an issue which I feel is equally, if not more, important: that of the perception of us as anesthesiologists. I can think of no other medical specialty in which the practitioner can read while actually performing his or her job. Reading during cases implies to all those present in the operating room that anyone off the street should be capable of providing anesthesia. After all, what special training, expertise or technical skills are required to put your feet up on the anesthesia machine and read a novel, a newspaper or even a medical journal? As we try to educate our patients, our colleagues and the public at large about the important job we perform (particularly regarding patient safety), I strongly believe that reading in the OR does nothing to advance our cause. Vigilance, we must demonstrate, is a continuous phenomenon, not one that begins when the crossword puzzle ends.

David J. Cohen M.D.

North Oakland Medical Centers

Clinical Assistant Professor of Anesthesiology Wayne State University Pontiac, MI