Driving Paradigms Shifts Is at the Core of Our Specialty

Abstract

The origin of the idea of the Earth being spherical—as opposed to a flat structure—is credited to Pythagoras around 500 bc. However, it was not until around 350 bc that Aristotle made physical observations to support such a claim. Despite the astonishing precision achieved by Eratosthenes of Cyrene in determining the circumference of the Earth (ca. 240 bc), it was not until Portuguese explorer Ferdinand Magellan circumnavigated the Earth between 1519 and 1522 that such estimation was widely accepted (“This Month in Physics History,” June 2006 [Vol 5, Number 6]. APS News. Retrieved from https:// www.aps.org/publications/apsnews/200606/history.cfm. Accessed on September 9, 2019). Ancient Greeks used ingenuity and available methods of the time to answer questions that affected civilization for centuries. Fortunately, curiosity and skepticism has often moved scientific discovery by challenging established paradigms, resulting in a new “truth” at a specific time. In a much shorter span of time, but in an analogous fashion, anesthesiology has evolved from the first demonstrations of surgical anesthesia in the 19th century to its contemporary form. Who would have thought development of our specialty will affect the practice of medicine in such way? Similar to the ancient Greeks, many challenges have been overcome in anesthesiology, and the paradigm of our understanding of physiology and pharmacology have evolved. Despite such progress, during recent decades global changes in many other aspects have also evolved, even forcing us to question the future of our practice. Our specialty in general, and cardiothoracic and vascular anesthesiology in particular, are young and versatile fields that have embraced challenges as fuel for its progress. The development of research and improved practice patterns will continue to nurture our growth into the future. With that premise in mind, Seminars in Cardiothoracic and Vascular Anesthesia (SCVA), for the first time, includes abstracts of a scientific meeting as a reflection of developing ideas and evolving approaches to patient care. This issue of SCVA opens with an overview of abstracts presented at the 2019 Congenital Cardiac Anesthesia Society Annual Meeting. Dr Latham provides an excellent description of the abstract session and highlighted themes, including a concise review of selected oral presentations. His description of the abstract session is further accompanied by his highly informative podcast, which can be viewed at https://journals.sagepub.com/home/scv. The diversity of sources and nature of articles presented in this issue of SCVA are encouraging. Collectively, they represent ingenuity and adaptability in the face of a changing perioperative environment. Whether in the form of original research, description of institutional experience, or review of available evidence, they all shift accepted paradigms of intraoperative care and help establish new truths in our understanding of patient care. Such works are pushing the boundaries of anesthesia practice beyond the operating room while embracing the new paradigm of integrated perioperative care. The Cardiac Review section of the present issue includes a comprehensive, yet concise and very useful review of available evidence regarding periprocedural management of oral anticoagulants for nonoperating room settings written by Drs Tao and Oprea. Almost certainly, the most significant change in the practice of anesthesiology is expansion of nonoperating room procedures. Given the increased trend toward less invasive interventions and more complex diagnostic procedures, it is projected that within the next 10 years, more than 50% of procedures involving anesthesiology care will be performed in nonoperating room settings. The highly relevant article by Tao and colleague further contributes to the evidence of the importance of anesthesia care providers to add value to 881833 SCVXXX10.1177/1089253219881833Seminars in Cardiothoracic and Vascular AnesthesiaDel Rio et al editorial2019