Stephen H. Jackson

United States Anesthesiologists over 50 Retirement Decision Making and Workforce Implications

Background:Anesthesiology is among the medical specialties expected to have physician shortage. With little known about older anesthesiologists’ work effort and retirement decision making, the American Society of Anesthesiologists participated in a 2006 national survey of physicians aged 50–79 yr. Methods:Samples of anesthesiologists and other specialists completed a survey of work activities, professional satisfaction, self-defined health and financial status, retirement plans and perspectives, and demographics. A complex survey design enabled adjustments for sampling and response-rate biases so that respondents’ characteristics resembled those in the American Medical Association Physician Masterfile. Retirement decision making was modeled with multivariable ordinal logistic regression. Life-table analysis provided a forecast of likely clinical workforce trends over an ensuing 30 yr. Results:Anesthesiologists (N = 3,222; response rate = 37%) reported a mean work week of 49.4 h and a mean retirement age of 62.7 yr, both values similar to those of other older physicians. Work week decreased with age, and part-time work increased. Women worked a shorter work week (mean, 47.9 vs. 49.7 h, P = 0.024), partly due to greater part-time work (20.2 vs. 13.1%, P value less than 0.001). Relative importance of factors reported among those leaving patient care differed by age cohort, subspecialty, and work status. Poor health was cited by 64% of anesthesiologists retiring in their 50s as compared with 43% of those retiring later (P = 0.039). Conclusions:This survey lends support for greater attention to potentially modifiable factors, such as workplace wellness and professional satisfaction, to prevent premature retirement. The growing trend in part-time work deserves further study.

The Metabolic Effects of Halothane on Mammalian Hepatoma Cells in Vitro II. Inhibition of DNA Synthesis

Halothane inhibits cell replition and depresses the incorporation of 3H-thymidine into trichlorocetic-acid (TCA)-insoluble material in a concentration-dependent manner. Three per cent halothane effects a time-dependent decrease of incorporation of 3H-thymidine into both TCA-soluble and TCA-insoluble material. The inhibition of incorporation into TCA-soluble material is delayed and of smaller magnitude. This indicates that halothane inhibits the synthesis of DNA and does not affect thymidine transport.

The Metabolic Effects of Nonvolatile Anesthetics on Mammalian Hepatoma Cells in Vitro: I. Inhibition of Cell Replication

Mammalian hepatoma liver cells were grown as a suspension tissue culture to allow investigation of the effects of nonvolatile anesthetics on cell replication. Logarithmic growth of a rat hepatoma tissue culture was reversibly inhibited by thiopental, methohexital, amobarbital, phenobarbital, lidocaine, and prilocaine in a dose-dependent fashion. Barbituric acid also reversibly inhibited logarithmic growth, but only at drug concentrations greater than those necessary for inhibition by the anesthetic drugs.

The Effects of Nondepolarizing Relaxants and Anticholinesterases on the Neuromuscular Refractory Period of Anesthetized Man

Neuromuscular refractory period was determined in anesthetized patients by measuring thenar EMG and adductor pollicis tension during single and paired ulnar nerve stimulation. Non-depolarizing muscle relaxants, d-tubocurarine and gallamine, decreased the refractory period. The anticholinesterases, neostigmine and edrophonium, increased the refractory period. The effects of d-tubocurarine and gallamine occurred at doses lower than those which cause any depression of the evoked twitch tension.

Therapeutic benefit of the anesthesiologist-patient relationship.

The psychologic effect of the preoperative visit by an anesthetist has been compared with the effect of pentobarbital for preanesthetic medication. Patients receiving pentobarbital 1 hour before an operation became drowsy but it could not be shown that they became calm. Patients who had received a visit by an anesthetist before operation (informing them about the events which were to occur on the day of operation and about the anesthetic to be administered) were not drowsy but were more likely to be calm on the day of operation. The importance of the preoperative visit probably explains, in part, the difficulties previous investigators have had in showing sedative effects from the barbiturates and narcotics before operation. The tremendous emotional significance to a patient of illness or an operation may explain why physicians are able to exert such influence upon their patients.

The metabolic effects of nonvolatile anesthetics on mammalian hepatoma cells in vitro. II. Inhibition of macromolecular precursor incorporation.

Mammalian hepatoma cells in suspension culture were exposed to thiopental, methohexital, amobarbital, and lidocaine in doses that reversibly inhibit cell multiplication. The effects of these drugs on the incorporation of exogenously administered macromolecular precursors (thymidine, uridine, and leueine) into their respective mac-romolecules (deoxyribonuleic acid, ribonucleic acid, and protein) were determined. All of these anesthetics produced nontelective, dose-related inhibition of precursor incorporation into the acid-insoluble cell fraction. This parallels their inhibitory effect on the rate of cell multiplication. The methodology used does not permit a more precise localization of the block in the incorporation processes.

The Effect of Depolarizing Relaxants on the Neuromuscular Refractory Period of Anesthetized Man

In anesthetized man decamethonium and succinylcholine, in subparatytie doses, increased the neuromuscular refractory period, as determined by observation of both the tension and the compound action potential of the indirectly stimulated adductor pollicis muscle. This is opposite to the effect previously reported for the nondepolarizing relaxants, curare and gallamine, which decrease the refractory period. Determination of changes in the refractory period allows detection of the presence of relaxant drugs in doses which fail to cause blockade.

Anesthesia, Anesthesiologists and Modern Medical Ethics

Historically, anesthesiologists have played pivotal roles in medical ethics by developing and applying technology that posed ethical dilemmas, and by their leadership in answering ethical questions and posing new ones. In 1853, Queen Victoria’s demand for chloroform for her labor undermined the religious demand that women must suffer the pains of childbirth. In the 1950s, Pope Pius XII consulted with anesthesiologists concerning humane and ethical pursuits centered in anesthesia. In 1957, the Pope supported the treatment of pathologic pain, even though such treatment might shorten life (the “double effect”). In 1973, John Bonica proposed that relief of pain is a basic human right.

Ethics in Research and Publication

Medical research and publication serve to promote the scientific integrity and efficacy of the medical profession. The ethical principles of beneficence and nonmaleficence demand that physicians strive to advance medical knowledge so as to improve patient’s lives and avoid harmful or ineffective patient care. The objective of medical research is to seek scientific truths and support these ethical principles. The integrity of clinical investigation involves the just and honest conduct of experimentation, the honest analysis and reporting of data, and then, the fair peer review and publication of these investigations. Research and the publication of research executed dishonestly divert the search for factuality and defile the medical literature. Within the last two decades, several clinical researchers from various specialties whose publications profoundly influenced the practice of anesthesiology were guilty of extensive research fraud and misconduct, and therein, adversely affected the safe practice of anesthesiology.