The place of the anesthetist in the medical hospital team.

The historical development of surgery and anesthesiology, has made the anesthetist an expert in the following fields: 1. Providing analgesia. 2. Homeostasis of the internal environment or respiratory, circulatory and metabolic resuscitation. 3. Continuous titrated therapy. 4. Applied pharmacology. The question put forward to the anesthetist has been, whether he should limit the application of his skills to the operating theatre, or whether he should take his skills to the whole hospital, by working in the intensive therapy unit and participating actively in the preparation of the patient for surgery, in the care of life threatening emergencies in the hospital and outside of the hospital, in treating pain problems in hospitalized and ambulatory patients. From our experience, we think that the anesthetist cannot and may not limit his activities to the operating theatre. In order however to maintain availability and competence, intensive therapy, emergency care and pain therapy, should be organized on an interdisciplinary basis. A special team, as old as anesthesia itself, is the team surgeon-anesthetist. The rules of conduct within this team are discussed. It is concluded that safety during anesthesia has increased, through the activities of the anesthetist outside of the operating theatre. One anesthetist should however remain available at any moment during anesthesia, for every one patient.