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Anesthesia & Analgesia in the New Century

Miller, Ronald D. MD

doi: 10.1097/00000539-200001000-00002

Department of Anesthesia, University of California–San Francisco, California

Address correspondence and reprint requests to Dr. Ronald D. Miller, Anesthesia & Analgesia, Editorial Office, The Hearst Building, #5 Third Street, Suite 1216, San Francisco, CA 94103.

RDM is Editor-in-Chief, Anesthesia & Analgesia

This issue of Anesthesia & Analgesia is the first for us of the new millennium. The Board of Trustees of the International Anesthesia Research Society has been dedicated to promoting excellence in the specialty of anesthesiology. Its members have allocated large sums of money for research in our specialty, both nationally and internationally. They also have been consistent and persistent in promoting excellence in their journal, Anesthesia & Analgesia. In 1976, they named Dr. Nicholas M. Greene, the former Editor-in-Chief of Anesthesiology to become Editor-in-Chief of Anesthesia & Analgesia. Under his 14 years of leadership, Anesthesia & Analgesia ’s intellectual contribution and importance to our specialty have gradually and consistently increased. When Dr. Greene retired in 1990, careful thought went into deciding what our journal should be in preparation for the new millennium.

In considering how Anesthesia & Analgesia should respond to the upcoming millennium, two trends became obvious. The first was the increasing specialization of anesthesiology, and the second was the growing importance of the international community in development of new concepts in clinical care and research. Also, there appeared to be a proliferation of new journals, making it difficult for the individual anesthesiologist to assimilate, in a coordinated way, the information needed to keep up to date. Also, it was increasingly uncomfortable and inappropriate for a “generalist” Editor-in-Chief, such as myself, to make the ultimate decisions regarding publishability of research performed in various subspecialties of anesthesiology. As a result, the idea of a “journal within a journal” was conceived.

Basically, according to this concept, discreet specialty sections were developed, each with its own section editor. The section editor of a particular subspecialty would then be in a very powerful position to determine the ultimate intellectual trend of the literature within his or her specialty. These section editors were initially chosen by the existing Editorial Board with input from the Board of Trustees of the International Anesthesia Research Society. Soon thereafter, the concept of having subspecialty organizations adopt Anesthesia & Analgesia as their journal was derived, and the section editors were then chosen as a result of cooperation among the particular subspecialty organization, the Board of Trustees of the International Anesthesia Research Society, and the Editorial Board of Anesthesia & Analgesia.

Thus far, the Society of Cardiovascular Anesthesiologists, the Society for Pediatric Anesthesia, and the Society for Ambulatory Anesthesia have adopted Anesthesia & Analgesia as their main publication conduit. As a result, they have been able to exert considerable influence and control over and facilitate the intellectual output of members of their societies. We are very pleased that this concept has been enhanced by the recent addition of the Society for Intravenous Anesthesia (SIVA) to those who now use Anesthesia & Analgesia as their “journal within a journal.”

We simultaneously tried to markedly enhance the international status of the journal. We felt this was important for many reasons, including improving world-wide communication and the increasing importance of clinical observations, clinical studies, and basic research being conducted in many countries around the world. Our initial approach was to gradually add non-North Americans to our Editorial Board. We now have members of the Board from Australia, Canada, France, Sweden, Japan, England, Germany, and Switzerland. This trend will continue. Also, there is now a Spanish edition of Anesthesia & Analgesia. On a quarterly basis, some of the original articles in the English-written Anesthesia & Analgesia have been translated into Spanish and distributed in Spain and Central and South America. In essence, the trend to do everything possible to make our journal truly international from a variety of directions will continue.

Also reassuring and exciting was the increasing trend toward cooperation among journals from different countries. At the World Congress meeting in The Netherlands, my conversations with Professor Graham Smith, who was then Editor-in-Chief of the British Journal of Anaesthesia, led to the idea of cooperatively developing a CD ROM. With the interest of Professor Lawrence Saidman, then Editor-in-Chief of Anesthesiology, and Professor David Bevan, Editor-in-Chief of the Canadian Journal of Anesthesia, “the electronic anesthesia library” (TEAL) was created. TEAL features five years of complete text and illustrations of four of the world’s leading journals on one CD ROM. TEAL was a major accomplishment because it represented the successful cooperation of many different entities, including four societies, four publishers, and four editorial boards in three countries. Obviously, the potential for legal roadblocks and other restrictions were immense, but because of the commitment of all four journals, this project developed smoothly, and TEAL has been immensely successful. Moreover, the goodwill generated by this effort has been enormous, and the project has clearly paved the way to increased cooperation among various journals to the benefit of all readers of the anesthesia literature.

The advent of TEAL made it increasingly obvious that the format of medical publishing was undergoing revolutionary changes. Increasing pressure was placed on journals to publish their articles and data electronically, online. In fact, over the past year, the National Institutes of Health launched its electronic archive and publication site, now called “Pub Med Central.” It will accept reports, both reviewed and some unreviewed material, comments, and data files from journals in scientific groups and redistribute them on the Internet at no charge. Clearly, online Internet publishing has many advantages. These include decreasing costs by reducing publishing infrastructure, reduced use of limited resources (trees), rapid and new universal access, new multimedia opportunities (e.g., sound and video), reduced submission-to-publication time, immediate search/retrieval of previous publications, and hypertext linking to references. However, there are certain problems with this approach: A society and its journals could lose their fiscal ability to support the complex editorial and review process; university promotion committees may have difficulty judging research productivity when articles are increasingly minimally reviewed and/or evaluated; and the total volume of publications may grow to burdensome proportions.

Despite these concerns, Anesthesia & Analgesia has decided to publish all articles, full text and illustration, online, of course after completion of the well established peer review process. This is just the beginning. Online publication offers many opportunities for providing our readers with enhanced readability and understanding of our clinical and basic research. Furthermore, the future seems to be limitless as publishers merge and share their databases. When weighing all of these possibilities, the Board of Trustees of the International Anesthesia Research Society and the Editorial Board of Anesthesia & Analgesia are dedicated to the primary goal of offering our readers the best and most current scholarship available in our specialty.

Despite the excitement associated with new publishing vehicles, the quality of the content is what matters most. In the last 40 years, there has been a dramatic improvement in the safety of intraoperative anesthesia, for which we should be quite proud. This is a result of improving technology in monitoring, demanding training and standards and the development of drugs with more specific actions and fewer side effects. Research will continue to improve intraoperative anesthesia, but the opportunities for additional improvement seem to be limited. If this prediction is accurate, the future of our specialty will be heavily dependent on the development of perioperative anesthesia to include the quadrangle of perioperative evaluation, intraoperative anesthesia, critical care medicine, and pain management. Clearly, critical care medicine presents a multitude of opportunities for research because it cares for the sickest patients of virtually every specialty in medicine. The transfer of molecular biology and neurosciences to the bedside also offers outstanding opportunities for research that a few of our colleagues are pursuing. In the area of pain management, whether it be that of acute postoperative pain or chronic pain states, new targets, and new mechanisms are being discovered: novel opioids, interactions with the immune system, the imaging of pain, N-methyl-D-aspartate receptor pharmacology, ion channels, and immune-derived opioids are just a few of the opportunities that exist.

The survival of our specialty is dependent on a commitment to academic anesthesiology and an awareness of the decreasing numbers of “clinical scientists.” Krause (1) has suggested that part of society should be viewed as a triangle, with the state, capitalism, and its professions, such as medicine, at its corners. The professions act to influence and control the power of both capitalism and the state. But from the patient’s point of view, who controls medicine? If we lose power over the delivery of health care, then it is lost to the state and capitalism, over which patients still have little power. It is therefore of prime importance that we retain control over our intellectual content (i.e., our research and its publication processes). Our future as a specialty is dependent upon this control, and Anesthesia & Analgesia is dedicated to preserving it.

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1. Krause EA. Death of the guilds: professions, states, and the advance of capitalism, 1930 to present. New Haven: Yale University, 1996.
© 2000 International Anesthesia Research Society