2026/05/21 by David S. Martin · 1 voice
Decision Sciences · Medicine · #Global Health and Surgery #Health and Medical Research Impacts #Research, Science, and Academia
paper · doi:10.1097/01.asm.0001194196.70274.04
openalex publication_date 2026/05/21 · openalex created_date 2026/05/22 · openalex updated_date 2026/07/23
Think about the last time you had a conversation with a legislator, a hospital administrator, or even a skeptical family member about what anesthesiologists actually do. If you're like most of us, you found yourself reaching for examples – moments when our specialty didn't just provide good clinical care, but fundamentally changed how safe surgery could be. Those examples are everywhere in our history, and they are the most powerful argument we have for the future of our profession. They're illustrated in ASA's “Made for This Moment” campaign (“when seconds count...”). I always feel gratitude when recalling the training, skills, tools, and pharmacology that we bring to the bedside. A legacy written in discovery Anesthesiology's identity was forged in the laboratory as much as in the OR. Long before the current scope-of-practice debates, anesthesiologists were developing the science that made modern surgery possible. Consider the arc: From the early work on barbiturate anesthesia and the physiology of mechanical ventilation, to Peter Safar's pioneering research in cardiopulmonary resuscitation, to the Clarke and Severinghaus electrodes that enabled arterial blood gas analysis and launched the modern intensive care unit. Each breakthrough was driven by physicians trained in both the science and the clinical art of anesthesiology. Research into the neuromuscular junction gave us the paralytics that made abdominal surgery safe and the reversal agents that made recovery predictable. And that work laid the foundation for one of the most elegant pharmacologic stories of our era: the development of sugammadex, a molecule designed from the ground up to encapsulate and neutralize rocuronium. That didn't happen by accident. It happened because physician scientists understood the basic biology well enough to imagine – and then engineer – a solution. Thirty years of transformation The Table captures just 15 of the advances that have reshaped our specialty in the span of my career. Some are technological, like pulse oximetry and videolaryngoscopy. Some are cultural, like the ASA Closed Claims Project, which made us the safety leaders other specialties now emulate. Others are pharmacologic, systemic, or procedural. What they share is a common origin: rigorous scientific inquiry conducted or championed by anesthesiologists. Table - Selected Advances in Anesthesiology Practice (Approximately 1978-Present) Date Range Advance Significance 1978-1985 End-Tidal CO2 Monitoring and Capnography Continuous respiratory gas analysis became a universal monitoring standard, dramatically reducing undetected esophageal intubations and hypoventilation events. 1980-1990 Pulse Oximetry as a Standard of Care Real-time oxygen saturation monitoring transformed vigilance and became a foundational ASA standard, virtually eliminating unrecognized hypoxemia. 1985-present ASA Closed Claims Project and Patient Safety Culture Systematic analysis of adverse outcomes – including positioning injuries – drove evidence-based practice guidelines and established anesthesiology as the patient safety pioneer among medical specialties. 1989-2000s Propofol and Modern Intravenous Anesthetics Introduction of propofol enabled total intravenous anesthesia (TIVA), transformed sedation practice, and set new standards for rapid onset and recovery. 1994-2010s Depth-of-Anesthesia Monitoring (BIS and Processed EEG) Bispectral index and processed EEG reduced awareness with recall and now serve as a “brain stress test” to identify patients vulnerable to postoperative neurocognitive disorders. 1995-2010s Anesthesia Information Management Systems (AIMS) Digital capture of intraoperative data replaced handwritten records, enabling quality improvement, research, and medicolegal documentation at scale. 1996-2020s Context-Sensitive Pharmacology: Remifentanil and Remimazolam Zero-order kinetics and organ-independent metabolism introduced predictable, titratable agents that redefined precision in anesthetic pharmacology. 2001-2010s Videolaryngoscopy Indirect visualization of the airway improved first-pass intubation success, reduced airway trauma, and became an essential tool in the difficult airway algorithm. 2003-2015 Ultrasound-Guided Regional Anesthesia Real-time needle visualization increased block success rates, reduced complications, and expanded the scope of regional techniques into everyday practice. 2006--2010 Intralipid Rescue for Local Anesthetic Systemic Toxicity (LAST) Discovery of lipid emulsion resuscitation provided a life-saving treatment for previously fatal bupivacaine cardiotoxicity. 2008-present WHO Surgical Safety Checklist Championed by Atul Gawande and implemented worldwide, structured team communication before, during, and after surgery measurably reduced complications and mortality. 2008-present Intraoperative Neuromonitoring and EEG-Guided Neuroprotection Electrophysiological monitoring during spine and neurosurgical procedures reduced neurologic injury; EEG applications expanded to identify perioperative neurocognitive risk. 2010-present Enhanced Recovery After Surgery (ERAS) Protocols Multidisciplinary, evidence-based perioperative pathways reduced length of stay, opioid consumption, and complications across surgical specialties. 2010-present Multimodal Analgesia and the Opioid-Sparing Movement Combining nonopioid analgesics, regional techniques, and targeted pharmacotherapy addressed the opioid crisis while maintaining effective pain management. 2015-present Sugammadex and Quantitative Neuromuscular Monitoring Selective relaxant binding agents and objective twitch monitoring eliminated residual paralysis as a hidden threat, completing the neuromuscular blockade safety cycle. This list is necessarily incomplete, and I owe apologies to the many investigators whose contributions aren't represented here. The point is not comprehensiveness – it's pattern recognition. Virtually every item in this table traces back to physician anesthesiologist-led inquiry. That pattern is not a coincidence. It is the sine qua non of a medical profession: the capacity to identify unsolved problems and invest in discovering solutions. Research as the foundation of professional identity This foundation matters profoundly in the current advocacy landscape. When we engage with legislators and regulators about scope of practice, the conversation often drifts toward clinical competency: who can intubate, who can place a block, who can manage a ventilator. Those are important questions, but they miss the deeper point. The distinction between a physician-led medical specialty and a clinical nursing practice is not merely a matter of technical skill – it is the commitment to advancing the field through scientific discovery, academic rigor, and the training of future physician scientists. On that measure, our record speaks volumes. The research contributions of anesthesiology have no parallel in nurse anesthesia practice. This is not a criticism of CRNAs, who are valued clinical partners. It is simply an honest accounting of where the science comes from – and why it matters that the profession generating that science has the support and recognition it deserves. Advocacy and research: A virtuous cycle Here is the insight I want to leave with you: advocacy and research are not separate lanes. They are a virtuous cycle. Strong advocacy secures the funding, the training pipeline, and the regulatory framework that enable research. And a robust research portfolio gives our advocates the most compelling stories they can carry into any room. When you tell a legislator about the Closed Claims Project's impact on patient safety, or the opioid-sparing protocols that are helping address the addiction crisis, or the WHO checklist that reduced surgical mortality worldwide, you are building common ground that transcends politics. Everyone cares about safer surgery. That shared value opens doors to conversations about research funding, graduate medical education, fair payment, and scope-of-practice protections. Sometimes I hear that advocacy has no place in academic departments or training programs. Nothing could be further from the truth. Strong advocacy is precisely what enables these programs to grow and thrive. Teaching residents to be effective advocates is not extracurricular – it is a core component of the professionalism competency we are obligated to instill. Research belongs to all of us An important nuance is that not all research happens in university health systems with NIH funding. A tremendous amount of meaningful clinical research is conducted by private practice groups participating in multicenter trials, quality improvement initiatives, and registry studies. In my role as ASA Vice President for Scientific Affairs, I've seen this firsthand through the Division of Scientific Affairs and through our partnership with the Foundation for Anesthesia Education and Research (FAER) and the Anesthesia Patient Safety Foundation. We are all researchers, in a sense, when we identify a clinical problem and take thoughtful, systematic steps to improve it. This broader conception of research also speaks to what younger members are telling us they want: a professional identity that is about more than reimbursement. They want to see wellness, sustainability, innovation, and scientific impact as central to our advocacy agenda. A membership that champions research and discovery – not just payment rates – has broader appeal. It attracts members from academic practices who might otherwise feel disconnected from organized medicine, and it resonates with trainees who entered medicine to make a difference. A story still unfolding Let me close with a story that illustrates why investment in basic science matters in ways we can't always predict. Reports are emerging of a mitochondrial DNA mutation in children of Venezuelan descent that causes devastating complications with sevoflurane. This is terrifying and urgent, but it is not a mystery without context. For decades, Marge Sedensky and Phil Morgan – physician scientists working within anesthesiology – have studied the genetics of anesthetic hypersensitivity in model organisms: worms, flies (with collaborative contributions from Howard Nash), and ultimately children, all carrying mutations in mitochondrial complex I. Their lifetimes of painstaking basic research, recently recognized with the ASA Award for Excellence in Research, are precisely the reason we understand the biological mechanisms behind this emerging clinical crisis. Without Marge and Phil's careers, which were made possible by the infrastructure of academic anesthesiology and the support of organizations like FAER, we would be confronting this threat with far less understanding and far fewer tools. That is the case for research in a single story. We cannot know which discoveries will prove critical, which is exactly why we must keep investing in the full spectrum of scientific inquiry – from bench to bedside to population health. I still believe in a bright future for anesthesiology, but it will only be achievable if we continue to identify critical unsolved problems, fund the people who pursue them, and carry their stories to the halls of power. Our research legacy is not just our history. It is our superpower. Let's use it.David Martin, MD, PhD, FASA, ASA Vice President for Scientific Affairs, Professor of Anesthesiology and Perioperative Medicine, Mayo Clinic Department of Anesthesiology and Perioperative Medicine, and Medical Director, Mayo Enterprise Procedural Sedation Practice, Rochester, Minnesota.