Journal of
Ca
8
ic and
la
FEBRUARY
VOL 5, NO 1
1991
EDITORIAL Vascular Anesthesia:
Recognized
T
HIS ISSUE MARKS the beginning of the 5th year of the JOURNAL. Its success has exceeded the expectations of its most enthusiastic supporters. Certainly, the subspecialty of cardiothoracic anesthesia has “spoken out” and been heard.’ In the first issue in February 1987, Dr Mangano, as Associate Editor for Vascular Anesthesia, emphasized the importante of the patient with cardiac disease undergoing vascular and other noncardiac (V/NC) surgery.’ He contrasted this V/NC group of patients to those undergoing cardiac surgery: (1) the V/NC group is much larger; (2) routine preoperative assessment and therapy of V/NC patients is usually not as comprehensive; (3) decisions regarding monitoring are not as clear-cut; and (4) postoperative disposition of V/NC patients is more difficult. Patients with cardiac disease undergoing V/NC surgical procedures have benefited from many of the innovations developed during cardiac surgery (eg, V, electrocardiographic lead, transesophageal echocardiography), but stil1 are often treated as second-class citizens in major medical centers. Cardiac anesthesia and thoracic anesthesia are wel1 recognized, and these cases are usually managed by dedicated subspecialists who spend a large percentage of their time in these areas. Vascular anesthesia has been slower to develop its own identity, but clearly it has now arrived. There are now dedicated subspecialists, clinical rotations in the field, fellowship programs, exciting new procedures (eg, liver transplantation), increasing research, and numerous textbooks. This identification as a clear-cut subspecialty of anesthesiology is now being recognized by changing the name of the JOURNAL to the Joumal of Cardiothoracic and Vascular Anesthesia. The change in the name of the JOURNAL is supported by a review of the contents of the first four volumes covering 1987 to 1990. There have been 36 articles dealing with vascular anesthesia subjects and another 59 on combined cardiac and vascular subjects (Table 1). The total vascular anesthesia-related articles equal 26% of those published in the JOURNAL versus 17% for al1 thoracic anesthesia-related articles. There also was an increase in the number of vascular articles published in the last 2 years. The vascular anesthesia articles have appeared in al1 sections of the JOURNAL (Table 2), and there has been a
Journalof Cardiofhoracic and VascularAnesthesia,
Vol 5, No 1 (February),
at Last
Table 1. Number of Articler Published Each Year by Subspecialty Anesthesiology Subspecialty
Publication Date 1987
1988
1989
1990
Total 237 (61%)
52
68
66
51
Thoracic
5
12
9
20
46 (12%)
Vascular
7
7
12
10
36 (9%)
Combined CT
-
2
1
3
6 (3%)
Combined CV
10
13
22
14
59 (15%)
Combined TV
-
2
3
1
Cardiac
6 (2%)
Abbreviations: CT. cardiothoracic; CV, cardiovascular; TV, thoracovascular.
relatively large percentage of laboratory studies with an emphasis on pharmacology and physiology. This trend continues with the first three articles in the present issue of the JOURNALdealing with cardiovascular physiology during aortic cross-clamping and hemodilution. A number of review articles have emphasized new aspects of vasoactive pharmacology and cardiovascular physiology, and in this issue, Johns reviews the latest material on the endothelialderived relaxing factor. Throughout the first 4 years of the JOURNAL, there has been a continued interest in new monitoring techniques and applications. 1 believe this wil1 continue to be one of the major areas of interest in the field of VINC surgery, because it has and wil1 continue to decrease morbidity and mortality. In the December 1990 issue of the JOURNAL,1 discussed the worldwide contributions to cardiothoracic anesthesia.’ This is also evident in vascular anesthesia-18% of the articles have come from outside the United States, with 12% being from Europe. It is hoped that these contributions to the JOURNAL wil1 continue and increase
Table 2. Types of Vascular Anesthesia Articles Published Publication Date JOURNALSections
1991:
1987
1988
1989
1990
Clinical studies
3
6
12
7
2%
Laboratory studies
6
10
10
5
31
Total
Case reports
2
3
6
5
16
Review articles
4
2
5
2
13
Case conferences
1
2
3
2
Pro and con
1
pp 1-2
3
8 4
1
JOEL A. KAPLAN
2
as more international meetings and research take place. In this regard, it is of note that the World Association of Cardiac, Thoracic, and Vascular Anesthesia has been established (see announcement in this issue). It is inevitable that this organization wil1 contribute to furthcr expanding and coordinating clinical, educational, and rcsearch efforts in the subspecialities of cardiac, thoracic, and vascular anesthesia. The success of the World Association should lead to even more international contribu-
tions to the JOURNAL and increased anesthesia.
recognition
of vascular
JoelA. Kuplan, MD
Editor in Chief Horace W. Goldsmith Professor Chairman, Department of Anesthesiology Mount Sinai School of Medicine Ncw York. NY
REFERENCES 1. Kaplan JA: Cardiothoracic anesthesia: The subspecialty speaks out. J Cardiothorac Anesth l:l-2, 1987 2. Mangano DT: The cardiac patient and noncardiac surgery: The real challenge. J Cardiothorac Anesth 1:5-6, 1987
3. Kaplan JA: Cardiothoracic anesthesia: A shrinking world. J Cardiothorac Anesth 4:669-671, 1990
Ca
8
ic and
la
FEBRUARY
VOL 5, NO 1
1991
EDITORIAL Vascular Anesthesia:
Recognized
T
HIS ISSUE MARKS the beginning of the 5th year of the JOURNAL. Its success has exceeded the expectations of its most enthusiastic supporters. Certainly, the subspecialty of cardiothoracic anesthesia has “spoken out” and been heard.’ In the first issue in February 1987, Dr Mangano, as Associate Editor for Vascular Anesthesia, emphasized the importante of the patient with cardiac disease undergoing vascular and other noncardiac (V/NC) surgery.’ He contrasted this V/NC group of patients to those undergoing cardiac surgery: (1) the V/NC group is much larger; (2) routine preoperative assessment and therapy of V/NC patients is usually not as comprehensive; (3) decisions regarding monitoring are not as clear-cut; and (4) postoperative disposition of V/NC patients is more difficult. Patients with cardiac disease undergoing V/NC surgical procedures have benefited from many of the innovations developed during cardiac surgery (eg, V, electrocardiographic lead, transesophageal echocardiography), but stil1 are often treated as second-class citizens in major medical centers. Cardiac anesthesia and thoracic anesthesia are wel1 recognized, and these cases are usually managed by dedicated subspecialists who spend a large percentage of their time in these areas. Vascular anesthesia has been slower to develop its own identity, but clearly it has now arrived. There are now dedicated subspecialists, clinical rotations in the field, fellowship programs, exciting new procedures (eg, liver transplantation), increasing research, and numerous textbooks. This identification as a clear-cut subspecialty of anesthesiology is now being recognized by changing the name of the JOURNAL to the Joumal of Cardiothoracic and Vascular Anesthesia. The change in the name of the JOURNAL is supported by a review of the contents of the first four volumes covering 1987 to 1990. There have been 36 articles dealing with vascular anesthesia subjects and another 59 on combined cardiac and vascular subjects (Table 1). The total vascular anesthesia-related articles equal 26% of those published in the JOURNAL versus 17% for al1 thoracic anesthesia-related articles. There also was an increase in the number of vascular articles published in the last 2 years. The vascular anesthesia articles have appeared in al1 sections of the JOURNAL (Table 2), and there has been a
Journalof Cardiofhoracic and VascularAnesthesia,
Vol 5, No 1 (February),
at Last
Table 1. Number of Articler Published Each Year by Subspecialty Anesthesiology Subspecialty
Publication Date 1987
1988
1989
1990
Total 237 (61%)
52
68
66
51
Thoracic
5
12
9
20
46 (12%)
Vascular
7
7
12
10
36 (9%)
Combined CT
-
2
1
3
6 (3%)
Combined CV
10
13
22
14
59 (15%)
Combined TV
-
2
3
1
Cardiac
6 (2%)
Abbreviations: CT. cardiothoracic; CV, cardiovascular; TV, thoracovascular.
relatively large percentage of laboratory studies with an emphasis on pharmacology and physiology. This trend continues with the first three articles in the present issue of the JOURNALdealing with cardiovascular physiology during aortic cross-clamping and hemodilution. A number of review articles have emphasized new aspects of vasoactive pharmacology and cardiovascular physiology, and in this issue, Johns reviews the latest material on the endothelialderived relaxing factor. Throughout the first 4 years of the JOURNAL, there has been a continued interest in new monitoring techniques and applications. 1 believe this wil1 continue to be one of the major areas of interest in the field of VINC surgery, because it has and wil1 continue to decrease morbidity and mortality. In the December 1990 issue of the JOURNAL,1 discussed the worldwide contributions to cardiothoracic anesthesia.’ This is also evident in vascular anesthesia-18% of the articles have come from outside the United States, with 12% being from Europe. It is hoped that these contributions to the JOURNAL wil1 continue and increase
Table 2. Types of Vascular Anesthesia Articles Published Publication Date JOURNALSections
1991:
1987
1988
1989
1990
Clinical studies
3
6
12
7
2%
Laboratory studies
6
10
10
5
31
Total
Case reports
2
3
6
5
16
Review articles
4
2
5
2
13
Case conferences
1
2
3
2
Pro and con
1
pp 1-2
3
8 4
1
JOEL A. KAPLAN
2
as more international meetings and research take place. In this regard, it is of note that the World Association of Cardiac, Thoracic, and Vascular Anesthesia has been established (see announcement in this issue). It is inevitable that this organization wil1 contribute to furthcr expanding and coordinating clinical, educational, and rcsearch efforts in the subspecialities of cardiac, thoracic, and vascular anesthesia. The success of the World Association should lead to even more international contribu-
tions to the JOURNAL and increased anesthesia.
recognition
of vascular
JoelA. Kuplan, MD
Editor in Chief Horace W. Goldsmith Professor Chairman, Department of Anesthesiology Mount Sinai School of Medicine Ncw York. NY
REFERENCES 1. Kaplan JA: Cardiothoracic anesthesia: The subspecialty speaks out. J Cardiothorac Anesth l:l-2, 1987 2. Mangano DT: The cardiac patient and noncardiac surgery: The real challenge. J Cardiothorac Anesth 1:5-6, 1987
3. Kaplan JA: Cardiothoracic anesthesia: A shrinking world. J Cardiothorac Anesth 4:669-671, 1990
