Multifaceted Anesthesia

Dr. Ilkka Kalli, MD, PhD, MBA Editor-in-chief, Clinical Window Web Journal See the editor-in-chief working and his Curriculum Vitae

Dear clinician,

The sixteenth Clinical Window Web Journal (CWWJ) has just appeared, and the current issue -Multifaceted anesthesia - starts the year 2004. I have selected a collection of articles to reflect the many sides of anesthesia in modern health care. In practice, anesthetists care and medicate; they optimize physiology and utilize modern technology and patient monitors (monitoring articles). The anesthetist is a coordinator and manager, oftentimes accustomed to work in a multi-professional team (organizational papers). Hence, extending from our clinical "comfort-zone" to outside of the OR and PACU should be good both for the specialty and for the hospital.

Gastric tonometry monitoring
I am particularly delighted to publish a paper Gastric tonometry today by Professor B. Vallet (Hôpital Claude Huriez CHU, Lille, France). Tonometry is a proven method of monitoring patients with potential risk of gastrointestinal (GI) ischemia. Inadequate GI blood flow increases the risk of tissue hypoxia, which may further facilitate multiple organ failure (MOF) and sepsis. Such a cascade should be detected and corrected without delay.
Typically, low cardiac output patients, trauma or intensive care patients, or patients undergoing high-risk surgery may be considered. From a previous issue, please remember Dr. J. Bailey's comprehensive article on hemodynamic instability. I quote from his text: "Mesenteric circulation is even more sensitive to excessive vasoconstriction and the global cardiac output needed to insure mesenteric and renal perfusion is unclear". That important point sparked the idea to follow with a paper on monitoring of GI perfusion.

Entropy monitoring
The paper by Dr. D. Campbell (University of Auckland, New Zealand) has the title Initial impressions of the clinical applicability of entropy monitoring. He gives an interesting and practical insight into Entropy measurement with a fresh, New Zealand perspective. It continues the discussion from our Tailor-made Anesthesia -issue last autumn.
In the CWWJ, special educational articles on the anesthesia concept and hypnosis monitoring have also seen light. These topics may influence our thinking and future clinical practice. Hence, I also recommend you to revisit the scientific review articles from our Adequacy of Anesthesia issue. Remember that in our 'Previous issues' page, you find all our previous topics, including Brain monitoring.

Information management, a practical case
Dr. U. Korell (Westpfalz Klinikum, Germany) has written about the Evolution of information management in anesthesia and critical care. His paper is an interesting and practical case example reflecting organizational aspects and change management thinking in implementing new technology in healthcare. In the future, information and communication technology (ICT) may alter our traditional way of work. Even in today's heath care, information overflow is a reality, and resource constraints need to be balanced with quality patient care. Hence, there are great expectations on ICT solutions to facilitate optimal care decisions at the bedside.

Obstetric analgesia for labor patients
I very much appreciate this column Drs. V. Lanza and G. Di Fiore (Buccheri La Ferla Hospital, Palermo, Italy) wrote for us: The anesthesia department's role outside the O.R. is important in organizing obstetric analgesia services for labor patients. As I stated earlier, we as clinicians should be ready to move outside the OR, and that is what our colleagues in Palermo, Italy have done already many years ago. In the future issues of CWWJ we will publish similar columns, all which reflect the practical issues many clinicians face when providing care or managing services in their hospital. Our international readers may then share their experiences and learn from the others, as well.

A few final points
Our three plus year tradition to publish clinical and educational articles will continue. You may have heard that GE Healthcare has bought Instrumentarium and Datex-Ohmeda. Thus, CWWJ has a new sponsor, and that will just facilitate our effort.

In the coming issue, we will have a critical care orientation, and we will also reflect the Clinical Window presence in Brussels. In addition, CWWJ will closely follow the World Congress of Anesthesiology in Paris. I will attend that congress also myself - it would be most welcome to meet our readers in person.

I would be delighted to receive input from our many readers, including letters, comments, and suggestions. I greatly appreciate hearing your opinions. Thank you in advance!

Ilkka S. Kalli, MD, PhD, MBA
Anesthesiologist, Editor-in-Chief
Clinical Window Web Journal

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Last updated: 25 March 2004 Created
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