The American Board of Anesthesiology was 50 years old in 1988. More than 16000 certificates have been awarded to physicians who now represent the fourth generation of anesthesiologists in the United States. In 1988, it was estimated that there were 5000 anesthesiologists in training.
New pharmacologic agents include esmolol hydrochloride, an ultrashort-acting parenteral β-blocker; propofol, an intravenous induction agent with rapid recovery and little or no hangover; and flumazenil, a benzodiazepine antagonist.
Esmolol, with a half-life of 9 minutes, has been used effectively to control undesirable hypertensive and tachycardiac responses in the perioperative period, particularly in patients with cardiac and intracranial disease processes.1,2 Potential exacerbation of myocardial ischemia, of cerebral edema, or of intracranial hypertension related to the hyperdynamic state associated with laryngoscopy or emergence from anesthesia can be effectively and safely managed within 2 to 3 minutes by injection of a loading dose followed by an infusion of