Anesthesia, which once started merely as a technique and procedure to kill pain during operation, has developed into an independent medical speciality including pain management, intensive and critical care as well as cardiopulmonary resuscitation. This fact is to be welcome, but on the other hand it seems worthwhile to reconsider how anesthesiologists should be and what their proper activities are, because their working fields have extended too widely. The author emphasizes that the orthodox tasks of anesthesiologists are analgesia and management of patients in relation to operation and that outstanding knowledges and techniques in anesthesia are the essential background for their participation in pain clinic, intensive care unit and other related fields. In the practice of anesthesia "safety first" should be kept in mind as a supreme requirement. In pain clinic they should be aware of the indications and limitations of their techniques and make more efforts to alleviate postoperative pain. In intensive care unit it is desirable for them to have more concern about terminal care. Recently brain death has drawn an increasing attention, particularly in connection with human death and organ transplantation. Anesthesiologists should take a prudent attitude when they are confronted with a case of suspected brain death in resuscitation.
1. Risks of Patients and Environment The risks to patients from equipment and the environment may be classified as follows: a) High risk: Equipment in close contact with a break in the skin or mucous membrane, or introduced into a sterile body area. Sterilization is usually required of items ire this category. b) Intermediate risk: Equipment in close contact with intact skin or mucous membranes. Items in this category usually require disinfection, although cleaning may sometimes be adequate. c) Low risk: This category includes e.g. floors, walls, ceilings, sinks and drains. Cleaning is usually adequate, although some environmental areas may be classified as high risk and disinfection may be preferred, e.g. operating rooms and ICU. 2. Hygienic Hand Disinfection The hands are often contaminated with various microbes as a result of patient care or therapeutic work, or from hospital environment. The contaminated hands are also a cause of nosocomial infections. The selection of the hand-washing method and disinfectants to be used, therefore, is important. 3. Disinfection of Medical Equipment Ventilators, humidifiers and associated tubing and equipment are frequently contaminated with Ps. aeruginosa or other Gram negative bacilli. Ventilators can usually be disinfected with nebulized disinfectants solution or fromaldehyde gas. The smaller ventilators can often be decontaminated by ethylene oxide or possibly with low temperature steam. Humidifiers should be autoclavable but, if this is not possible, they can be treated with hot water or low temperature steam or a chemical disinfectant.