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LETTER TO THE EDITOR

Ambulatory Anesthesia: Whither Thou Goest

Editor-in-Chief, Anesthesia & Analgesia, sshafer{at}anesthesia-analgesia.org

In Response:

I commend Dr. Maurer for his careful examination of the December cover of Anesthesia & Analgesia (1) that accompanies the operating room management papers (2–4). Our covers are intended to reward close inspection for artistic nuance, editorial comment, and an occasional puzzle or joke. We kick around many ideas before settling on a graphic that is appropriate, nuanced, and affordable.

Careful thought was given to labeling of the anatomy for this graphic. For example, we attempted to write "otorhinolaryngologic" on the trunk, but the type was illegibly small, so we relegated the entire head to neurosurgery. Similarly, cardiac surgery is vaguely over the heart, although the labeling of the elephant on the right suggests heart surgery is performed through the acoustic meatus. Orthopedic surgery was related to the back, and general surgery was related to the stomach, both for the reasons specified by Dr. Maurer. The elephant did not afford a place for the labels "urologic," and "obstetrics," perhaps thankfully.

Which brings me to ambulatory anesthesia. "Ambulatory" comes from the latin ambulare, meaning "to walk." Thus, the logical region for the "ambulatory" label is the legs. The front legs are not fully visible so we chose to label the back legs as ambulatory. This resulted in placing the label on the elephant hindquarters. The potential adverse connotations observed by Dr. Maurer did not occur to us when the graphic was composed, and we apologize for any offense.

However, there are merits to being associated with the hindquarters of an elephant. These legs are famously powerful. Indeed, they are the main engines of locomotion, just as ambulatory surgery and anesthesia are the main economic engines of many practices. They are also the source of most of the edible meat of the animal. They may even be the most attractive part of the animal, at least to other elephants.

Anesthesia & Analgesia holds SAMBA, an affiliate Society of Anesthesia & Analgesia, in the highest regard. We respect their clinical and scientific contributions to the practice of anesthesia, and value their ongoing contributions to the Journal. We highly value the association with SAMBA, and would never make SAMBA the butt of any joke, either privately or on the cover of the Journal.

REFERENCES

1. Maurer WG. Ambulatory anesthesia: whither thou goest. Anesth Analg 2007; 104:1299.[Free Full Text]
2. Shafer SL. Case scheduling for dummies. Anesth Analg 2006;103:1351–2.[Free Full Text]
3. McIntosh C, Dexter F, Epstein RH. The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital. Anesth Analg 2006;103: 1499–516.[Abstract/Free Full Text]
4. Dexter F, Epstein RH. Holiday and weekend operating room on-call staffing requirements. Anesth Analg 2006;103:1494–8.[Abstract/Free Full Text]

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