Ether Dome. Photo by Steve Donisch.

Ether Dome. Photo by Steve Donisch.

The Ether Dome and the Macintosh blade are two of many quintessential innovations that make up the rich history of anesthesiology and which allowed us to routinely and safely perform once-improbable surgeries (Lancet 1943;241:205; Ether Day. 2001). Subsequently, anesthesiology led developments such as John Severinghaus’ blood gas analysis and Ted Eger’s characterization of minimum alveolar concentration (MAC), paving the way for present-day standards for safe intraoperative monitoring (Am J Respir Crit Care Med 1998;157:S114-22; Anesthesiology 1965;26:756-63). While it may feel as though the technology industry is a distinct entity separated from our daily lives as anesthesiologists, the reality is that our industries are closely intertwined and dependent on one another. Anesthesiologists utilize new and old technologies constantly, from standard monitors to more advanced devices for perioperative monitoring and drug delivery, to facilitate safer anesthesia. At one point in time, each of these tools was unknown to the anesthesiologist but have now become ubiquitous and necessary for performing our jobs.

As perioperative physicians, anesthesiologists have a unique responsibility to address not only dysregulation of hemodynamic or cardiopulmonary processes, but also the broader perioperative health of the patient and surgery-specific considerations. This constant exposure to the many different facets of patient care, optimization, and rescue means that anesthesiologists are uniquely poised to see failure modes and unmet medical needs that may be present in the current standard of care throughout the perioperative journey, such as the need for individualized anesthesia, clinical pathways for care optimization, and health care disparities in the perioperative setting

Appreciation for the key deficiencies in the medical system is often the first step in creating innovative solutions to improve medicine. Anesthesiologists today are innovating in many ways, from inpatient settings, to outpatient monitoring, to quality improvement protocols. In the inpatient setting, anesthesiologists are improving clinical mobility evaluations in postoperative ICU patients through noninvasive, wireless, and objective sensor and software technologies, leveraging advancements in technologies developed for other uses to derive clinical meaning (Crit Care Med 2017;45:630-6). Using machine learning, a team of anesthesiologists and biomedical engineers pioneered software for the prediction of hemodynamic instability (Anesthesiology 2018;129:663-74). Anesthesiologists were also at the forefront of employing existing anesthesia machinery during the COVID-19 pandemic to provide necessary ventilatory support through innovative modifications of the existing technology (J Intensive Care Med 2020;35:927-32; Intensive Care Med 2020;46:1642-44). Furthermore, quality improvement initiatives such as the Perioperative Surgical Home (“PSH”) model and Enhanced Recovery After Surgery (“ERAS”) pathways are innovations in processes that cannot only improve patient outcomes but limit health care spending and optimize workflow – important advancements for the field as we tackle the economic implications of medical practice (Anesth Analg 2014;118:1126-30). Finally, consider the modern role for outpatient monitoring technologies through wearable devices such as the Apple Watch, FitBit, AliveCor or Zio Patch monitors, and even the Eko Health smart stethoscope. The capability of tracking vital signs and measurements of functional capacity in the remote setting has vast potential in expanding the scope of anesthesiology practice (Anesth Analg 2006;102:1463-7; BMJ Innovations 2020;6:55-71).

These examples only begin to demonstrate a key point: the anesthesiologist has the expertise, clinical knowledge, and direct exposure throughout the perioperative journey to identify critical unmet medical needs and the pathways to innovative solutions for improving them.

When it comes to critical skills needed to drive innovation, many aspects of the training provided by an anesthesiology residency afford any anesthesiologist with a “leg up” when it comes to innovation in medicine. Anesthesiologists are quick critical thinkers and problem solvers. Recognition of a problem (e.g., abnormal readings on a monitor), screening and triaging the issue (determining the significance and severity), problem-solving by forming and evaluating differentials, and practical troubleshooting while keeping the patient safe are things anesthesiologists do on a daily basis. These are the same skills that are needed in the conception, development, and maintenance of an innovative concept.

On the other hand, business strategies and marketing plans are not often taught in medical schools or residencies, although the educational value of these topics has been brought up in discussions (Anesth Analg 2017;124:998-1004). Understanding various go-to-market strategies, how hospitals purchase new equipment, which clinical trials are needed to allow for FDA-approved marketing campaigns, etc., is critical for the daily operations of the medical technology industry and is useful knowledge for anyone interested in breaking into the sector as a consultant, innovator, or founder themselves. An anesthesiologist can work to develop these skills through interactions with industry partners and within their own hospital administrative systems, to absorb business knowledge and take those skills on to new ventures.

Additionally, there is a wealth of resources provided online to allow for self-guided exploration and study on how to successfully innovate in a variety of biomedical fields. Biodesign is a process that, in short, guides us to parse out the unmet medical need and determine what the must-have elements are in the solution ( A solution or product is developed after thorough exploration of the multifaceted nature of a clinical problem, thus allowing the innovator to thoroughly tease out what key elements must be addressed, why they are necessary for the target population, and how the ultimate product will evoke positive change in medical practice. Throughout the process, one will also identify key stakeholders who must buy into your concept. This is where expanding one’s skills through experiences within industry can allow an anesthesiologist to gain the added knowledge of the health care ecosystem that drives business decisions and progress in medicine.

In summary, anesthesiologists have the fundamental training and expertise to drive progress in medicine, as well as the skill sets that are easily transferrable to work in industry. Anesthesiologists have a long history of being innovators in a full range of devices, pharmacology, software, and quality improvement. Collaboration with industry partners could allow one to refine technical and nontechnical skills in a different setting, while developing new skills needed to bring a novel clinical solution to fruition. Meanwhile, physician involvement in technological development and advancement could guide a product toward a solution that will ultimately lead to better patient care.