After 11 years of reviewing more than 10,000 manuscripts (and the associated 25,000 reviews), innumerable letters to the editor, and other miscellaneous materials submitted to Anesthesiology for publication, I am leaving the Editorship of this Journal with very mixed emotions. Whereas, I will welcome my newly gained freedom from the omnipresent responsibility of the editorship, I will also deeply miss serving as editor-in-chief. This has been the highlight of my professional life, and I would not have exchanged the opportunity for any other position in our specialty.
As editor, I have learned an enormous amount regarding almost every facet of our specialty, and even after 11 years, I am still in awe at the breadth of the research interests displayed by our basic and clinical scientists. Borrowing from the political jargon of today, the tent within which anesthesiology resides is very large indeed. As a consequence of this exposure to the specialty, the editor-in-chief enjoys a unique perspective. In this editorial, I wish to provide my thoughts regarding the current status of the Journal, why we publish what we do, and the Journal's role in defining the standards and quality of our clinical practice.
If judged by the number and the quality of submissions, the condition of the Journal is better than ever, even in the face of competition from a growing number of anesthesia journals and other publications. If judged by the frequency with which articles published in Anesthesiology are cited by other authors ("impact factor"), no other journal in our specialty comes close. In addition, more than half of our submissions and more than one third of the laboratory and clinical investigations published originate outside of the United States. Therefore, it is reasonable to conclude that Anesthesiology has become not only the largest and most important anesthesia journal in the United States, but also the premier international journal in the specialty.
I recognize that some of what is published in Anesthesiology does not appeal to every reader. Because anesthesiology as a discipline is extremely heterogeneous (with physicians dealing with everything from geriatrics to clinical pediatrics), this shouldn't be surprising. Nevertheless, there is an audience (however small) for every article we publish. It has long been the editorial philosophy of Anesthesiology that articles reporting the results of well-done studies, basic or clinical, if related to our specialty, deserve publication, no matter how small their constituent audience. We have a remarkably diverse readership that includes not only private and academic clinical anesthesiologists, but also clinical and laboratory-based researchers, clinicians from other specialties, and scientists from what on the surface would seem to be fields only remotely related to anesthesiology. To those who believe that, because Anesthesiology is the journal of the American Society of Anesthesiologists (ASA), we should publish only that which is "clinically relevant," let me state that all of the above groups are important components of the Journal's audience. In addition, it is the editor-in-chief's responsibility to present those articles that provide new ideas and new insights into basic mechanisms underlying why we do what we do, and that tell us what "really works and matters." It is not the Journal's role to simply provide material that is "easy" to understand, or tells people only "how I do it..." Articles that define mechanisms or that clearly define the consequences of our actions (e.g., a well done prospective, randomized outcome study) are far more important than are articles in which researchers report unexplained observations (phenomenology).
Anesthesiology has often been criticized for overlooking clinical studies. Nothing could be further from the truth. We do publish the results of well-done clinical research; we have published more than 400 Clinical Investigation articles in the past 3 years. In addition, these articles are extremely "relevant." Just think how our clinical practice has been changed in the past decade as a consequence of articles establishing the role of major conduction blockade on outcome from major surgery, or articles in which researchers described new ways to manage postoperative pain (including the role of preemptive analgesia and of epidural opioids, alpha-2-adrenergic agonists, and anticholinergic agents). Defining the pharmacokinetics and pharmacodynamics of intravenous agents, along with the characteristics of related infusion pumps, has made total intravenous anesthesia not only possible, but safe and practical as well. The relations between intraoperative temperature change and anesthesia have been thoroughly characterized, and our patients need no longer awaken hypothermic and shivering. Children are no longer brought to surgery in a state that approaches dehydration, and anesthetic techniques and monitoring methods that were once restricted to adults are now used in the tiniest baby. Identifying the factors related to postanesthesia apnea of former premature infants has had an impact far beyond our specialty, and the many articles from the ongoing Closed Claims Study and other large scale outcome studies have helped identify ways to avoid some of the terrible complications to which our patients are susceptible. We have published the ASA Practice Parameters and Guidelines, written by the best experts in our specialty. We have published articles in which authors describe how economics and clinical medicine interact, as well as complex mathematical evaluations of such mundane issues as operating room efficiency. These have both assumed new importance in this era of managed care. In addition, we have attempted to honor our heritage by publishing articles in which events and persons of historical interest are described. We introduced those designated as winners of the ASA research award, published the text of the annual Rovenstine lecture, and have given the American Board of Anesthesiology and the Food and Drug Administration space to announce new initiatives and new drugs, respectively. The above, I think, is a fairly eclectic representation of our "anesthesia world," and we have only begun to respond to our readers' needs. (See next month's editorial for Mike Todd's vision of the Journal's future.)
Whatever success I and the Journal have enjoyed is due, in large part, to an abundance of hard-working, dedicated, and very talented individuals, some of whom I wish to thank publicly. First, Jack Michenfelder, the first editor for whom I worked, defined "integrity" by his actions and served as my role model and editorial mentor.
Second, our editors, associate editors, and consultant reviewers epitomize the best science and practice of anesthesiology. The quality of the peer review process is absolutely dependent on their commitment to the Journal. Few readers of the Journal realize what is required to expertly review a scientific manuscript, to advise the editor regarding its quality, and to instruct the authors about appropriate revisions. It is a demanding task that requires experience, expertise, judgment, patience, and hard work. Those who do this work provide an indispensable service to our specialty, and I believe that our Journal's tradition and reputation for thorough and critical review improves not only what we publish but that which is published in other journals after being reviewed by Anesthesiology.
Third, I thank Janet Bailey, the Journal's editorial assistant for the past 17 years. Janet represents the editorial office to the world, and we owe her our gratitude for her efforts. I was fortunate 11 years ago when she agreed to move from Rochester to San Diego, and, clearly, my "learning curve" into the editorship was speeded because Janet was there to keep me from mistakes she knew had already been made.
Fourth, I am indebted to the members of ASA who support the Journal with their dues, the officers and Board of Directors of ASA, and the incredibly talented staff that runs the organization. The Editor-in-Chief has a seat on the Board and the Scientific Council and I have always been treated with respect while participating in the affairs of the society. At the same time, and of greatest importance, the Editor-in-Chief and the Journal have had absolute editorial freedom, and at no time has there ever been any interference with the editorial process from the ASA hierarchy.
Fifth, no journal can survive without its authors, and I wish to thank those who submit manuscripts to Anesthesiology. It is not easy for individuals, especially if English is not their native language, to expose their work to review and criticism. I am grateful to all senior and junior investigators, basic and clinical scientists, and the clinicians who report their experiences caring for patients, for selecting Anesthesiology as the journal in which they want their work published. Peer review is, although the best system available, an imperfect process, and I thank those authors who, when they thought the editorial decision to be incorrect, appealed with compelling words and data. We didn't always agree with the appellant, but I always attempted to leave the door open to those who disagreed with the editorial decision.
Sixth, Lippincott-Raven Publishers (formerly J.B. Lippincott Company) has been the publisher for Anesthesiology for the past 35 years. The relationship with the publisher has, for me, been one of the more satisfying aspects of the editorship, and after all of these years, can be best described as a true partnership. Their willingness to both adapt to change and suggest new ideas is a mark of a forward-thinking company, and we are fortunate that this relationship will continue.
Finally, I thank our readers who signal their interest in the Journal by their letters and comments, both favorable and otherwise, that enliven our correspondence section and cause us to think about what we do. All the kudos in the world would mean little if our editorial product served as nothing save an archival function. But the changes that have revolutionized our practice have virtually all derived from that which has been published in the Journal, and if our editorial efforts have, in some small way, ensured the quality of what was published, then I and my colleagues are satisfied with our efforts.
Thank you all for allowing me the honor of serving as Editor-in-Chief of Anesthesiology.
Lawrence J. Saidman, M.D., Editor-in-Chief.