The brain as a central key organ

Sometimes progress is hard to see, when looking at the big picture, because there is very little of it. But sometimes progress is hard to see because the big picture is out of focus. When perioperative deaths ascribed to anae sthesia are in the order of 1 in 20 000 operations and even changes in majo r morbidity require massive sample sizes to detect, neuroanaesthesia's most emphatic yardstick of progress is too crude to measure advances that have occurred over the most recent decade. We clearly need to become more famili ar with neuropsychological tests that can detect subtle changes. Today, for elective neurosurgery, we are primarily in the business of doing two thing s - pushing the envelope for surgical intervention to include cases that wo uld have been considered too risky 15 years ago, and reducing the frequency of ''Uncle-Joe-has-never-been-the-same-since-they-operated-on-his-brain sy ndrome''. Both of these areas of progress are empirically measurable, but w e have not made much progress towards measuring them. Of course, this measu rement problem plagues anaesthesiology generally, and we need to attend to it in general. Meanwhile, saying where we are relative to the recent past a nd the near future involves a lot of guesswork. What follows is my guesswor k about progress in neurosurgical anaesthesiology.