In clinical anesthesia, the success of our practice is not determined only by drugs, monitors, or machines, but by how well we establish contact, maintain communication, and build connection—not just with patients, but with their biology. Every anesthetic encounter is a dialogue between human physiology and our interventions.

This article reframes routine anesthetic practice as an ongoing conversation with physiology, pharmacology, and pathology, highlighting the hidden language anesthesiologists use every day.

References

1. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL, editors. Miller’s Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.
2. Weinger MB, Slagle JM. Human factors research in anesthesia patient safety: techniques to elucidate factors affecting clinical task performance and decision making. J Am Med Inform Assoc. 2002;9(Suppl 6):S58–63.

• Patient-Level Contact
• Gaining intravenous access is not just “putting in a line.” It is contact with the bloodstream, opening a gateway to influence cardiac output, preload, and vascular tone.
• Airway examination is contact with anatomy. By assessing Mallampati or thyromental distance, you establish the first dialogue with airway structures that may later resist intubation or cooperate with a supraglottic airway.
• Physiology-Level Contact
• Every induction agent is our first touchpoint with the central nervous system. Propofol “contacts” GABA-A receptors, enhancing chloride channel opening, hyperpolarizing neurons, and initiating hypnosis.
• Dexmedetomidine “contacts” α2-adrenergic receptors in the locus coeruleus, decreasing norepinephrine release and producing sedation that resembles natural sleep.
• Succinylcholine “contacts” nicotinic acetylcholine receptors at the neuromuscular junction, depolarizing muscle membranes to produce fasciculations before paralysis.
• Broader Clinical Examples
• In neurosurgery, hyperventilation reduces CO₂, “contacting” cerebral vessels to constrict and lower ICP.
• In obstetric anesthesia, spinal anesthesia “contacts” maternal sympathetic outflow, lowering vascular tone but indirectly affecting uteroplacental perfusion.
• In pediatrics, IV induction with propofol must be rapid yet gentle, as children’s higher metabolic rates mean physiology “responds faster.”

Clinical Pearl: Poor contact (failed IV, missed vein, unanticipated airway difficulty) often results from failing to anticipate how the body presents itself for dialogue.

References

3. Hemmings HC, Egan TD. Pharmacology and Physiology for Anesthesia. 2nd ed. Philadelphia: Elsevier; 2019.

4. Morgan GE, Mikhail MS, Murray MJ, Larson CP. Clinical Anesthesiology. 7th ed. New York: McGraw-Hill; 2022.

5. Brown EN, Lydic R, Schiff ND. General anesthesia, sleep, and coma. N Engl J Med. 2010;363(27):2638–50.

An anesthesiologist does not “control” physiology—we communicate with it.

• Hemodynamics
• Phenylephrine speaks firmly to α1-adrenergic receptors: “Constrict,” raising systemic vascular resistance.
• Nitroglycerin gently requests relaxation through nitric oxide–mediated cGMP pathways.
• The blood pressure cuff “listens” every few minutes, providing feedback on whether the message was...