It is my opinion that an anesthesiologist should be the “intensivist” of the OR. We should know a lot of medicine and especially how anesthetic may exacerbate conditions, how we can acutely manage exacerbation. Because at the end of the day, surgery is an iatrogenic trauma and stress to a patient like no other. Everyday I ask myself how can I best optimize this patient for surgery, do they have medications I need to be worried about, medical conditions that would be suitable for stressful surgery, are their heart/lungs okay and what kind of comorbities that may interact. And then through the surgery I’m thinking how can I can I safely induce and intubate this patient given the medical issues, what access do I need, what drips/drugs do I need for hemodynamics, can I do regional anesthesia for post op pain, can I safely extubate, if there is an unforeseen emergency (arrhythmia most commonly), larger cases have acid/base issues, coagulation management. Then I think Pacu care. So just listing all that you can see there’s TONS of medicine involved. Having said that, anesthesia has become very “safe”. In that we have a lot of tools to keep a patient alive and in general, patients have a lot more resilience than you’d think. So nurses have learned meds that bring up or down the BP, airway skills oxygenation ventilation, vascular access, pain control, etc. But anesthesiologist are physicians for a reason where we use medical knowledge to best take care of our patients. We hopefully know a lot but also know what our limitations are through our medical training.