What’s old is new – or relevant – again
Experts revive “forgotten tricks” to strengthen modern patient care.
In an era increasingly defined by sophisticated monitoring systems, automation, and digital decision-support tools, anesthesiologists are urging physicians to remember the value of practical bedside skills that once formed the foundation of the specialty.
Classic clinical techniques that continue to offer meaningful benefits for patient safety, efficiency, and resource stewardship will stand the test of time, according to Albert J. Varon, MD, Miller Professor of Anesthesiology at the University of Miami Miller School of Medicine. Dr. Varon is among the speakers at the Sunday session, “Learning From the Wise: Forgotten Tricks, Practical Pearls, and Timeless Judgment.”
“There are several specific techniques that have quietly fallen out of common practice, despite remaining highly useful,” Dr. Varon said. “They were all once standard skills, and each still has a clear, practical place in modern practice when clinicians know how and when to use them.”
One such technique, Dr. Varon said, is digital nerve block, a simple maneuver to restore a pulse oximetry signal when peripheral vasoconstriction or poor perfusion causes the monitor to lose the waveform, rather than defaulting immediately to another device or site. Another is single-breath induction, which allows for rapid, controlled airway management, both as an elective option for the right patient and as a backup option when the I.V. fails during induction.
The panel will explore other techniques as well, including closed-circuit anesthesia, an older practice that is seeing renewed relevance as a strategy for environmental and resource stewardship, since it minimizes fresh gas flow and volatile agent waste.
“Another classic that we will revisit are neuraxial approaches for labor analgesia that newer trainees may only know from textbooks rather than hands-on repetition,” said session presenter Regina Y. Fragneto, MD, FASA, Professor of Anesthesiology at the University of Kentucky College of Medicine in Lexington.
Reviving these techniques in the OR goes beyond practical learning. It involves a mindset, too, Dr. Varon said.
“It’s essential to pair these specific techniques with the judgment that makes them useful in the moment. Knowing how to perform a digital nerve block only helps if a physician recognizes, in real time, that a lost pulse oximetry signal may reflect a perfusion problem rather than a monitor malfunction, and reaches for that maneuver instead of replacing the sensor,” he said.
The same applies to single-breath induction, according to session presenter Beverly K. Philip, MD, FACA, FASA, an ASA Past President and Professor of Anaesthesia Emerita at Harvard Medical School. It requires the judgment to identify which patients are appropriate candidates and the discipline to execute it.
“It’s important to emphasize anticipatory planning, thinking through which technique fits a given scenario before it arises, and the discipline of slowing down at the moment a case gets difficult rather than defaulting to the most technology-dependent option out of habit,” Dr. Philip said. “These are pattern-recognition skills built over years of repetition, and they are exactly what this panel intends to pass along.”
Importantly, Dr. Varon rejected the notion that traditional skills and modern technology are competing approaches. Instead, he argued that the strongest physicians combine both. Modern monitoring systems can validate and enhance the effectiveness of manual techniques, while foundational clinical skills provide critical options when technology alone is insufficient.
A digital nerve block, for example, should restore a pulse oximetry signal only after clinical assessment has confirmed the patient is otherwise stable, rather than substituting for that assessment. Closed-circuit anesthesia works the same way, using data from modern gas monitoring and delivery systems to run the circuit safely and efficiently instead of relying on rigid fresh gas flow alone, Dr. Varon said.
According to session presenter James H. Philip, MEE, MD, CCE, Emeritus Professor of Anaesthesia at Harvard Medical School, single-breath induction and classic neuraxial techniques for labor analgesia both depend on the clinician's hands and judgment but are safest when practiced in a setting where modern monitoring can confirm what the clinician is sensing.
“Our panelists want trainees to see these techniques as another tool that expands what they can safely offer a patient, not a rejection of the technology they trained on,” Dr. Philip said. “The goal is to know how to move fluidly between manual, experience-based skills and digital tools, choosing whichever gives the most reliable information or the safest path forward in a given moment.”
Panelists said the session was designed to close an educational gap affecting many early-career anesthesiologists whose training has increasingly emphasized digital systems and automated workflows. By sharing lessons developed through decades of clinical experience, panelists said they hoped to equip the next generation of physicians with a broader repertoire of skills and a deeper appreciation for the judgment that underpins excellent patient care.
“These are not relics,” Dr. Varon said. “They are tools that strengthen safety, resource efficiency, and precision when used alongside modern technology rather than in place of it.”
