CHALLENGES and opportunities. Despite huge challenges and resistance, a handful of individuals developed and defined the core of our medical specialty less than 100 yr ago. Now, having developed intraoperative care, which is remarkably safe, we are challenged to defend anesthesiology as more than a technical art and truly requiring the rigorous training of physicians. Despite reluctance and indifference by many members of the American Society of Anesthesiology, this journal was founded as a monthly periodical 70 yr ago. Now, we face continued indifference, if not hostility, from many readers regarding the relevance of publishing original research and a revolution in publishing, questioning the use of expert peer review, rather than free and open discussion. How the specialty and this journal respond to these challenges will determine the very existence of each in the not-too-distant future.

I see 2011 as a time of tremendous opportunity to advance medicine and demonstrate why anesthesiology exists as a medical specialty. The mission of this journal is to advance our specialty by promoting new discovery. We lag behind, often far behind, our colleagues in other specialties in terms of extramural funding and volume of research. Yet there is a growing awareness that, although few patients die in the operating room, the perioperative period remains fraught with significant and long-lasting morbidity and mortality. We are now contributing to, and often leading, research to address these concerns. We cannot offer our patients better medical care tomorrow than today without fundamental research in the identification, pathophysiology, prevention, and treatment of disease in perioperative, critical care, and pain medicine. It is this work that we primarily provide you.

Just as a medical specialty is defined by the progress it makes through research in patient care, so it is defined by the passion, compassion, and equanimity that physicians bring to the care of their patients. We are honored to describe and celebrate this human side of medicine through a new feature beginning with this issue, Mind to Mind, edited by author and anesthesiologist Carol Wiley Cassella. These essays, short stories, and poems will express the complexity of caring for disease from our own perspective and that of our patients, families, and colleagues.

This is also a time of opportunity in promoting our work to you and to the public. We began an experiment in 2010 with the addition of a fourth section to our table of contents with articles focused on education, and, according to a survey performed 6 months ago, readers embraced this content. This is no longer an experiment and will remain a feature of the journal. The American Society of Anesthesiologists continues active promotion of research published in Anesthesiology through press releases, and you should expect to continue to hear and read of work from the journal in the lay press. To improve the overall quality of scientific figures in the journal, which often are used by readers in presentations, we are recreating all figures using a standard template and color palette with Origin (OriginLab Corp, Northampton, MA).

We realize that many of our readers keep up with the literature in a different way, more than by simply reading a scientific article. Information needs to be immediate. Better experiences include links, interactive graphics, video, and a timely and active interchange of ideas among our readers, editors, and authors. Social networks are used to help individuals navigate through this information at a quicker pace. Together with our publisher, Wolters–Kluwer (Philadelphia, PA), and led by our first Web Editor, J. Lance Lichtor, M.D., we hope to go through a digital metamorphosis. Although there will be change, we will not deviate from our high standard of prepublication peer review as a measure of the quality of work that we publish.

I titled this editorial thinking that I would write about the obvious cosmetic changes that debut in this issue of the journal, from the cover (returning to the original 1940 font for the cover title) to color to redrawn figures. But as I sat here on a bright and sunny fall day in Winston-Salem, it occurred to me that it is instead the fundamental aspects of anesthesiology, directly addressing the current challenges and opportunities, that deserve highlighting.

Department of Anesthesiology and Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, and Editor-in-Chief, Anesthesiology.