A tribute to Professor J. Antonio Aldrete-Salceda 1937-2025

doi:10.15406/jaccoa.2025.17.00624

Journal of

eISSN: 2373-6437

Anesthesia & Critical Care: Open Access

Editorial Volume 17 Issue 3

A tribute to Professor J. Antonio Aldrete-Salceda 1937-2025

Víctor M. Whizar-Lugo,^1,2

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Francisco Romo-Salas²

¹Chief Editor Journal of Anesthesia and Critical Care: Open Access, Mexico
²Former President of the Federación Mexicana de Colegios de Anestesiología, Mexico

Correspondence: Victor M. Whizar-Lugo MD, Anesthesiologist at Lotus Med-Group, Tijuana, México

Received: May 25, 2025 | Published: June 23, 2025

Citation: Whizar-Lugo VM, Romo-Salas F. A tribute to Professor J. Antonio Aldrete-Salceda 1937-2025. J Anesth Crit Care Open Acces. 2025;17(2):82-84. DOI: 10.15406/jaccoa.2025.17.00624

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Editorial

World Anesthesiology has lost a great professor of international reputation; J. Antonio Aldrete-Salceda MD has died on January 12^th, 2025. Without a doubt, his greatest legacy for our profession is the score to assess post-anesthetic recovery that all anesthesiologists around the world use every day.^1,2 Toño, as he was known among his Latin American friends, was born in Mexico City in 1937 and graduated in 1960 from the School of Medicine at the Universidad Nacional Autónoma de México. After completing two years of surgical training, he entered the anesthesiology residency at Case Western Reserve University in Cleveland, Ohio, under the guidance of Robert Hingson MD, and then he moved on to the Administration Veterans Hospital in Denver, Colorado, where he was the anesthesia director and pioneer in anesthesia for liver transplants. Professor Aldrete also served as Chief of Anesthesia at Cook County Hospital in Chicago and as Professor of Anesthesia at Tampa, Florida. The University of Alabama at Birmingham founded the Aldrete award for Excellence in Pain Medicine, which is given to distinguished anesthesiologists at the annual banquet offered to the new residents. He founded the Arachnoiditis Foundation in Birmingham, AL.

While working in the Administration Veterans Hospital, he saw the need for a scale to assess patients post anesthetic recovery. This score was validated and sent to the editor of the journal Anesthesiology, who rejected it arguing that it has no clinical usefulness. A revised version of his original manuscript was sent to the journal Anesthesia and Analgesia, where it was published in 1970.¹That same year, Dr. Aldrete presented his score at the International Anesthesia Research Society congress and the official commentator was Dr. Hingson himself, who accurately predicted a practical future for this clinical measurement, which was also recommended by the Joint Commission of Accreditation of Hospitals in 1980, and revised by its author in 1995.²

It is important to mention that before the publication of Aldrete score in the journal Analgesia and Anesthesia, Aldrete and Kroulik published their idea in Spanish in the Revista Mexicana de Anestesiología.³ In this original publication, the authors propose their score making a similarity to the Apgar score for newborns, and mention that it can be used in all types of patients, regardless of sex, age and type of anesthesia. Unlike the score that would be used later, in this first report the fifth parameter referred to the color of the patient (skin and mucous membranes) as indirect oxygenation data, a measurement that would later be replaced by oximetry.

Variable

Assessment Interpretation

Score

Activity

Able to move all extremities voluntarily or on command

Able to move two extremities voluntarily or on command

Unable to move extremities voluntarily or on command

Respiration

Able to breathe deeply and cough freely

Dyspnea or limited breathing

Apneic or on the mechanical ventilator

Circulation

Blood pressure +/- 20% or less of the preanesthetic level

Blood pressure +/- 20% to 49% of the preanesthetic level

Blood pressure +/- 50% or more of the preanesthetic level

Consciousness

Fully awake

Arousable on calling

Not responding

Color

Pink

Pale, dusky, blotchy, jaundiced, other

Cyanotic

Table 1 The Aldrete scoring system¹

The objective assessment of physiological and physical vital parameters after anesthesia-surgery is a fundamental part of the safe recovery of each patient before being discharged from the post anesthesia recovery unit (PACU) to their hospital bed or home. The first Aldrete score had five crucial parameters: activity, respiration, circulation, consciousness, and changes in color of mucous membranes and skin. Each parameter is assigned a score ranging from 0 to 2, with a maximum score of 10 (Table 1). Almost 25 years later, in a letter to the editor of the Journal of Clinical Anesthesia, Aldrete made substantial modifications to his score following several ideas from various researchers^4-8who suggested replacing the color of the skin and mucous membranes with the measurement of oxygen saturation. In this new score, in addition to replacing the patient's color index with oximetry, he included 5 new signs: the appearance of surgical dressings, postoperative pain, ambulation, fasting-feeding, and urine output (Table 2).

Variable

Assessment Interpretation

Score

Activity

Able to move all extremities voluntarily or on command

Able to move two extremities voluntarily or on command

Unable to move extremities voluntarily or on command

Respiration

Able to breathe deeply and cough freely

Dyspnea or limited breathing

Apneic or on a mechanical ventilator

Circulation

Blood pressure +/- 20% or less of the preanesthetic level

Blood pressure +/- 20% to 49% of the preanesthetic level

Blood pressure +/- 50% or more of the preanesthetic level

Consciousness

Fully awake

Arousable on calling

Not responding

Oxygenation

Able to maintain O2 saturation >92% on room air

Needs supplemental O2 to maintain O2 saturation >90%

O2 saturation <90% even with supplemental oxygen

Dressing

Dry and clean

Wet but marked and not increasing

A growing area of wetness

Pain

No pain

Mild pain handled by oral medication

Severe pain requiring parenteral medication

Ambulation

Able to stand up and walk straight

Vertigo when erect

Dizziness when supine

Fast-feeding

Able to drink fluids

Nauseated

Nausea and vomiting

Urine output

Has voided

Unable to void but comfortable

Unable to void and uncomfortable

Table 2 The modified Aldrete scoring system for ambulatory surgeries

Since the first Aldrete's score was published, countless studies have been published assessing this scale with this same goal to evaluate post-anesthesia discharge from the PACU to the hospital bed or home in the case of outpatient surgery. Currently, there are several scales to measure recovery from anesthesia;^9-13 all of these measurements have their own merit and usefulness, although the most widely used scale due to its simplicity and effectiveness continues to be the Aldrete score, both in patients who remain hospitalized and in those who are discharged on the same day of their surgery.

A born professor-researcher, he published hundreds of articles and several books in English and Spanish on topics as varied as malignant hyperthermia, low flows and closed systems of anesthesia, psychological aspects and anesthesia, costs and theories on anesthesia, and pain. In addition to supporting young doctors for their entry into anesthesiology residency and having been a professor at hundreds of congresses and medical meetings around the world, Professor Aldrete enjoyed participating in humanitarian campaigns. In 1985, he was one of the leaders of the medical group that supported the Mexican Red Cross during the earthquake that shook Mexico City, a story that was repeated in the earthquake in 1986 in the Republic of El Salvador. This type of actions showed his altruism and generosity by helping hundreds of affected individuals who needed medical attention in disaster areas.

During his retirement he gave us part of his personal library, which is now an historical piece of the library of the Colegio de Anestesiología de León, in México. He made us think about our future as anesthesiologists, as lecturers, as professors and most of all, as human beings. One of his frequent pieces of advice was that we should always seek to update our knowledge with the goal that proper information and experience are the best resources in the daily practice of anesthesiology, in the responsible care of each patient. We also learned that anesthesiology has countless resources to solve each particular case, as long as you have the resources, knowledge, and honesty to know when to change techniques for the benefit of our patients.¹⁴

Thank you Toño for being a great human being, for the trust and the wise advice that you give us when we started in anesthesiology. You will continue to be our guide in these professional endeavors, and you will surely continue to be the example of numerous anesthesiologists around the world for many years to come.

Professor J. Antonio Aldrete-Salceda was a world-renowned anesthesiologist, expert in algology, tireless author of a large volume of articles and books, mentor, researcher, clinician, and inventor. Rest in Peace