Anesthesiology, anaesthesiology, anaesthesia or anaesthetics (see Terminology) is the medical speciality concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialised in this field of medicine is called an anesthesiologist, anaesthesiologist or anaesthetist, depending on the country (see Terminology).The core element of the specialty is the study and use of anesthesia and anesthetics to safely support a patient's vital functions through the perioperative period. Since the 19th century, anesthesiology has developed from an experimental area with non-specialist practitioners using novel, untested drugs and techniques into what is now a highly refined, safe and effective field of medicine. In some countries anesthesiologists comprise the largest single cohort of doctors in hospitals, and their role can extend far beyond the traditional role of anesthesia care in the operating room, including fields such as providing pre-hospital emergency medicine, running intensive care units, transporting critically ill patients between facilities, and prehabilitation programs to optimize patients for surgery.