The Anesthesia Simulator-Recorder is a computer program that trains and evaluates anesthesiologists' management of critical incidents. The program executes on IBM compatible personal computers, combining a graphic display of the operating room with mouse-driven input and using an integrated set of physiological and pharmacological models to predict patient responses. The program records the simulated patient's vital signs and all management decisions, and produces a printed case summary. The Anesthesia Simulator-Recorder was evaluated by 44 resident and attending anesthesiologists at seven different anesthesia training centers. These anesthesiologists found the simulator easy to use with clear presentation of the case and management options. The physiological and pharmacological models produced clinically realistic predictions of patient behavior (mean score = 8.5, where 10 is highly realistic and 1 is unrealistic). The Anesthesia Simulator-Recorder was appraised as an excellent training device (mean score = 8.5, where 10 is outstanding and 1 is poor) because it provides the ability to repeatedly practice the management of critical incidents. The simulator was judged to be a good evaluation device (mean score = 6.6, where 10 is outstanding and 1 is poor). No significant differences were found in evaluations between the institution where the program was developed and other institutions, or between residents and attendings.