Advanced Perioperative Crisis Management

Abstract

Anesthesiologists frequently encounter situations of high acuity that require rapid recognition of a problem, quick and accurate assessment of contributing factors and causes, and swift and skillful action to resolve or ameliorate the crisis. The foundational requirements to successfully perform these tasks are a thorough knowledge and understanding of relevant pathophysiologic factors and an objective approach to the situation and possible resolution. The recently published textbook, Advanced Perioperative Crisis Management, edited by Drs Matthew McEvoy and Cory Furse, provides practitioners with just those tools. The book is designed for those caring for surgical patients and provides an effective strategy for emergencies encountered in this population. The editors hail from 2 large academic centers, with an impressive group of authors from their own and other institutions, many of whom are well respected in their areas of expertise, lending weight to the provided recommendations. This 732-page book appears to be well suited as both a reference and resource in anticipation of critical events or for review during and/or after a critical event. There is an electronic version of the printed material available, which would be useful as a reference in an acute event, but it is not necessary for general review and preparation. Given the wide range of presented situations, the editors might consider hyperlinked text/references and more interactive features in future editions. Additionally, a searchable format that is accessible on handheld devices would be useful to providers during crisis management. The book is comprised of 9 parts. Part I sets the foundation and provides background on techniques, theory, and approach to crisis management, all relevant, topical subject matter for perioperative practitioners. The following 8 parts are organ- and condition-specific, with sensible organization and presentation of topics and chapters. Sections on cardiac crises (including shock as a separate section), pulmonary, metabolic and endocrine crises, and neurologic crises are presented by physiologic system, and there is a separate section devoted to toxicities. The 2 parts related to obstetric and pediatric emergencies stand alone, also divided by physiologic system and specific conditions relevant to each patient group. This approach is consistent with similar topics presented together, which facilitates review and understanding. Although multiauthored, each individual chapter within each part is well edited, and without significant repetition and similar presentation of key subject matter, is likely to be useful to those reviewing for both clinical and examination purposes. Each chapter begins with a clinical vignette, which becomes the basis for discussion of the topic(s) for that chapter. The reader is thus drawn into a real-world scenario that provides context for the subsequent scientific discussion and management recommendations. The chapter ends with well-constructed questions for a case-based review of the presented information. Management and therapeutic options in these learning scenarios are particularly useful to gauge comprehension of the chapter’s information, especially as the “case” progresses in each management step. Some authors have chosen broad questions that can be approached with provider judgment, and others have more specific questions with answers incorporated into the text. Greater consistency in presentation of these question-based clinical scenarios may be helpful in future editions. The substance of the discussion throughout the text is excellent. Analysis of each topic is succinct, well referenced, and algorithms and recommendations are up to date. The text is easy to read and may be especially useful for readers who find themselves less engaged with traditional reference textbooks. Images, tables, and algorithms are used frequently and are very appropriate to demonstrate numerous key concepts. Overall, this is an excellent reference text for crisis management in perioperative patients. It is a valuable addition to several other available comprehensive resources.1,2 The style of Drs McEvoy and Furse lends itself to efficient review, with the use of a clinical case foundation, physiologic and systems-based organization, and use of appropriate figures and algorithms, all of which make the text less dense for the reader. The easily digestible and clear, concise approach to clinical situations that may be encountered is an ideal source for those involved in the perioperative care of surgical patients, and offers specific benefit to those in an acute care setting as well as those preparing for high-stakes examinations. It will be beneficial to purchase for a department or individual collection, and will provide an excellent supplement to other available crisis management resources. Srikanth Sridhar, MDEvan G. Pivalizza, MDDepartment of AnesthesiologyUT Health McGovern Medical School-HoustonHouston, Texas[email protected]