Crises Management in Anesthesiology

Abstract

Every now and then, one comes across a book that tackles a particular subject in a rather special way. This is what I found with this 300-page softcover book. It is unique because it covers the basic principles of how anyone involved in the practice of anesthesia should approach one of the most challenging and important tasks: managing critical events. This book is written for everyone who administers anesthesia, from the experienced practitioner to those who are beginning their training. The first section, “Basic Principles of Crisis Management in Anesthesiology,” is particularly distinct because it focuses on the mind of the anesthesia provider and analyzes his or her expertise in terms of its component parts. The 2 chapters in this section are very psychology-oriented and discuss the theories of dynamic decision-making and the principles of anesthesia crisis resource management. The material is similar to the programs that are part of airline pilot training. The second section, “The Catalog of Critical Events in Anesthesiology,” outlines 83 events based primarily but not exclusively on various body systems and specific types of surgery. These include everything from hypoxemia, hypotension, myocardial infarction, the difficult airway, and local anesthetic toxicity to various equipment-related events. Each “event” is described under the headings of “Definition,” “Etiology,” “Typical Situations,” “Prevention,” “Manifestations,” “Similar Events,” “Management,” “Complications,” and “Suggested Readings.” The authors assume that the reader has a sound knowledge base and adequate technical skills. The book is not meant to be either a reference text on anesthesia or a “cookbook.” Instead, “The Catalog of Critical Events” is a guide only. The “Management” section is purposely not in the form of a decision tree or algorithm, rather, the management guides are written more as a hierarchical list of what to check or to do in roughly the same order that an experienced practitioner would do them. Although comprehensive, this book makes no claim to be exhaustive. It focuses on the anesthesia provider's mind, trying to help him or her optimize his or her own performance. The catalog presents events in a uniform, concise fashion and strives to improve the recognition of and response to a crisis. It is very easy to read and is truly a source of education that no one but the most thrill-seeking anesthetist wants to experience but that every anesthesia provider will experience. This innovative book effectively captures the essence of what should become instinctive. What it describes should be required reading for anyone who administers anesthesia.