The Anesthetic Crisis Manual - North American Edition

Abstract

David C. Borshoff (author). Geoffrey Lighthall (editor). Leeuwin Press Pty Ltd; website: http://theacm.com.au/ product/the-acm-international-edition-us/. Supported by the Australian Society of Anaesthetists – Endorsed by the European Society of Anaesthesiology The Anesthetic Crisis Manual is intended to serve as a ‘‘cognitive aid’’ and ‘‘quick reference handbook’’ for anesthetic crises commonly encountered in the operating room (OR). Written by David Borshoff, an Australian anaesthetist, supported by the Australian Society of Anaesthetists, and endorsed by the European Society of Anaesthesiology for its crisis checklists, the Manual has been adapted for North American practitioners with help from the Editor, Geoffrey Lighthall of Stanford University School of Medicine. The Manual bears a number of similarities to aviation quick reference handbooks (QRHs) – perhaps not surprising considering the author is also a general aviation (private) pilot. An example of this similarity is an initial suggestion to have an assistant ‘‘read and communicate the directive’’. Also, like other QRHs, and given its intended use in the OR, the Manual has been robustly constructed. The pages, which apparently are waterproof, tear resistant, and easy to clean, feel thick and durable. Furthermore, the Manual’s spiral binding has been helpfully fitted with an attachment to allow easy tethering to an anesthesia machine or crash cart. The Manual is organized into two parts. The first, the heart of the Manual, is a crisis management section which lays out management protocols in checklist format for 23 intraoperative emergencies. At least nine draw on established guidelines addressing issues such as cardiac arrest, malignant hyperthermia, and local anesthetic systemic toxicity (LAST). A sequence of colour-coded tabs directs the reader to the appropriate well-described and colour-matched protocol. From a human factors standpoint, the colour sequence appears to have only esthetic and not functional use, with the sequence for tabs 1-14 repeated for tabs 15-23. Each page is clearly laid out with a series of easy-toread numbered points that take the reader systematically through critical steps in the immediate management of a problem. The focus on describing management clearly and concisely means that some details are lost; however, on each facing page, there is additional information, such as salient points related to the problem, doses of medications, and further management options. Nevertheless, it is worth pointing out that the neonatal resuscitation checklist appears to be modelled after the UK guidelines, which differ slightly from the current recommendations of the North American Neonatal Resuscitation Program. Also, there is an error in the Intralipid dose in the LAST protocol (quoted as 1.5 mg kg instead of the correct 1.5 mL kg). The author has posted a correction on his website (http:// theacm.com.au/alerts/), but this correction is also incorrect. Four tabs are dedicated to airway emergencies: difficult mask ventilation, unanticipated difficult intubation, the dreaded ‘‘can’t intubate can’t ventilate’’, and laryngospasm. For these, the author’s recommendations reflect the UK Difficult Airway Society guidelines, which differ slightly from the 2013 Canadian Airway Focus Group recommendations. Nonetheless, the information provided is succinct while emphasizing appropriate time management and highlighting that the points provided are D. Finegan, MD J. M. Davies, MD (&) Department of Anesthesia, University of Calgary, Calgary, AB, Canada e-mail: jdavies@ucalgary.ca