Anesthesiology is unique among medical specialties because most anesthetics and surgical procedures are uneventful. Critical events can, however, occur without warning, are usually sudden, and may be life-threatening. Anesthesiologists must be ready to detect and manage unpredicted emergencies at any time. Although anesthesia itself has a low risk (independent of patient disease), a recent review offered suggestions as to how safety in the perioperative period can be further improved and how postoperative complications can be avoided.1
The initial response to a critical event may determine its outcome. The use of checklists and established protocols, long an accepted practice in aviation, can help health care providers quickly establish a diagnosis and begin treatment. Anesthesia Emergencies is written to help an anesthesia provider deal with common complications or unforeseen emergencies that happen during the perioperative period.
This updated edition of Anesthesia Emergencies can be used to prepare for emergencies that may occur in the future, and to deal with critical events as they happen. Chapters have been organized alphabetically, and each section within a chapter is arranged alphabetically by type of problem. Critical information has been highlighted. Each chapter contains one or more references to textbook chapters or review articles that will provide additional information. The second edition has been expanded to include chapters on crisis management and disaster preparedness, and new emergencies have been added to nearly every chapter.
Health care providers must have the knowledge, skills, and equipment necessary to resolve unforeseen emergencies. This book will ideally be used to prepare for emergencies before they occur. The authors recommend that if a specific type of problem can be anticipated (e.g., massive hemorrhage in a postpartum patient being brought to the operating room) the appropriate chapter should be reviewed beforehand. All personnel on the care team should be briefed on the critical events most likely to occur, and the actions that will be taken during an emergency. This book can be used outside of the operating room to prepare for future events by reviewing a section and thinking through the steps that would be needed for successful resolution of the problem.
This second edition will ideally be one part of an organized approach that includes simulation and training in crisis resource management. The authors recommend that when an emergency occurs, the anesthesia provider call for help as quickly as possible and delegate tasks as personnel arrive. There should be one person who is clearly in charge and directs the others, but that person should ask for advice and help as needed. When an anticipated critical event occurs, the Immediate Management, Differential Diagnosis, and Subsequent Management sections can be used as checklists, to help the anesthesia provider remember each of the steps that must be taken. If an unforeseen emergency occurs, the same sections can be used as a Do list. Follow the suggested procedure, and then refer to the article in Further Reading for more information after the patient has been stabilized.
This book would not have been possible without the help of many people. The authors would first like to thank their families for their constant support. We would like to thank our editors, Andrea Knobloch and Rebecca Suzan, for their advice and guidance. We also thank our authors, who produced outstanding manuscripts and turned them in on time. We acknowledge Keith Allman, Andrew McIndoe, and Iain Wilson, whose Oxford Publication, Emergencies in Anaesthesia, served as inspiration for this work. Lastly, we thank the residents and faculty of the Yale University School of Medicine, Department of Anesthesiology, for their critical review of the manuscript and their thoughtful comments.
1 Wacker J, Staender S. The role of the anesthesiologist in perioperative patient safety. Curr Opin Anaesthesiol. 2014 Dec 27(6):649–656.