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Complications and Mishaps in Anesthesia

Cases, Analysis, Preventative Strategies

Yusof, Aizad

European Journal of Anaesthesiology (EJA): August 2015 - Volume 32 - Issue 8 - p 590
doi: 10.1097/EJA.0000000000000273
Book review

Specialist Trainee in Anaesthesia Queens Medical Centre, Nottingham UK

M. Hubler, T. Koch and K. B. Domino (eds). Heidelberg, Germany: Springer-Verlag, pp 365; £53.99 (€62.39) ISBN 978-3-642-45406-6

This text is written by German and American anaesthesiologists. The previous editions of the book were written in German, and this version is a completely revised and aimed primarily for the American anaesthesiologist. The premise of this book is that there is a gap between learning from personal errors and learning from the errors of others. Thus, the editors’ first goal is to bridge this gap. They attempt this by sharing their experiences with complications and mishaps based on real-life anaesthetic practice, with modifications to make patient recognition impossible. The editors’ second goal is to assist the reader to reduce errors. Interestingly, this part of the text is not only focused on medical facts but also on the non-technical aspects of the job such as organisational, leadership and management skills.

The text is laid out in brief case-based chapters, of which there are 33, with a chapter on ‘tips to reduce human error’ at the end. Each chapter is based on a patient-related issue or a surgical catastrophe and is divided into case introduction and case analysis & debriefing. The different sections of each chapter are headed by questions such as ‘what would you do next?’ and ‘what lab values are you interested in?’ followed by the answers. Medical facts are presented in the case analysis section and also introduced with questions such as ‘define blood pressure’ and ‘define arterial hypertension’ which make revision seamless and clinically relevant. Non-technical themes and behaviours are examined throughout the text including communication, vigilance and task fixation.

As this text is written for the American anaesthesiologist, readers would immediately notice some differences in practice such as the use of an ‘anesthesia tech’, Certified Registered Nurse Anesthetist, and propofol for rapid sequence induction. However, the differences are mainly related to terminology, and the reader gradually realises that there are more similarities than differences in practice as they go through the text. More importantly, these differences would not impact on the ‘take home message’ of each chapter.

What sets the text apart from other books is that there is a story for each of the cases presented. Here, detailed information is given in a narrative format which reveals the exact circumstances of each case. The authors make an effort to delve into the mind of the anaesthetist as the stories unfold, including feelings of fear, insecurity, and the pressure of dealing with expectations. Not only these keep the reader interested, they are written in such a way that the reader gets emotionally involved, which is indeed the aim of the authors. By holding the reader's attention, and making it clinically and emotionally relevant, the editors succeed in getting their point across.

In short, this book achieves what it set out to do, which is to help promote higher standards of safety in anaesthetic practice. Who is this text aimed at? I would certainly recommend it to anaesthetists of all grades. However, senior trainees and staff anaesthetists in particular would find it most useful as they would most likely be able to relate to the stories in the text. Non-technical skills in anaesthesia have only been scrutinised in recent years, and this text complements it greatly in a succinct, interesting and informative manner.

© 2015 European Society of Anaesthesiology