Emilio B. Lobato，Nikolaus Gravenstein和Robert R. Kirby今年出版了一本引起同道关注的新书《Complications in Anesthesiology》，新英格兰医学杂志为此发表了一篇新书介绍，通过这篇短文，可以了解当代学术界对于麻醉并发症的新认识和新期待。作者文辞优美，值得借鉴！
Complications in Anesthesiology
Edited by Emilio B. Lobato, Nikolaus Gravenstein, and Robert R. Kirby. 1008 pp., illustrated. Philadelphia, Lippincott Williams & Wilkins, 2008. $169. ISBN 978-0-7817-8263-0.
Contemporary anesthesia is an important "safety paradox" of excellent outcome despite routine risk. Although it carries perhaps the greatest potential for hazard for millions of patients annually, anesthesia also has medicine's best track record for the safety of patients. Gone are the days of patients' "taking a bad anesthetic" and nothing more being said. Now the clinician rightly carries the burden of accountability, and nothing less than near-perfection is satisfactory. Even though some interventions in Western medicine are believed — perhaps naively — to have the potential to save thousands of lives if added to conventional practice (e.g., proprietary "care bundles" for patients suffering from sepsis), conventional anesthesiology performs very well indeed. We know this from epidemiologic data, and for those less easily persuaded, the reduction in anesthesiologists' malpractice premiums over the past decade should convince.
This book is about complications, and it is the prevention of complications that makes a practice safe. The recent film Awake initially scared the profession and shocked the public about safety in anesthesia. But it did much more than scare — it focused attention on the potential for harm in an area that most see as harmless. This is crucial, because anesthesia has advanced to a stage where it appears simple and is practiced largely in the background. Indeed, many people do not know that anesthesiologists are physicians, do not know the difference between nurse anesthetists and anesthesiologists, and have little idea about what is done during the induced coma that constitutes their general anesthetic.
In this sense, anesthesia is a victim of its own success, building on decades of overwhelming accomplishment in the safety of patients, to the extent that studies of adverse events in anesthesia are difficult to perform — because serious adverse events, although dangerous, are rare. Beyond the public perception, the safety paradox has an unfortunate association with research and further improvement; anesthesia shares (with orthopedic surgery) the ignominy of being allotted the least funding through the National Institutes of Health research training grants. Thus, assumptions of safety — perhaps coupled with ignorance of risk — may have translated into thinking that ongoing research and development in anesthesiology do not matter.
Against this background, Complications in Anesthesiology is a welcome addition to the literature. Although written for the anesthesiologist, it contains chapters that should be read and understood by many across today's health care spectrum, including providers, administrators, regulators, payers, and perhaps journalists and even patients. The format is systematic and works well; the book is anything but dull. A clinical summary starts off each chapter, followed by essays of generally high quality, with each chapter summarized by a final analysis and an enumeration of key points.
The first chapter, "Anesthesia, Perioperative Mortality and Predictors of Adverse Outcomes," is a gem, and it sets the tone — and the standard — for the book. We live in days of dubiously defined "access" and "outcomes," and here the real meanings of numerators and denominators in the guessing game of anesthesia performance are laid bare. Anyone who has witnessed the superficiality of statements that claim "no difference" in outcome when only crude data are used to compare alternative models of anesthesia care will appreciate the clarity in this chapter. The authors differentiate among complications attributable to anesthesia, surgery, or characteristics of patients, as opposed to system failures or situations where attribution is not possible (or, as is often the case, not useful). These are recurrent themes, and the overlap with other chapters in this book integrates and never irritates.
The section on pharmacology reflects editorial imagination, with discussion of herbal remedies and over-the-counter drugs. Finally, the book takes a thoughtful look at complications to which the anesthesiologist may be susceptible. Thought-provoking essays place bioterrorism and exposure to fatigue into perspective, as well as that ever-present threat to the health of all anesthesiologists and those around them: substance addiction.
I liked this book; the content is clear yet not naive, and the format is thorough while maintaining interest. If you think that anesthesia is usually safe, you are basically correct. However, if you think that anesthesia is necessarily safe — or you don't understand why it isn't — then you should read this book carefully.
(hippocampus 瑞金麻醉论坛)
[ 本帖最后由 小麻生 于 2008-9-6 18:43 编辑 ]
作者: xyz-cn99 时间: 2009-8-26 06:27
Complications in Anesthesiology电子书：
http://www.xqnmz.com/viewthread.php?tid=8096
作者: 员外 时间: 2009-8-31 20:39
这书值得收藏精读:$
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