Patient Safety in Anesthetic Practice

Abstract

Patient Safety in Anesthetic Practice, Robert C. Morell and John H. Eichhorn. New York: Churchill Livingston, 1997, ISBN 0-443-07682-0, 527, pp, $65.00. For this reviewer, the essence of the book is best summarized in the foreword by Ellison "Jeep" C. Pierce, Jr., MD, when he writes, "The editors and authors are to be congratulated for bringing together in one volume, a thorough review of anesthesia patient safety endeavors over the last decade and a half and the state-of-the-art of this field." This reviewer recommends this book to anyone who is actively involved in the delivery of a safe anesthetic. The book is written in a style that is easy reading for individuals with varied backgrounds ranging from technician to physician to corporate CEO. The 36 authors have presented in 20 chapters a wide variety of topics for consideration and discussion. Although the book is not officially organized into particular sections, there appear to be six major areas of focus and emphasis. The first is represented in the first chapter: "A Historical Perspective of the Approach to Patient Safety in Anesthesia," by a well known colleague, Dr. Leroy D. Vandam. A second area of focus is comprised of chapters discussing the mechanical and electronic aspects of the delivery of anesthesia. These chapters are titled "Medical Gas and Vacuum Systems," "A Case-Oriented Approach to Electrical Safety," "Anesthesia Machine Safety and the FDA Checklist," "Advantages and Limitations of Pulse Oximetry and Capnography," and "The Automated Anesthesia Record." The third area of focus pertains specifically to the patient side of the delivery of anesthesia. These chapters, "The Pediatric Patient," "The Adult Patient," and "The Pregnant Patient" emphasize the unique patient aspects of a safe anesthetic. In addition to specific patients, several chapters, including "The Airway Algorithm: Safety Considerations," "Drugs," "Positioning," and the techniques for safe regional anesthesia deal with delivery techniques. The fourth area focuses on patient safety considerations for both the postanesthesia care unit and the intensive care unit. As the title of the chapters imply, the fifth area considers those situations involving the safety aspects for anesthesiologists in "Human Performance and Patient Safety," "Health and Safety for Anesthesia Personnel," and, of course, "Adverse Events, Malpractice Claims and the Litigation Process." Finally, the sixth area leads us to toward chapters discussing standards and guidelines and toward the future with the chapter "Simulators and Training Devices Safety in Anesthesia." Each chapter provides a definite message of safety. Although those chapters discussing specific patient populations present material that should be familiar to the anesthesia practioner, it is done in such a manner that the emphasis on safety is toward taking the particular steps necessary in preparation and delivery of a safe anesthetic. In addition to familiar topics, several chapters present new information that may not be as familiar but that are extremely important. A good example is the chapter written by Drs. Moss, Petty, and Peterson discussing medical gas and vacuum systems. This particular chapter focuses on what is happening behind the walls. Not only will the practioner develop an understanding of medical gas systems but also the types of problems that these systems can produce for the patient, ranging from poor connectors and outlets to contamination of gases by materials that are both biological and physical in nature. In summary, this is a book that covers many topics of importance. It has information for everyone. It can be used as either a primary text or a general reference. It belongs in every personal, departmental, and institutional library. Jerry M. Calkins, PhD, MD Department of Anesthesiology; University of Arizona and; Maricopa Medical Center; Phoenix, AZ 85008