British Journal of Anaesthesia: P. L. Gambús

It was probably more than 30 yr ago, after the manuscript by J. B. Cooper on Preventable Anesthesia Mishaps was published, that a new perspective on training in anaesthesia to minimize human error started. In 1994, the book Crisis Management in Anesthesiology by D. M. Gaba and colleagues marked another milestone in this new approach to teaching and learning in anaesthesiology that has extended to almost all clinical training in medicine. Since then several publications on crisis management, the use of simulation in residency programmes or the introduction of cognitive aids and other tools have changed the way our speciality is taught. The Anaesthetic Crisis Manual by D. C. Borshoff is the latest incorporation to this line and it comes intended to be a real aid in the everyday work of anaesthesiologists. The general perspective of the book, as stated in the prologue, is that ‘it has been designed to be used as a cognitive aid but not a substitute for clinical acumen’ with a full clinically oriented approach. The manual reviews a total of 22 critical events. They are grouped in four sections: cardiovascular, respiratory, obstetric, and miscellaneous. Examples of events are ‘Haemolytic Transfusion Reaction’, ‘Can’t intubate Can’t ventilate’, ‘Post-Partum Haemorraghe’, or ‘Malignant Hyperthermia’ to cite just a representative of each section. In facing critical events, there is not much time for discussion

but rather they require immediate action. The format in which the book has been published agrees with this view. It is ready to hang from the anaesthesia workstation, handy, easy to open, colour coded (each section has its own colour to be differentiated and easy located), and with big font size to allow for easy reading and understanding. Around 10 steps to go are presented for every critical event. The steps will guide the clinician when diagnosis is already done. The crisis prevention section includes a 15-point machine check, adverse parameters checklist, and diagnostic pathways to help rapid diagnosis on deteriorating events. The diagnostic pathways are specially helpful when there is a real evidence that something is not going well, but the source of the problem has not been clearly identified yet. As a summary, the ‘10 T checklist’ is a help to guide clinicians in orienting diagnosis and initially manage the crisis when diagnosis has not been established. Crisis prevention is also addressed in a specific chapter and it is advisable to use routinely to make sure that prevention checking has been done before starting any anaesthetic procedure. This section contains the description of 11 events. Crisis aftermath is also addressed and a way to manage and take the positive from it is well explained. The format is great. It has a ring for hanging the book close to the anaesthesia workstation. Last but not least, a blank page for notes and a list of the Local and Hospital Emergency Phone Numbers to be filled by the anaesthesiologist is also available. The Manual has been endorsed and supported by the European Society of Anaesthesiology (ESA), supported by the Australian Society of Anaesthetists (ASA), and highly commended by the BMA Medical Book Awards 2012. Summarizing, this is not a textbook, not even a book as we understand it. The Anesthetic Crisis Manual must be considered an aid, a piece of fast use information that will help us when anaesthetic crisis shows up, to orient the kind of crisis and act accordingly for the benefit of the patient. It should not be kept in our pockets or on bookshelves but rather hanging very visible and handy in any anaesthesia workstation in or out of the operating theatre.

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