Practical Anesthetic Management PDF – The Art of Anesthesiology
3.42 MB PDF
Contemporary anesthesia care, like virtually all segments of medicine, requires its practitioners to adhere to evidence-based medicine in their daily practice to the maximum extent possible. This policy has the effect of both standardizing much of the care provided and presumably providing the highest quality of care. These represent distinct advantages to patients requiring anesthesia. However, neither the content nor the quality of evidence-based practice is perfect. From time to time on careful reanalysis, “best practice” is found to be fl awed. Many evidence-based findings become “fact” and part of everyday practice without their ever being verified or even reanalyzed by other investigators. Understandably, scientists would rather publish “a new study with new findings” than painstakingly undertake a study to confirm what another scientific group has already reported. “Best evidence” may also be misinterpreted, applied in an inappropriate way or extended to all patient populations beyond what is justified from the data, or simply wrong. A perfect example of the latter is the fact that for years, it was believed and supported by some scientific studies that anesthesia caused long-term decline in cognitive dysfunction in the elderly. A recent study has documented the fallacy of that conclusion [ 1 , 2 ]. Some have characterized strict adherence to evidence-based practice as “mindless medicine” because of bureaucratic rules that prevent deviation from a standard protocol regardless of its appropriateness for any specific patient.
As a result of the importance given to evidence-based anesthesia, practices based on experience or common sense are suspect and often denigrated. Further, some clinical practices do not lend themselves to scientific validation, as examples in this textbook will show. This is where the art of anesthesia plays an important role in maintaining the highest quality of anesthesia care.
This book is not intended to be a comprehensive textbook of anesthesiology. Rather, we have selected key topics in the specialty where we believe the art of anesthesiology has been generally overlooked, misunderstood, or forgotten. The art of anesthesia encompasses a whole host of practices that are based on long- standing, effective experiences and common sense. When combined with the science of anesthesia, the art of anesthesia gives clinicians powerful tools that will make their practices safer, more effective, and efficient and will bring greater satisfaction to their patients. The expectation is that teachers of anesthesia who use this text will find useful pearls that will enhance their teaching skills. It is expected that students of anesthesia who use this text will learn that there is an art to anesthesia and that it is reasonable or even desirable to accept and practice principles based on experiences not documented by double-blind studies and scientific validation. Just as the absence of randomized controlled trials should not preclude the use of parachutes, anesthesiologists should not limit patient care to the exclusion of common sense and clinical experience [ 3 ].
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