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Anesthesiology, and indeed all of US health care, is influenced currently by two dominant trends. First, the passage of the Patient Protection and Affordable Care Act (PPACA) of 2010 codified the US commitment to broad-based access to health care, and it underscored that such care must be more efficient and cost effective. Second, the emphasis on quality and safety in health care has gained even greater momentum. Together, these trends emphasize the concept of value in health care. These trends are not unique to the United States. Rather, they represent global trends in health care policy and practice. We believe they will be dominant themes for many years to come and thus they are guiding principles in the second edition of this text.

Fortunately, the specialty of anesthesiology is well positioned to lead these initiatives. Anesthesiology is already recognized as the pioneering leader in patient safety and we see no reason why anesthesiologists should not be leaders in efficiency and value in health care as well. Indeed, we believe that continuing to position our specialty at the forefront of these initiatives is a key strategy for both the current and future success of anesthesiology and its practitioners.

In 2000, the Institute of Medicine (IOM) published its landmark analysis of American health care, "To Err is Human," a treatise that emphasized the fallibility of even highly motivated humans, and emphasized that systems of safe care must be constructed to protect patients from potential harm. That report specifically cited anesthesiology as a leader in the patient safety movement and urged other disciplines to follow, which many have done subsequently. A subsequent IOM publication, "Crossing the Quality Chasm; A New Health System for the 21st Century" (2001) described the attributes of a model health care system that is safe, timely, efficient, effective, patient centered and equitable to all. The PPACA legislation underscored these principles and subsequent regulations translated them into operational policies and practices. We agree with these principles and have worked diligently to adopt them in our own practices and departments, for they are guideposts to the professional and ethical practice of medicine and anesthesiology. Further, we have designed this text around the concepts of safe, effective, efficient, and patient-centered care, and we urge others to approach their practice with a similar commitment to these principles.

Our goal is to provide the practitioner with a single resource that captures the essence of the full spectrum of anesthesia practice. There are multiple sources of information about anesthesiology but many ignore the full breadth of the practice. Further, there are numerous focused texts that delve into specific subdisciplines in great detail; often more detail than the trainee or practitioner desires or needs. In this text, we have focused on what is truly important for the clinical practice of anesthesiology in all its dimensions, while being efficient in the presentation of this essential material. Throughout, we have asked "What is important?" "Why is it important?" "When should it be applied?" and "How should it be applied?" Our goal was to write for practitioners, not physician scientists. That said, this is not a users' manual of anesthesia care, but rather a text that constantly builds on the concepts of safe, effective (ie, evidence-based), efficient, and patient-centered care, distilled in a manner that facilitates easy access to the key scientific concepts that underpin the rationale for that practice. Thus one finds Key Points and Key References in each chapter, while an extensive reference list is provided for those who seek in-depth research-based documentation.

Throughout, we embrace an encompassing view of modern anesthesiology practice, including especially perioperative medicine, critical care medicine, and pain medicine, each of which improves patient care and enhances the value of anesthesia care within the overall health care process. We have emphasized important trends in both the specialty and in health care in general, to ensure that the reader is not required to go elsewhere for additional information to support the mainstream of their practice. These trends include the expanded use of regional anesthesia, the remarkable explosion in pain medicine practice, and the expanded need for practitioners who are skilled in the practice of critical care medicine. No careful observer of the specialty could miss these trends, and no text could be considered "comprehensive" if it did not embrace them as full components of the modern practice of anesthesiology.

Further, we have woven the concepts of quality, safety, cost effectiveness, and value into the text by emphasizing that anesthesia care is one system of care within a larger system of care that focuses on overall patient outcomes, not independent events by individual practitioners working in isolated clinical disciplines.

We have approached these and other key "drivers" of contemporary and future anesthesia practice with care, commitment, and enthusiasm for the future of the specialty. We trust that you share this enthusiasm and hope our efforts will serve you well as you continue to translate your knowledge and skills into safe, effective, efficient, and patient-centered care; our patients want nothing less and our surgical and medical colleagues are looking to anesthesiology to continue to set the example for implementation of these principles. We are honored to serve you through our efforts here.

David E. Longnecker, MD
David L. Brown, MD
Mark F. Newman, MD
Warren M. Zapol, MD

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