TY  - CHAP
M1  - Book, Section
TI  - Chapter 25. Anesthesia Risk
A1  - Orkin, Fredrick K.
A1  - Longnecker, David E.
A2  - Longnecker, David E.
A2  - Brown, David L.
A2  - Newman, Mark F.
A2  - Zapol, Warren M.
PY  - 2012
T2  - Anesthesiology, 2e
AB  - Anesthesia  risk  estimates  are  influenced  by  the  circumstances  in  which  they  are  generated;  estimates  developed  in  one  clinical  setting  or  selected  population  may  not  be  relevant  to  other  settings  or  specific  patients.The  risk  of  death  related  primarily  to  anesthesia  is  estimated  to  be  as  low  as  approximately  1  in  200,000  anesthetics  in  some  large  populations  and  reflects  improvement  of  perhaps  2  orders  of  magnitude  over  more  than  60  years.Despite  the  very  low  anesthesia-attributable  mortality  rate,  the  very  large  and  increasing  number  of  anesthetics  engenders  a  substantial  burden  of  mortality  and  morbidity,  much  of  which  may  be  preventable.The  very  low  anesthesia-attributable  overall  mortality  should  not  be  a  cause  for  complacency  but  rather  an  impetus  toward  a  greater  emphasis  on  improving  anesthesia-related  morbidity  in  selected  subpopulations  of  high-risk  patients  or  high-risk  procedures.Approximately  75%  of  risk  actually  relates  directly  to  patient-specific  characteristics,  including  age,  gender,  and  comorbidity;  20%  to  surgical  issues,  such  as  experience  and  judgment;  and  the  remaining  5%  to  anesthesia  factors,  including  experience,  board  certification,  pharmacologic  issues,  and  overall  management  of  care.The  American  Society  of  Anesthesiologists  physical  status  classification  correlates  with  risk  for  mortality  and  morbidity,  but  it  is  somewhat  subjective  and,  without  additional  clinical  information,  is  alone  not  as  strong  a  predictor  of  poor  outcomes  as  other,  morbidity-specific  measures.Although  randomized  clinical  trials  have  rightly  become  the  gold  standard  for  establishing  efficacy  in  clinical  research,  randomized  clinical  trials  have  a  limited  role  in  studying  anesthesia  risk,  particularly  because  they  cannot  efficiently  and  at  reasonable  cost  identify  the  confounding  clinically  relevant  variables.Well-conducted  observational  studies  reveal  that  anesthesia  risk  is  influenced  much  more  by  how  the  anesthesiologist  provides  care  rather  than  specifically  what  methods  are  used.  Thus  careful  attention  to  such  factors  as  blood  pressure,  perfusion,  oxygenation,  body  temperature,  and  depth  of  anesthesia,  for  example,  are  often  more  beneficial  than  the  specific  anesthetic  drug  or  technique  that  is  selected.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/20
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=56628414
ER  -