TY - CHAP M1 - Book, Section TI - Anesthesia Risk A1 - Orkin, Fredrick K. A1 - Longnecker, David E. A2 - Longnecker, David E. A2 - Mackey, Sean C. A2 - Newman, Mark F. A2 - Sandberg, Warren S. A2 - Zapol, Warren M. PY - 2017 T2 - Anesthesiology, 3e AB - KEY POINTSAnesthesia risk estimates are influenced by the circumstances in which they are generated; estimates derived from one site or population may not be valid in other settings or specific patients.The risk of death related primarily to anesthesia is estimated to be as low as 1 in 200,000 anesthetics in some large populations, reflecting improvement of perhaps two orders of magnitude over more than 70 years.Despite the very low anesthesia-attributable mortality rate, the large and increasing number of anesthetics engenders a substantial public health burden of mortality and morbidity, much of which may be preventable.The overall low anesthesia-attributable mortality should not be a cause for complacency but rather an impetus for continued emphasis on improving anesthesia safety, particularly for high-risk patients and high-risk procedures.Most anesthesia risk results from patient-specific characteristics, with additional contributions from surgical and anesthesia factors, but there is growing recognition that organizational culture and other characteristics of the clinical setting, including experience, teamwork, and communication, are important contributors to overall risk.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 indicators.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 parse the confounding clinically relevant variables.Well-conducted observational studies reveal that anesthesia risk is influenced more by how the anesthesia provider delivers care rather than which specific drugs and techniques are used. Thus, careful attention to factors such as blood pressure, perfusion, oxygenation, body temperature, and depth of anesthesia are often more beneficial than the specific anesthetic drug or technique that is selected. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1144114661 ER -