Perioperative Medicine – Current Controversies PDF
Preview Perioperative Medicine – Current Controversies
Karen Stuart-Smith E ditor Perioperative Medicine – Current Controversies Perioperative Medicine – Current Controversies Karen Stuart-Smith Editor Perioperative Medicine – Current Controversies Editor Karen Stuart-Smith Waimairi Anaesthesia Ltd Christchurch New Zealand ISBN 978-3-319-28819-2 ISBN 978-3-319-28821-5 (eBook) DOI 10.1007/978-3-319-28821-5 Library of Congress Control Number: 2016934461 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. T he publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www. springer.com) For Pepsi Pref ace The World Health Organization estimates that 11 % of the global burden of disease can be treated with surgery, and yet there are no specifi c charitable organisations nor government departments anywhere in the world that view high-quality periopera- tive care as a public health priority. Surgery costs money and carries both benefi ts and risks, and the anaesthetist is an integral part of this complex and expensive way of managing disease. Careful preoperative assessment, attention to fl uid balance, pain control and depth of anaesthesia, as well as meticulous post-operative manage- ment, would seem intuitively to be benefi cial for both the individual patient and society as a whole. It might even appear obvious that a well-managed perioperative course reduces complications and readmissions to hospital. However, there is very little hard evidence at a population level to determine whether these intuitions are valid in practice, and thus it becomes extremely diffi cult to persuade national budget holders to prioritise perioperative care over other disease burdens which appear more pressing. It is up to clinicians to provide this evidence. No other group has the necessary knowledge to make the case. The role of the anaesthetist in the twenty-fi rst century has expanded well beyond the operating room and now effectively encompasses the entire journey of the surgi- cal patient, from the moment the decision to operate is made to patient discharge from hospital and, in the case of chronic pain management, for some time after that. In the last 5 years or so, it has become increasingly clear that the choices anaesthetic clinicians make in the operating room, including such fundamental details as ‘how much’ and ‘what’ to give of everything, may have profound short- and long-term implications for the patient. Anaesthesia has long been regarded as simply a rela- tively safe way of rendering the patient amenable to surgery, but the transition from ‘anaesthetist’ to ‘perioperative medicine specialist’ now seems inevitable. Indeed, many professional bodies around the world, including most notably the Royal College of Anaesthetists in the United Kingdom, advocate this transition as a vital component of patient care that is both clinically effective and cost-effective. In spite of this recent interest, the concept of perioperative medicine remains somewhat ill defi ned. The purpose of this book is to try and gather together at least some of the subject areas relevant to perioperative medicine in one place. This vii viii Preface v olume covers topics relevant to adult surgical patients. The perioperative manage- ment of paediatric patients and the management of obstetric anaesthesia are both substantial areas of interest in their own right and will require their own books— possibly a project for either myself or others in the future. This book describes ‘cur- rent controversies’ for the obvious reason that nothing is settled and most of the topics covered here arouse strong feelings one way or the other at major anaesthetic meetings worldwide. There is no intention to be prescriptive or attempt to establish one type of care over another. The invited authors have given a comprehensive over- view of their own areas of special interest. I have no doubt the reader will be able to think of many topics that they feel should have been covered and have not. I am rather in that position myself. All suggestions for future editions are welcome. Christchurch, New Zealand Karen Stuart-Smith , MD, FRCA November 2015 Biogr aphy Karen Stuart-Smith was born and raised in Glasgow, Scotland, and graduated in physiology and medicine from the University of Glasgow. She is a Fellow of the Royal College of Anaesthetists and has enjoyed a long career as a clinical anaesthe- tist. Early training in cardiorespiratory research led to an enthusiasm for applying scientifi c methodology to clinical practice, and she is also a passionate believer in the role of clinical audit in assessing the quality of patient care. Karen presently resides in New Zealand, where she continues to practice as an anaesthetist and enjoys the outdoor lifestyle in her spare time. ix
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