Crisis Management in Anesthesiology, 2nd Edition.

Crisis Management in Anesthesiology is an important resource on my library shelf. I came across the first edition of this book when I graduated from anesthesia residency in 1995. The title was enticing, and I was motivated by a desire to improve my skills as a clinician in challenging and complex settings. It was the first book I had seen that detailed the cognitive processes of the anesthesia provider—something not explicitly taught in residency programs at the time. My original copy is full of dog-eared pages and underlined and starred passages. The book contained a catalog of critical events in anesthesiology, which I used as an efficient and high-value study tool for the American Board of Anesthesiology oral examinations. A few years later, I became the Director of our Department’s new anesthesia simulation center and was given the task of teaching crisis management to our residents. This book became the “bible” for our efforts. Why did it take 20 yr to produce a second edition? Classic teaching suggests that scientific discoveries take an average of 17 yr to become widely implemented in clinical practice. The principles of crisis management are based in the social sciences, which are often viewed skeptically by the medical profession. Medical practice has certainly evolved in the last two decades, with an increased emphasis on patient safety and teamwork in healthcare settings. The proliferation of anesthesia simulation centers has provided a setting for structured teaching of crisis management. In 2009, the American Society of Anesthesiologists created a network of endorsed simulation centers to provide simulation training that allows American Board of Anesthesiology diplomates to earn points to fulfill the American Board of Anesthesiology’s Maintenance of Certification in Anesthesiology Part 4 requirements. Crisis Management in Anesthesiology is divided into two sections. The first section, titled Basic Principles of Crisis Management in Anesthesiology contains four chapters. The first chapter explores fundamental aspects of the dynamic decision-making process during intraoperative anesthesia care. The best figure of the entire book ( figure 1–4) is in this chapter and displays a model of the anesthesia provider’s cognitive processes during complex intraoperative decision-making. This diagram is worthy of extensive review and reflection, as it illustrates the interplay of different levels of mental activity such as paying attention to data streams, predicting future states, and prioritizing problems and activities. The second chapter addresses the principles of anesthesia crisis resource management (ACRM). The authors describe how they adapted the principles of crew resource management in the aviation industry to the field of anesthesiology and chose the either in the margin or in conjunction with a highlighted passage.