This textbook is the latest in the Oxford University Press Case Histories series. It has tried to stay true to the basic form of the earlier works, i.e. the case histories are largely based on (anonymous) real cases, and a small amount of information is given, followed by a question posed as to how the patient should be managed. The reader should thus try to formulate a management plan in their own mind at each stage before reading further. However, the authors recognize that a book on anaesthetic management is subtly different from other specialties.
First, the diagnosis has generally been made, and one is usually asked to provide an anaesthetic intervention for a procedure to treat that diagnosis. That said, one should always keep an open mind. Thus, there is a break from the pattern in other books of history–investigation–diagnosis–treatment. Each chapter in this book has a brief introduction with some learning outcomes for the following cases. As some of the chapters could warrant a book in their own right, we have not attempted to give a comprehensive overview of all possible cases within one area. Rather, we have attempted to report important cases which illustrate learning outcomes within this field.
Second, there is often a lack of what would arguably be called the gold standard of treatment in medicine (an adequately powered randomized controlled trial in humans) in the practice of anaesthesia. The decision as to which anaesthetic technique is used will be determined by such factors as the condition and comorbidities of that patient, the experience of the individual anaesthetist, and, in some circumstances, the equipment available. There is thus generally a discussion of the advantages and disadvantages of the techniques used.
There are also some concepts in anaesthesia that do not fit easily into a case-based discussion yet are still important to the practice of anaesthesia as a whole. This is best exemplified in Chapter 1, which touches on the efficient running of an anaesthetic list and department, as well as the discussion of anaesthetic risk.
Whilst every care has been taken to ensure that the book is free from factual errors, it is left to the reader to ensure the correct dosage of any drug regimen mentioned.
We hope this textbook will be of use to not only anaesthetic colleagues in training, particularly those preparing for professional examinations, but also to the established anaesthetist in terms of their continuing education.
We acknowledge that there is some overlap between cases. However this merely emphasizes the multi-faceted way that similar problems may present to colleagues regardless of which subspecialty of anaesthesia they practice.
We would like to thank all the colleagues who contributed to this book. Most of all, we would like to thank our respective families for their tolerance and unstinting support during the preparation of this work.
JG McCormack, KP Kelly
Edinburgh, July 2014