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Anesthesia for the High-Risk Patient. 2nd edition

Edited by McConachie I. Cambridge, UK: Cambridge University Press; 2009. 302 pages. ISBN: 978-0-521-71018-3

In fewer than 300 pages, this book covers the complex topic of anesthesia for the high-risk patient in a comprehensive and complete way. Each chapter covers the most up-to-date literature, providing a summary of evidence as well as practical advice on how to approach and tackle the multitude of different problems of highrisk patients. This book describes anesthesia as the science of perioperative medicine, from preoperative assessment to postoperative analgesia, via intraoperative management.

In the first chapters, the reader is led through the topics of risk, epidemiology, and risk assessment. Statistical concepts such as the number needed to treat and absolute and relative risk reduction are also explained, making the subsequent chapters even easier to understand. Particular attention is given to cardiovascular and respiratory risk; guidelines on how to manage cardiovascular risk in cardiac and noncardiac surgery are also available, indicating which drugs to start, continue, or stop before surgery. The book presents an extensive explanation of the different intraoperative approaches to the high-risk surgical patient. A chapter not to miss is definitely 'Pharmaco-physiological approaches to the high-risk surgical patient', in which the pathophysiology of surgery is explained together with different approaches to identify, stratify, and treat high-risk surgical patients. In this chapter, a literature review brings an up-to-date view on hemodynamic intraoperative optimization, showing that this approach carries important advantages to improve patient outcomes. Importantly, this book does not forget that the role of perioperative medicine is also one of managing high-risk patients after surgery. Postoperative complications are classified and described, with appropriate consideration given to the early recognition and management of these problems. An interesting chapter that completes a 360-degree view of anesthesia is the one on the anesthesia of critically ill patients ('The critically ill patient undergoing surgery'). Now that more and more intensive care units are populated by anesthetists, optimal anesthetic management of critically ill patients requiring surgery is mandatory in order to provide a continuum of care and the best chances for the patient to recover from a critical illness.

In conclusion, this book could be placed on every desk in the hospital and would be a valuable resource in the hands of the junior as well as the more experienced anesthetist.

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Correspondence to Andrew Rhodes.

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AR has received lecture fees from LiDCO (Cambridge, UK). The authors declare no other competing interests.

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Cecconi, M., Rhodes, A. Anesthesia for the High-Risk Patient. 2nd edition. Crit Care 14, 312 (2010).

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  • Critical Illness
  • Postoperative Analgesia
  • Relative Risk Reduction
  • Anesthetic Management
  • Statistical Concept