Risk and Uncertainty in Anesthesia

Abstract

This article discusses risk and uncertainty, both stochastic and epistemic, as it applies to anesthesia. It shows the difficulty in quantifying risk of individual case and the somewhat arbitrary and even incorrect and naive assignment of risk in individual patient care management. Effective and honest communication remains at the core of physician-patient relationship in discussing, evaluating and managing the individual case for optimum outcome as well as patients’ and their families' satisfaction and understanding.

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R. Pohorecki and G. Hill, "Risk and Uncertainty in Anesthesia," Open Journal of Anesthesiology, Vol. 3 No. 7, 2013, pp. 338-344. doi: 10.4236/ojanes.2013.37072.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] J. Gullberg, “Probability Theory,” In: J. Gullberg, Ed., Mathematics. From the Birth of Numbers, W.W. Norton & Company, New York, 1997, p. 963.
[2] V. Collins, “Records, Mortality and Medical Legal Considerations,” In: V. Collins, Ed., Principles of Anesthesiology, Lea & Febiger, Philadelphia, 1976, pp. 31-42.
[3] T. Perez and I. D. Voters, “Legal Opinion,” 2012. www.justice.gov/crt/about/vot/sec_5/ltr/l_031212.php
[4] A. Pan, Q. Sun, A. Bernstein, M. Schulze, J. Manson, M. Stampler, et al., “Red Meat Consumption and Mortality,” Archives of Internal Medicine, Vol. 172, No. 7, 2012, pp. 555-563. doi:10.1001/archinternmed.2011.2287
[5] D. Spiegelhalter, “What Does a 13% Increased Risk of Death Mean?” 2012.
[6] M. Galesic and R. Garcia-Retamero, “Statistical Numeracy for Health. A Cross-Cultural Comparison with Probabilistic National Samples,” JAMA Internal Medicine, Vol. 107, No. 5, 2010, pp. 462-468. doi:10.1001/archinternmed.2009.481
[7] Adams AM, Smith AF. Risk perceptionand communication: Recent developments and implications for anesthesia,. Anaesthesia, Vol. , No. , 2001;56(8):745-55. doi:10.1046/j.1365-2044.2001.02135.x
[8] T. E. Schulte and H. Tinker, “Narkomed 6400 Anesthesia Machine Failure,” Anesthesia & Analgesia, Vol. 106, No. 3, 2008, pp. 1018-1019. doi:10.1213/ane.0b013e3181632257
[9] J. J. Wang, S. T. Ho, Y. H. Liu, Y. Lee, Y. C. Liao and C. M. Ho, “Dexamethasone Reduces Nausea and Vomiting after Laparoscopic Cholecystectomy,” British Journal of Anaesthesia, Vol. 83, No. 5, 1999, pp. 772-775. doi:10.1093/bja/83.5.772
[10] W. O. Bobo, W. A. Billups and J. Hardy, “Boerhavee’s Syndrome: A Review of sIx Cases of Spontaneous Rupture of the Esophagus Secondary to Vomiting,” Annals of Surgery, Vol. 172, No. 6, 1970, pp. 1034-1038. doi:10.1097/00000658-197012000-00017
[11] S. Slogoff and A. Keats, “Does Perioperative Myocardial Ischemia Lead to Postoperative Myocardial Infarction? Anesthesiology, Vol. 62, No. 2, 1985, pp. 107-114. doi:10.1097/00000542-198502000-00002
[12] K. Raby, S. Brull, F. Timimi, S. Akhtar, S. Rosenbaum and C. Naimi and A. Wittermore, “The Effect of Heart Rate Control on Myocardial Ischemia among High-Risk Patients after Vascular Surgery,” Anesthesia & Analgesia, Vol. 88, No. 3, 1999, pp. 477-482. doi:10.1097/00000539-199903000-00002
[13] R. Weron, “Levy-Stable Distributions Revisited: Tail Index > 2 Does Not Exclude the Levy-Stable Regime,” International Journal of Modern Physics, Vol. 12, No. 2, 2001, pp. 209-223. doi:10.1142/S0129183101001614
[14] N. Taleb and A. Pilpel, “On the Unfortunate Problem of Nonobservability of the Probability Distribution,” 2004. www.fooledbyrandomness.com/knowledge.pdf
[15] J. Zar, “Data Transformation,” In: J. Zar, Ed., Biostatistical Analysis, Prentice-Hall, Upper Saddle River, 1984, pp. 236-243.
[16] B. Riou, P. Landais, B. Vivien, P. Stell, I. Labbene and P. Carli, “Distribution of the Probability of Survival Is a Strategic Issue for Randomized Trials in Critically Ill Patients,” Anesthesiology, Vol. 95, No. 1, 2001, pp. 56-63. doi:10.1097/00000542-200107000-00014
[17] A. Schwartz and G. Bergus, “Embracing Uncertainty,” In: A. Schwartz and G. Bergus, Eds., Medical Decision Making Cambridge University Press, Cambridge, 2008, pp. 55-74. doi:10.1017/CBO9780511722080.007
[18] J. Ioannides, “Why Most Published Research Findings Are False,” PLoS Medicine, Vol. 2, No. 8, 2005, p. E124. doi:10.1371/journal.pmed.0020124
[19] B, Castro, L, Freedman, W, Craig and C. Lynch, “Explosion within an Anesthesia Machine: Baralyme, High Fresh Gas Flow and Sevoflurane Concentration,” Anesthesiology, Vol. 101, No. 2, 2004, pp. 537-539. doi:10.1097/00000542-200408000-00036
[20] J. Wu, J. Previte, E. Adler, T. Myers, J. Ball and J. Gunter, “Spontaneous Ignition, Explosion, and Fire with Sevoflurane and Barium Hydroxide Lime,” Anesthesiology, Vol. 101, No. 2, 2004, pp. 534-537. doi:10.1097/00000542-200408000-00035
[21] K, Eagle, P, Berger, H, Calkins and B. Chaitman, “ACC/ AHA Guidline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery—Executive Summary,” Circulation, Vol. 105, 2002, pp. 1257-1267.
[22] P. Devereaux, H. Yang, S. Yusuf, G. Guyatt, K. Leslie, J. Villar, et al., “Effects of Extended-Release Metoprolol Succinate in Patients Undergoing Non-Cardiac Surgery (POISE trial): A Randomised Controlled Trial,” Lancet, Vol. 371, No. 9627, 2008, pp. 1839-1847. doi:10.1016/S0140-6736(08)60601-7
[23] J. Sear, J. Giles, G. Howard-Alpe and P. Foex, “Perioperative Beta-Blokade, 2008: What Does POISE Tell Us, and Was Our Earlier Caution Justified?” British Journal of Anaesthesia, Vol. 101, No. 2, 2008, PP. 135-138. doi:10.1093/bja/aen194
[24] T. Monk and B. Weldon, “Anesthetic Depth Is a Predictor of Mortality: It’s Time to Take the Next Step,” Anesthesiology, Vol. 112, No. 5, 2010, pp. 1070-1072. doi:10.1097/ALN.0b013e3181d5e0eb
[25] C. Kalkman, L. Peelen and K. Moons, “Pick up the Pieces: Depth of Anesthesia and Long-Term Mortality,” Anesthesiology, Vol. 114, No. 3, 2011, pp. 485-487. doi:10.1097/ALN.0b013e31820c2ba2
[26] J. Guay, “First, Do No Harm: Balancing the Risks and Benefits of Regional Anesthesia in Patients with Underlying Neurological Disease,” Canadian Journal of Anesthesia, Vol. 55, No. 8, 2008, pp. 489-494. doi:10.1007/BF03016667
[27] R. Litman and H. Rosenberg, “Malignant Hypethermia-Associated Diseases: State of the Art Uncertainty,” Anesthesia & Analgesia, Vol. 109, No. 4, 2009, pp. 1004-1005. doi:10.1213/ane.0b013e3181ae6b96
[28] T. Shiga, Z. Wajima, T. Inoue and A. Sakamoto, “Predicting Difficult Intubation in Apparently Normal Patients,” Anesthesiology, Vol. 103, No. 2, 2005, pp. 429-37. doi:10.1097/00000542-200508000-00027
[29] J. Tse, E. Rimm and A. Hussain, “Predicting Difficult Endotracheal Intubation in Surgical Patients Scheduled for General Anesthesia: A Prospective Blind Study,” Anesthesia & Analgesia, Vol. 81, No. 2, 1995, pp. 254-258. doi:10.1097/00000539-199508000-00008
[30] J. Homburger and S. Meiler, “Anesthesia Drugs, Immunity, and Long-Term Outcome,” Current Opinion in Anesthesiology, Vol. 19, No. 4, 2006, pp. 423-428. doi:10.1097/01.aco.0000236143.61593.14
[31] U. M. Stamer, R. W. Stuber and T. M. Wulf, “Contraindications to Regional Anaesthesia in Obstetrics: A Survey of German Practice,” International Journal of Obstetrics, Vol. 16, No. 4, 2007, pp. 328-335. doi:10.1016/j.ijoa.2007.05.011
[32] T. Gernsheimer, A. H. James and R. Stasi, “How I Treat Thrombocytopenia in Pregnancy,” Blood, Vol. 121, No. 1, 2013, pp. 38-47. doi:10.1182/blood-2012-08-448944
[33] L. C. Stehling, D. C. Doherty, R. J. Faust, A. G. Greenburg and C. R. Harrisonl, “Practice Guidlines for Blood Component Therapy: A Report by the American Society of Anesthesiologists Task Force on Blood Component Therapy,” Anesthesiology, Vol. 84, No. 3, 1996, pp. 732-747. doi:10.1097/00000542-199603000-00032
[34] G. Nutall, B. Brost, R. Connis, J. Gessner, C. Harrison, R. Miller, et al., “Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies: An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies,” Anesthesiology, Vol. 105, No. 1, 2006, pp. 198-208. doi:10.1097/00000542-200607000-00030
[35] D. Lloyd-Jones, M. Larson, A. Beisera and D. Levy, “Lifetime Risk of Developing Coronary Heart Disease,” Lancet, Vol. 353, No. 9147, 1999, pp. 89-92. doi:10.1016/S0140-6736(98)10279-9
[36] S. Oskamp, “Overconfidence in Case-Study Judgments,” In: S. Oskamp, Ed., Judgment under Uncertainty: Heuristics and Biases, Cambridge University Press, Cambridge, 2001, pp. 287-293.
[37] E. Berner and M. Graber, “Overconfidence as a Cause of Diagnostic Error in Medicine,” American Journal of Medicine, Vol. 121, No. 5, 2008, pp. S2-S23. doi:10.1016/j.amjmed.2008.01.001
[38] D. N. Wijeysundera, P. C. Austin, W. S. Beattie, J. E. Hux and A. Laupacis, “Outcomes and Processes of Care Related to Preoperative Medical Consultation,” Archives Internal Medicine, Vol. 170, No. 15, 2010, pp. 1365-1374. doi:10.1001/archinternmed.2010.204
[39] M. Stiegler, C. Neelankavill, C. Canales and A. Dhilon, “Cognitive Errors Detected in Anesthesiology: A Literature Review and Pilot Study,” British Journal of Anaesthesia, Vol. 108, No. 2, 2012, pp. 229-235. doi:10.1093/bja/aer387
[40] D. Kahneman, “The Fourfold Pattern,” In: D. Kahneman, Ed., Thinking, Fast and Slow, Farrar, Straus and Giroux, New York, 2011, pp. 300-321.

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