Quantifying Risk in Clinical Anesthesia - Abstract
This article discusses risk and uncertainty of general anesthesia, taking into account consideration of unknown and random variables and probabilities as well as the acknowledgment of known and possibly controlled variables as it applies to anesthesia. It shows the difficulty in quantifying risk of individual case and the somewhat arbitrary and even incorrect and naïve 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 family satisfaction and the acceptance of the inherent risks involved in the administration of general anesthesia in humans.
Risk is an integral part of life that is brought by natural forces as well as human activity. Though it is reasonable to assume that many people pondered on the nature of the risk, one can, somewhat arbitrarily, trace the beginnings to 16th century Italian mathematician and physician Gorelamo Cardano, who was more interested in risk related to money wagering and potential monetary gain than to outcomes of medical practice [1]. The assessment of the inherent risk of general anesthesia administration became possible only after introduction of anesthesia record over 100 years ago, which allowed more substantiated and reproducible comparisons [2]. Once risk is quantified it can and should be used to guide the decision process through the meaningful narrative. It is common to express risk as a probability or probability distribution. That method, even in simple models, forces us to make certain assumptions and often tends to obscure the difference between the uncertainty about the sensitivity and specificity of the collected data and the uncertainty about the accuracy and significance of the results.
In this review we attempt to broadly define the risk in anesthesia and discuss the relation between risk and uncertainty. We also want to bring to light some imperfection of human mind that are relevant in addressing risk. The decision process, studied by cognitive psychologists, has innate flaws that, even with obvious data limit our ability to recognize, to address, and to properly react to issues related to risk.