Preface

Obstetric Anesthesia: Quick References & Practical Guides is a new book designed for clinicians and for their obstetric anesthesia practices.

Several high-quality textbooks have been published that provide detailed understanding of the current science behind obstetrics and obstetric anesthesia. Obstetric Anesthesia: Quick References & Practical Guides complements existing textbooks by assisting learners and clinicians with concise answers and applicable clinical pathways. By condensing most topics into short, evidence-based description and clinically useful tables and charts, a busy clinician can find the answer to a question, learn clinical pearls. This book represents a collection of common and uncommon clinical challenges with up-to-date obstetric anesthesia practices that serve both experienced and novice clinicians.

This book also supports the obstetric anesthesia practice by providing easily adaptable pathways, protocols, and standard operating procedures. Standard work has been a guiding principle in the manufacturing industry for over a century. As stated by a founding father of Toyota’s manufacturing, Taiichi Ohno, “Without standards, there can be no improvement.” Only recently has medicine begun to explore the idea of standardization, not just of clinical work but also the working environment. This crucial evolution in medicine will lead to better outcomes for patients, providers, and trainees.

The training of anesthesia providers has historically been performed using an apprenticeship model. We all learned from our teachers, who learned from theirs, and so forth. There was little uniformity in training. Even large training programs have clinicians with differing knowledge and practice styles. At times this can be confusing, as the clinician of the day may do things that are the opposite of the clinician from the day before. Gradually, medical education has evolved from this apprenticeship model to evidence-based medicine, whereby clinicians address problems in a similar fashion.

Over 20 years ago, the obstetric anesthesia service at Beth Israel Deaconess Medical Center began the evolution from an individual clinician practice to a group practice where each of us practices similarly. To do this, we implemented practice protocols and standard operating procedures based on the best scientific evidence. At the same time, we started an intense quality improvement program to understand where our failures were and how they could be improved. The lessons we learned are enmeshed in this book. While our information will need to be adapted to local environments, we believe that the value of a shared model of clinical practice is extremely rewarding and essential for patient care.

We sincerely hope that by providing our clinical tips, guidelines, and protocols, we can further the clinical improvement of obstetric anesthesia.