Complications: an anaesthetist's rather than a surgeon's notes (with apologies to Atul Gwande)

Eight years ago, we identified a gap in the anaesthetic literature, and edited a book on anaesthetic and peri-operative complications [1]. The topics covered generated sufficient interest that we were invited to organise a seminar on perioperative complications at the Association of Anaesthetists of Great Britain and Ireland (AAGBI); it has grown in popularity and attendance year on year. The seminar now takes place twice a year, and is expanding into other UK venues. We did not anticipate that there would be so much interest among anaesthetists regarding the complications of anaesthetic practice and how to manage them. We felt the reason for the popularity of the seminars was that we attracted great speakers every time – real jobbing doctors, facing complications and providing advice to other front-line doctors, just like us. This special supplement of Anaesthesia focusing on risk and complications provides a timely and much-needed update; quantifying risks and addressing complications to help our understanding, while adding to our cognitive framework and filling in the gaps. This information helps us put more accurate, current figures to patients in a meaningful way when making shared decisions regarding best treatment options. We are familiar with the panoply of risk stratification scores available to help doctors; we believe that these articles will provide us with additional up-todate information to start helping patients. They offer us the starting point of facts and knowledge that we require when consulting with patients on material risks, so that we can tailor our information them in a personalised way. However, before the wider issues regarding complications can be discussed, there are two questions which need to be addressed; namely, ‘Why are anaesthetists so interested in complications? ’ and ‘What is a complication? ’. These questions are particularly pertinent when we hear the paradox that, although the number of serious mistakes reported to the national reporting and learning system (NRLS) is falling, the overall number of incidents is increasing [2]. Alan Merry goes some way to answering the surprisingly difficult question of how to define exactly what constitutes a complication [3]. The AAGBI and Royal College of Anaesthetists recognised many years ago the need to understand complications of anaesthesia from a more pragmatic, rather than definitional viewpoint, and have worked to set standards globally, with national audit projects in order to provide both numerator and denominator data for major anaesthetic complications, as well as offering recommendations and advice on best practice [4]. As anaesthetists, the majority of complications we see take immediate effect and require immediate action to prevent life-altering or life-threatening outcomes. There are two ways in which we can arm ourselves to deal with these stressful events. An understandable first response is to read and share knowledge of core topics, such as obstetric anaesthesia [5] and the management of adverse drug reactions [6], to enable us to recognise and manage events promptly. Another approach is to consider the management of the complication more broadly, in order to consider the impact of human factors on our individual and team performance in dealing with the emergency; Jones et al. talk explicitly about this area in their systematic review [7]. It is also important to highlight more insidious, slowly evolving, yet equally devastating complications, such as postoperative cognitive