Anesthesia in High-Risk Patients: Advanced Perioperative Medicine for Complex Comorbidities, Physiologic Instability, Critical Illness, and Special Surgical Populations

The anesthetic a healthy patient tolerates without a second thought can push a patient with little physiologic reserve past the point of compensation within minutes.

Patients now reaching the operating room are older and sicker. Many arrive with heart failure, valve disease, kidney or liver failure, diabetes, frailty, pregnancy complications, or a medication list that touches every decision. The knowledge needed to care for them is scattered across organ-system texts and guidance that is revised year after year, and under time pressure it is easy to miss the one factor that changes the plan.

This comprehensive textbook brings that knowledge together. It treats high risk as a physiologic state rather than a label, and every chapter returns to four questions: What reserve does this patient have? What will this operation ask of it? Where is the margin narrowest? What will you do if it fails?

Inside, you will learn how to:

• Assess and stratify risk with functional capacity, frailty, and validated scoring tools, and decide what can realistically be optimized before surgery.
• Apply organ-specific physiology to plan induction, ventilation, fluids, and blood pressure targets in cardiac, pulmonary, renal, hepatic, and endocrine disease.
• Time medications precisely, including anticoagulant and antiplatelet interruption, neuraxial intervals, reversal, glucose-lowering drugs, and opioid treatment for substance use disorders.
• Recognize population-specific traps in older adults, pregnant patients, neonates and children, and patients with neurologic, psychiatric, or substance use conditions.
• Act decisively under pressure in trauma, emergency surgery, sepsis, shock, and postoperative deterioration.
• Check your reasoning with worked calculations that show every unit, original clinical cases, and review questions with explained answers.

Key topics

Coronary disease and heart failure; aortic stenosis and pulmonary hypertension; arrhythmias and cardiac devices; patient blood management; sleep apnea and the high-risk airway; dialysis and acute kidney injury; cirrhosis; glucose control and obesity; high-risk obstetric anesthesia; congenital heart disease in children; chronic pain and opioid tolerance; regional anesthesia for risk reduction; and massive transfusion.

Each chapter closes with a short note naming the principal professional guidance behind its recommendations. A glossary, a detailed index, and eight quick-reference appendices on drug dosing, risk tools, antithrombotic timing, vasoactive drugs, acid-base, pediatrics, the difficult airway, and postoperative escalation support use at the point of care.

Who this book is for

Anesthesiology residents and fellows, nurse anesthetists and anesthesiologist assistants, perioperative physicians, intensivists, and experienced clinicians who want their most complex patients organized in a single volume. Suitable for teaching programs, examination preparation, and daily clinical reference.

Add this reference to your practice and approach your next high-risk patient with a clear plan for where the margin is narrowest and what you will do if it fails.