Description

Several of the seminars in this issue discuss the concept of risk. Risk and chance are concepts which we know are poorly understood by the general public, but are also often poorly estimated by the professions, sometimes due to poor understanding of the known relative risks, but often due to the paucity of research data to elucidate differential risk. Several of these articles highlight these issues in detail.

Most of us judge that we estimate risk well, but when we refuse to place an epidural in the elderly COPD patient with a perforated viscus, for fear of epidural abscess or start to use a new drug or technique, can we really say that we understand the relative risk and risk/benefit ratio? Indeed does such information actually exist that may help us to make sensible and considered judgements in such circumstances?

In the first of 2 excellent and thought provoking articles on risk, Jepegnanam & Smith outline some of the processes involved in evaluating risk and making judgements on relative risk. We do this on a daily basis, almost instinctively, yet we rarely think in detailed evidence based terms about how we should evaluate risk in many of our daily challenges. They follow this with a series of interesting case histories outlining our attitude to risk in everyday anaesthetic practice for commonly encountered situations.

Fairgrieve & Robinson then debate one of the old perennial problems of when it is safe to anaesthetise a child with an URTI. This involves careful judgement of risk and although there is some evidence in the literature, We suspect that this is poorly understood and many of us may make such decisions more on our own preparedness to accept risk taking than on an evidence based approach. This article summarises current understanding of the relative risk and when elective anaesthesia should be delayed and for how long.

Another common area of controversy in relative risk assessment is in thromboprophylaxis in major joint replacement. The current evidence and pros and cons of different thromboprophylactic techniques are well summarised in the article by Dolenska & Yanni. What is notable is that many of the most important questions remain to be answered and this article should stimulate all of us, including our surgical colleagues, to question our own practice in this area.

Indeed what is common to all these articles is how do we evaluate risk when a lot of the answers are not known. The importance remains in continually keeping up to date from the literature and meetings and evaluating our own practice against available standards and the practice of colleagues.