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Anesthesiology. 2014 Jan;120(1):204-17. doi: 10.1097/ALN.0000000000000073.

Cognitive processes in anesthesiology decision making.

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From the Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (M.P.S.); and Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois (A.T.). The figures were redrawn by Annemarie B. Johnson, C.M.I., Medical Illustrator, Vivo Visuals, Winston-Salem, North Carolina.


The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology.Many nonrational (i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making.

[Indexed for MEDLINE]

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