Preface

In 1977, Dr. Kenneth Walker called his young colleague, Dr. Michael Lubin, to tell him that there was going to be a new consultation service and he was going to be the first attending. Dr. Lubin replied, “A consult service? That's great! I don't know anything about that stuff.” Dr. Walker said, “Don't worry,” and hung up the phone.

And now, 35 years later, I and my co-editors are publishing the fifth edition of our textbook on perioperative consultation! The core of knowledge in perioperative care has changed immensely; in 1977 there was no information until Dr. Lee Goldman's seminal paper in the New England Journal of Medicine [1]. Since then, there has been an explosion of new information. Many medical people have built their academic careers in this area.

In some specialties, like cardiology, there has been a huge amount of exploration and progress, albeit along with some backtracking. In the previous edition, the latest advance was perioperative beta blockade; today, there is less enthusiasm for this intervention. While in the early days of cardiac evaluation, there was great emphasis placed on invasive testing and interventions, for many surgery patients there has been little benefit found in an aggressive approach to perioperative revascularization. The perioperative management of diabetes has also been the focus of much investigation. Indeed, progress is being made in a multitude of fields.