Figure 83-1 Cognitive process model of the anesthetist's real-time problem-solving behavior (see text for detailed description). Five levels of cognition operate in parallel. The core process involves a main loop (arrows) of observation, decision, action, and reevaluation. The core process is managed by two levels of metacognition, involving supervisory control, allocation of attention, and resource management (above the core process). Each component of the model requires different cognitive skills, and each component is vulnerable to a different set of performance failures or "errors." BP, blood pressure; CO, cardiac output; MAP, mean arterial pressure; SVR, systemic vascular resistance. (From Gaba DM, Fish KJ, Howard SK: Crisis Management in Anesthesiology. New York, Churchill Livingstone, 1994.)