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Advances in Neurology, Volume 28, Brain Edema: Pathology, Diagnosns, and Therapy. Edited by Cervos-Navarro J and Ferszt R. Published by Raven Press, New York. Pp 511; illustrated; indexed. Price $865.28.
Br. J. Anaesth. (1982), 54, 367
BOOK REVIEWS The Quantitattvt Practice of Anaesthesia: Use of Closed Circuit.
By Harry J. Lowe and Edward Ernst. Published (1981) by Williams & Wilkins, Baltimore. Pp 234, illustrated, indexed Price not stated.
Electrical Safety in Hospitals. By C. S. Ward. Published (May, 1981) by Henry Kunpton, London. Pp 197; illustrated; indexed. Pnce £10.25. The search for safe electromedical equipment has led to a steady senes of developments in design and circuitry intended to protect the panent from the hazards of electric shock and bums in the event of faults developing in the equipment or in the event of misuse. Nevertheless, the education of the user of the equipment is of equal importance, particularly m the case of apparatus such as the diathermy or the defibnllator with which large elcctnc currents and voltages are deliberately applied to the patient. Dr Ward's book is a valuable contribution to the problem of education in the safe use of electromedical equipment. The book is concerned pnmanly with the question of electrical safety in hospitals, which it covers in a comprehensive manner and with medical readership in mind. The subject matter is somewhat broader than that suggested by the otic, as the earlier chapters are devoted to an examination of the nature of electricity, its properties and the behaviour of elecmcal components. This treatment is necessanly sketchy in places. A detailed desenption of the detection of biological electrical potentials is not included, but the book covers in depth all techniques involving the elective application of electric potentials to the body as well as certain salutory lessons drawn from incidents involving non-elecn ve application Anyone who is concerned to know the reasons behind the various operating procedures of electromedical equipment and who is concerned to use it safely will find the later chapters well worth reading, even if the introductory material is heavier going. P. B. Davis
Downloaded from http://bja.oxfordjournals.org/ at Cornell University Library on July 28, 2015
There is every indication that closed and low-flow breathing systems in anaesthesia are enjoying something of a renaissance. If there is a single obvious impediment to this it is that a generation of anaesthetists has been trained in the administration of comparatively safe inhalation anaesthesia using systems which have minimal or no rebreathing, thus the inspired concentration of a volatile anaesthetic is thought to be easily predictable from the vaporizer setting This, together with the concept of MAC as a measure of dose has lessened the need for skill in recognizing the signs of anaesthesia. If this deficiency can be corrected—and there are many reasons in addition to the use of closed and low-flow systems to justify the attempt—there is no reason why the use of lowflowsystems, particularly where oxygen is the sole earner gas, should call for any great fuss. Even the use of nitrous ojnde with oxygen as the earner gas can be quite safe if the pattern of nitrous oxide uptake to the tissues is understood and an oxygen monitor is used. I have laboured these points because I believe that closed or low-flow system anaesthesia is not too diificult and can be fun Having perused their book I am satisfied that Drs Lowe and Ernst would agree with me on the latter, but within the book they have elevated what should be a relatively simple art to an elaborate science and some of their text is likely to scare off all but those who have an advanced capability in mathemancs I do not wish to suggest that there is nothing of value in this text because the theontician will find much that is of interest and a good deal to argue about; Drs Low and Ernst, in spite of their elaborate text, confine themselves to an ideal panent considered as a series of tight compartments which do not leak. In the preface it is implied that the text is designed to encourage the wider use of closed and low-flow systems. If it is to do that, I would recommend that ordinary mortals might begin at page 153. Here they will learn that, in an anaesthesia machine, the source of gases might come from a central line or from tanks attached to the machine—trivial perhaps, but a blessed relief after the mental gymnastics that were necessary to follow all that preceded it There is much in this book which will reward careful study because the text extends beyond the immediate considerations of closed and low-flow systems and reviews fundamental aspects of the uptake and elimination of gaseous and volatile anaesthetics. Some of the tables will be useful sources of reference. My disappointment is that the authors have failed to define their target readership adequately. In additon there is a lack of balance: Dr Low's demonstration that the cumulative vapour requirements in a closed system are proportional to the square root of elapsed time is of interest, and occasionally of practical value. It does not deserve one-sixth of the space allocated to a bnef introduction chapter of the history of closed-circuit anaesthesia or a 31-page chapter within the main text. Alastatr A. Spence
Advances in Neurology, Volume 28, Brain Edema: Pathology, Diagnosis, and Therapy. Edited by J Cervos-Navarro and R Ferszt. Published by Raven Press, New York. Pp 511; illustrated; indexed. Pnce $65.28. This is an unusual book, in that it consists not only of papers given at a scientific conference (in this case, 1979—Earnst Reuter Symposium), but also a number of chapters which review the current position in different areas of research in brain oedema. I began to read it expecting that this would be a thinly-veiled disguise to put across another Conference Proceedings, but in fact found the book to be most worthwhile. The following subjects are amongst those covered in these review chapters: Quantification of brain edema, Intracranial pressure monitoring, CSF Formation and absorption, Ischaemic brain edema, Metabolic basis of brain edema, Biochemistry of brain edema and a fascinating chapter by Klatzo and colleagues on the time-course of the resolution of brain edema It was interesting to read that the vasogenic oedema of expenmental cold injury mainly resolves between 4 and 7 days, which agrees rather well with clinical expenence in the management of severe head injury. The book finishes with several chapters on the treatment of brain oedema. This book is produced on high-quality paper with excellent illustrations and is recommended to those anaesthetists who wish to have more than a basic understanding of this important type of brain pathology. D. G. McDowall
BOOK REVIEWS The Quantitattvt Practice of Anaesthesia: Use of Closed Circuit.
By Harry J. Lowe and Edward Ernst. Published (1981) by Williams & Wilkins, Baltimore. Pp 234, illustrated, indexed Price not stated.
Electrical Safety in Hospitals. By C. S. Ward. Published (May, 1981) by Henry Kunpton, London. Pp 197; illustrated; indexed. Pnce £10.25. The search for safe electromedical equipment has led to a steady senes of developments in design and circuitry intended to protect the panent from the hazards of electric shock and bums in the event of faults developing in the equipment or in the event of misuse. Nevertheless, the education of the user of the equipment is of equal importance, particularly m the case of apparatus such as the diathermy or the defibnllator with which large elcctnc currents and voltages are deliberately applied to the patient. Dr Ward's book is a valuable contribution to the problem of education in the safe use of electromedical equipment. The book is concerned pnmanly with the question of electrical safety in hospitals, which it covers in a comprehensive manner and with medical readership in mind. The subject matter is somewhat broader than that suggested by the otic, as the earlier chapters are devoted to an examination of the nature of electricity, its properties and the behaviour of elecmcal components. This treatment is necessanly sketchy in places. A detailed desenption of the detection of biological electrical potentials is not included, but the book covers in depth all techniques involving the elective application of electric potentials to the body as well as certain salutory lessons drawn from incidents involving non-elecn ve application Anyone who is concerned to know the reasons behind the various operating procedures of electromedical equipment and who is concerned to use it safely will find the later chapters well worth reading, even if the introductory material is heavier going. P. B. Davis
Downloaded from http://bja.oxfordjournals.org/ at Cornell University Library on July 28, 2015
There is every indication that closed and low-flow breathing systems in anaesthesia are enjoying something of a renaissance. If there is a single obvious impediment to this it is that a generation of anaesthetists has been trained in the administration of comparatively safe inhalation anaesthesia using systems which have minimal or no rebreathing, thus the inspired concentration of a volatile anaesthetic is thought to be easily predictable from the vaporizer setting This, together with the concept of MAC as a measure of dose has lessened the need for skill in recognizing the signs of anaesthesia. If this deficiency can be corrected—and there are many reasons in addition to the use of closed and low-flow systems to justify the attempt—there is no reason why the use of lowflowsystems, particularly where oxygen is the sole earner gas, should call for any great fuss. Even the use of nitrous ojnde with oxygen as the earner gas can be quite safe if the pattern of nitrous oxide uptake to the tissues is understood and an oxygen monitor is used. I have laboured these points because I believe that closed or low-flow system anaesthesia is not too diificult and can be fun Having perused their book I am satisfied that Drs Lowe and Ernst would agree with me on the latter, but within the book they have elevated what should be a relatively simple art to an elaborate science and some of their text is likely to scare off all but those who have an advanced capability in mathemancs I do not wish to suggest that there is nothing of value in this text because the theontician will find much that is of interest and a good deal to argue about; Drs Low and Ernst, in spite of their elaborate text, confine themselves to an ideal panent considered as a series of tight compartments which do not leak. In the preface it is implied that the text is designed to encourage the wider use of closed and low-flow systems. If it is to do that, I would recommend that ordinary mortals might begin at page 153. Here they will learn that, in an anaesthesia machine, the source of gases might come from a central line or from tanks attached to the machine—trivial perhaps, but a blessed relief after the mental gymnastics that were necessary to follow all that preceded it There is much in this book which will reward careful study because the text extends beyond the immediate considerations of closed and low-flow systems and reviews fundamental aspects of the uptake and elimination of gaseous and volatile anaesthetics. Some of the tables will be useful sources of reference. My disappointment is that the authors have failed to define their target readership adequately. In additon there is a lack of balance: Dr Low's demonstration that the cumulative vapour requirements in a closed system are proportional to the square root of elapsed time is of interest, and occasionally of practical value. It does not deserve one-sixth of the space allocated to a bnef introduction chapter of the history of closed-circuit anaesthesia or a 31-page chapter within the main text. Alastatr A. Spence
Advances in Neurology, Volume 28, Brain Edema: Pathology, Diagnosis, and Therapy. Edited by J Cervos-Navarro and R Ferszt. Published by Raven Press, New York. Pp 511; illustrated; indexed. Pnce $65.28. This is an unusual book, in that it consists not only of papers given at a scientific conference (in this case, 1979—Earnst Reuter Symposium), but also a number of chapters which review the current position in different areas of research in brain oedema. I began to read it expecting that this would be a thinly-veiled disguise to put across another Conference Proceedings, but in fact found the book to be most worthwhile. The following subjects are amongst those covered in these review chapters: Quantification of brain edema, Intracranial pressure monitoring, CSF Formation and absorption, Ischaemic brain edema, Metabolic basis of brain edema, Biochemistry of brain edema and a fascinating chapter by Klatzo and colleagues on the time-course of the resolution of brain edema It was interesting to read that the vasogenic oedema of expenmental cold injury mainly resolves between 4 and 7 days, which agrees rather well with clinical expenence in the management of severe head injury. The book finishes with several chapters on the treatment of brain oedema. This book is produced on high-quality paper with excellent illustrations and is recommended to those anaesthetists who wish to have more than a basic understanding of this important type of brain pathology. D. G. McDowall