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An Integrated Approach to Monitoring. Edited by Gravenstein J. S. Newbower R. S., Ream A. K. and Smith N. Ty Published by Butterworths. Pp. 243; indexed; illustrated. Price £32.00.
Br. J. Anaesth. (1985), 57, 243
BOOK REVIEWS
Anaesthesia Review 2. Edited by L. Kaufman. Published by Churchill Livingstone. Pp.228; indexed; illustrated. Price £12.00.
T.E.J.Healy An Integrated Approach to Monitoring. Edited by J. S. Gravenstein, R. S. Newbower, A. K. Ream and N. Ty Smith. Published by Butterworths. Pp.243; indexed; illustrated. Price £32.00. Perhaps part of the art of medicine is to assess the state of health of a patient from the value of, rate of change of and association between the various variables that developments in science now allow the clinician to measure. Often, the physiological quantities actually monitored are chosen simply because equipment or transducers are available to make the measurements. Sometimes, only an assessment of the average performance of an organ such as the lung can be made, and it may be impossible or impracticable to monitor the variable which is really of interest. The problems of determining the state of the patient and his prognosis by the use of multiple and imperfect measurements are examined in this book. While multiple measurements are becoming easier and perhaps more routine, there is the increasing problem of interpreting all the information presented. Naturally, computers play a large part in overcoming this problem and the latter part of the book concentrates on developments in computer programming and the interaction between the computer and the user. Currently, the principal concerns in the use of computers are data security and confidentiality, but the introduction of systems which aid the decision-making process of the clinician rather than simply record information raise further legal issues. For example, what are the consequences of using, not using or ignoring the advice of computer-aided decision-making systems? This book considers such matters in the form of various selected topics extracted from quite a wide field of interest. The book comprises 17 chapters in four sections: monitoring the cardiovascular system, monitoring the respiratory system, the use of modelling and the problems associated with the handling of large amounts of information. Chapter 16 is an analysis of computeraided decision making in nuclear plants and strays a little from the otherwise direct consideration of medical topics. As each chapter has different authorship, there is a noticeable lack of continuity in the book, which reads more like a conference report than a progressive treatment. However, the editors have not sought to be comprehensive, but to present selected examples of some of the thinking in the field of physiological monitoring. There are useful references at the end of each chapter and these are needed, because the topics are treated in a rather concise manner. A good grasp of mathematics is necessary to understand fully the arguments in some of the chapters. This book is nevertheless interesting and well worth reading, because the matters examined probably form the basis of future research and development in patient monitoring. P. D. Davis
Downloaded from http://bja.oxfordjournals.org/ at Georgetown University on August 26, 2015
Dr Kaufman has selected the subject matter extremely carefully, to produce a book which appears to touch on most things of importance to anaesthetists. The mechanisms of both general anaesthesia and local anaesthesia are discussed. Pain is considered in depth, in respect of the physiological aspects of pain perception and of narcotic analgesia, including extradural and intrathecal narcotics. There are chapters on paediatric anaesthesia, closed circuit anaesthesia and non-invasive monitoring. Even regurgitation and aspiration find a place. The book commences well, with relevant recent advances in medicine and the sleep apnoea syndrome. It is a pity that the inclusion of references in the text has not followed the form adopted by the U.S. National Library of Medicine and used in Index Medicus. For a review to be valuable, it must be well referenced and these reviews are no exception in this respect. However, the inclusion of the authors' names in the text does make easy reading more difficult and interrupts a train of thought. Nonetheless, I found the chapters and their content to be extremely interesting and likely to be effective in keeping the reader up to date in those aspects of the discipline with which he may be less familiar as a result of limited contact. Some comments in the book are, of course, more up-to-date than others. One would expect and, indeed, finds that the references in the Appendix are more up to date than some of those in the main body of the book itself. Indeed, most quote papers published in the 1980's. This cannot be said about each of the other chapters, and in some respects I feel that a Review, presumably aimed at updating the reader, should not contain so many references already available to the reading public when the previous edition appeared. The value of these kind of Reviews is that they alert the anaesthetist to situations and conditions which, although they may be extremely rare, may prove very hazardous to patients. The sleep apnoea syndromes mentioned in the first chapter and detailed in the second chapter could be such a condition. Of particular interest was the review of pulmonary complications following general anaesthesia. Dr Jones has restated the factors which predisposed to pulmonary complications and he has considered management and response. While he reminds us that adequate pain relief and physiotherapy have not been shown to ameliorate the respiratory effects of surgery, he admits that few would be prepared to look after patients in the intensive care unit without the aid of a physiotherapist. The mechanisms of action of antibiotics are discussed in detail, but this is a chapter that requires re-reading a number of times lest ignorance is replaced only by confusion. The allergic responses chapter is wide-ranging, although it might confuse the clinical anaesthetist. The value of skin tests is discussed very clearly. This is a complex subject, and the response to some drugs such as neuromuscular blockers is indeed controversial. For those interested in the direction in which anaesthesia may move in the future, the last paragraph of Chapter 10 is pertinent. "A new and powerful idea has emerged that the pharmacology of the spinal cord is accessible to anaesthetic practice. Eventually this may be the principle of the principles".
In conclusion, this is an excellent book. In some parts it is a little hard going and in others it is straightforward, but every anaesthetist would benefit from reading it at least once. Some of our accepted practices are questioned, and that is the way progress is made.
Group Advertisement Manager, Mr. R. Hayzen. Advertisement Executive, Mr. T. Lovell., BMA House, Tavistock Square, London WC1H 9JR. 01-387 4499.
Whilst every effort is made by the publishers and editorial committee to see that no inaccurate or misleading data, opinion or statement appears in this Journal, they wish to make it clear that the data and opinions appearing in the articles and advertisements herein are the responsibility of the contributor or advertiser concerned. Accordingly, the publishers and the editorial committee and their respective employees, officers and agents accept no tiability whatsoever for the consequences of any such inaccurate or misleading data, opinion or statement. Whilst every effort is made to ensure that drug doses and other quantities are presented accurately, readers are advised that new methods and techniques involving drug usage, and described within this journal, should only be followed in conjunction with the drug manufacturer's own published literature.
® Copyright: Professional & Scientific Publications Ltd, BMA House, Tavistock Square, London WC1H 9JR.
Downloaded from http://bja.oxfordjournals.org/ at Georgetown University on August 26, 2015
Papers for publication and all editorial communications should be addressed to the Editor, University of Glasgow, Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow G31 2ER; business communications to the publishers: Professional & Scientific Publications Ltd, BMA House, Tavistock Square, London WC1H 9JR. The GUIDE TO CONTRIBUTORS can be found on pages x, xii & xiv of the advertisement section of the issue. Published monthly: Annual subscriptions: UK/Eire £41.00; Elsewhere US$90.00 Trainee rate UK/Eire £26.00; Elsewhere US$53.00. Airmail rates on application. ISSN 0007-0912. Orders must be accompanied by payment; cheques should be made payable to Professional and Scientific Publications. Orders and payments should be sent to Professional and Scientific Publications, BMA House, Tavistock Square London, WC1H 9JR. Orders in the United States of America may be sent to Professional and Scientific Publications, Box 560B, Kennebunkport, Maine 04046.
BOOK REVIEWS
Anaesthesia Review 2. Edited by L. Kaufman. Published by Churchill Livingstone. Pp.228; indexed; illustrated. Price £12.00.
T.E.J.Healy An Integrated Approach to Monitoring. Edited by J. S. Gravenstein, R. S. Newbower, A. K. Ream and N. Ty Smith. Published by Butterworths. Pp.243; indexed; illustrated. Price £32.00. Perhaps part of the art of medicine is to assess the state of health of a patient from the value of, rate of change of and association between the various variables that developments in science now allow the clinician to measure. Often, the physiological quantities actually monitored are chosen simply because equipment or transducers are available to make the measurements. Sometimes, only an assessment of the average performance of an organ such as the lung can be made, and it may be impossible or impracticable to monitor the variable which is really of interest. The problems of determining the state of the patient and his prognosis by the use of multiple and imperfect measurements are examined in this book. While multiple measurements are becoming easier and perhaps more routine, there is the increasing problem of interpreting all the information presented. Naturally, computers play a large part in overcoming this problem and the latter part of the book concentrates on developments in computer programming and the interaction between the computer and the user. Currently, the principal concerns in the use of computers are data security and confidentiality, but the introduction of systems which aid the decision-making process of the clinician rather than simply record information raise further legal issues. For example, what are the consequences of using, not using or ignoring the advice of computer-aided decision-making systems? This book considers such matters in the form of various selected topics extracted from quite a wide field of interest. The book comprises 17 chapters in four sections: monitoring the cardiovascular system, monitoring the respiratory system, the use of modelling and the problems associated with the handling of large amounts of information. Chapter 16 is an analysis of computeraided decision making in nuclear plants and strays a little from the otherwise direct consideration of medical topics. As each chapter has different authorship, there is a noticeable lack of continuity in the book, which reads more like a conference report than a progressive treatment. However, the editors have not sought to be comprehensive, but to present selected examples of some of the thinking in the field of physiological monitoring. There are useful references at the end of each chapter and these are needed, because the topics are treated in a rather concise manner. A good grasp of mathematics is necessary to understand fully the arguments in some of the chapters. This book is nevertheless interesting and well worth reading, because the matters examined probably form the basis of future research and development in patient monitoring. P. D. Davis
Downloaded from http://bja.oxfordjournals.org/ at Georgetown University on August 26, 2015
Dr Kaufman has selected the subject matter extremely carefully, to produce a book which appears to touch on most things of importance to anaesthetists. The mechanisms of both general anaesthesia and local anaesthesia are discussed. Pain is considered in depth, in respect of the physiological aspects of pain perception and of narcotic analgesia, including extradural and intrathecal narcotics. There are chapters on paediatric anaesthesia, closed circuit anaesthesia and non-invasive monitoring. Even regurgitation and aspiration find a place. The book commences well, with relevant recent advances in medicine and the sleep apnoea syndrome. It is a pity that the inclusion of references in the text has not followed the form adopted by the U.S. National Library of Medicine and used in Index Medicus. For a review to be valuable, it must be well referenced and these reviews are no exception in this respect. However, the inclusion of the authors' names in the text does make easy reading more difficult and interrupts a train of thought. Nonetheless, I found the chapters and their content to be extremely interesting and likely to be effective in keeping the reader up to date in those aspects of the discipline with which he may be less familiar as a result of limited contact. Some comments in the book are, of course, more up-to-date than others. One would expect and, indeed, finds that the references in the Appendix are more up to date than some of those in the main body of the book itself. Indeed, most quote papers published in the 1980's. This cannot be said about each of the other chapters, and in some respects I feel that a Review, presumably aimed at updating the reader, should not contain so many references already available to the reading public when the previous edition appeared. The value of these kind of Reviews is that they alert the anaesthetist to situations and conditions which, although they may be extremely rare, may prove very hazardous to patients. The sleep apnoea syndromes mentioned in the first chapter and detailed in the second chapter could be such a condition. Of particular interest was the review of pulmonary complications following general anaesthesia. Dr Jones has restated the factors which predisposed to pulmonary complications and he has considered management and response. While he reminds us that adequate pain relief and physiotherapy have not been shown to ameliorate the respiratory effects of surgery, he admits that few would be prepared to look after patients in the intensive care unit without the aid of a physiotherapist. The mechanisms of action of antibiotics are discussed in detail, but this is a chapter that requires re-reading a number of times lest ignorance is replaced only by confusion. The allergic responses chapter is wide-ranging, although it might confuse the clinical anaesthetist. The value of skin tests is discussed very clearly. This is a complex subject, and the response to some drugs such as neuromuscular blockers is indeed controversial. For those interested in the direction in which anaesthesia may move in the future, the last paragraph of Chapter 10 is pertinent. "A new and powerful idea has emerged that the pharmacology of the spinal cord is accessible to anaesthetic practice. Eventually this may be the principle of the principles".
In conclusion, this is an excellent book. In some parts it is a little hard going and in others it is straightforward, but every anaesthetist would benefit from reading it at least once. Some of our accepted practices are questioned, and that is the way progress is made.
Group Advertisement Manager, Mr. R. Hayzen. Advertisement Executive, Mr. T. Lovell., BMA House, Tavistock Square, London WC1H 9JR. 01-387 4499.
Whilst every effort is made by the publishers and editorial committee to see that no inaccurate or misleading data, opinion or statement appears in this Journal, they wish to make it clear that the data and opinions appearing in the articles and advertisements herein are the responsibility of the contributor or advertiser concerned. Accordingly, the publishers and the editorial committee and their respective employees, officers and agents accept no tiability whatsoever for the consequences of any such inaccurate or misleading data, opinion or statement. Whilst every effort is made to ensure that drug doses and other quantities are presented accurately, readers are advised that new methods and techniques involving drug usage, and described within this journal, should only be followed in conjunction with the drug manufacturer's own published literature.
® Copyright: Professional & Scientific Publications Ltd, BMA House, Tavistock Square, London WC1H 9JR.
Downloaded from http://bja.oxfordjournals.org/ at Georgetown University on August 26, 2015
Papers for publication and all editorial communications should be addressed to the Editor, University of Glasgow, Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow G31 2ER; business communications to the publishers: Professional & Scientific Publications Ltd, BMA House, Tavistock Square, London WC1H 9JR. The GUIDE TO CONTRIBUTORS can be found on pages x, xii & xiv of the advertisement section of the issue. Published monthly: Annual subscriptions: UK/Eire £41.00; Elsewhere US$90.00 Trainee rate UK/Eire £26.00; Elsewhere US$53.00. Airmail rates on application. ISSN 0007-0912. Orders must be accompanied by payment; cheques should be made payable to Professional and Scientific Publications. Orders and payments should be sent to Professional and Scientific Publications, BMA House, Tavistock Square London, WC1H 9JR. Orders in the United States of America may be sent to Professional and Scientific Publications, Box 560B, Kennebunkport, Maine 04046.