Br.J. Anaesth. (1978), 50, 869
BOOK REVIEWS Anesthesia and Respiratory Function. International Anesthesiology Clinics, Vol. 15, No. 2. Edited by Enid R. Kafer. Published (1977) by Little, Brown & Co., Boston. Pp. 205; illustrated; indexed. Subscription for year, US 5 35.
Clinical Physiology of the Lung. By Kenneth B. Saunders. Published (1977) by Blackwell Scientific Publications. Pp. 255; illustrated; indexed. Price £9.75. This is very nearly a magnificent book. It is "designed to bridge the gap between undergraduate curricula and more advanced and comprehensive textbooks of respiratory physiology, and to enable the reader to understand some difficult but basic ideas which underlie present work. . . ." Few authors come so near to their purpose. The material is presented beautifully, logically, pithily, with glints of humour and with many illustrations which are usually clear and good. Indeed, this is a text which makes one wonder as to the need for programmed learning and audiovisual teaching aids. The choice of topics and the weight given to them will be generally applauded. They include a section on the respiratory control system which, whilst presenting a great deal of data, emphasizes how much is still to be learnt in the field. The author is probably right to dismiss the measurement of respiratory work as too ill-defined in principle, but a brief description of the concept of the pressure-volume diagram would surely have been appropriate. It is strange that a book which deals at length with the effects of dynamic compression on airways does not make a more positive point of the transfer of the expiratory workload to the inspiratory muscles by means of pulmonary elastic properties. It is hard for an anaesthetist to praise a book on the physiology of breathing which makes no mention of gross respiratory obstruction. Presumably the justification lies in a strict interpretation of the title, rather than in a perpetuation of the classical error of the erudite in not being bothered about the extrapulmonary airway. The English is on the whole a happy compromise between the pompously correct and the slovenly slick, yet the reviewer has a personal objection to "neither/or . . . anatomic . . . physiologic... comparing t o . . . a variety of methods are . . . abolishment". There is a fair number of typographical errors, most of which are trivial, but it is more important that a line of text may be missing from p. 213, that "right" appears for "left" and that carotid bodies are "exercised" rather than "excised". Such mistakes do not presage the end of the world, but it is a great pity that this book, which is excellent in other respects, did not enjoy a comparable standard of checking and proof-reading. E. A. Cooper
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Because of an extremely high standard of presentation and clarity, each new edition of this series has been welcomed by anaesthetists. This volume is no exception. All the chapters contain a succinct account of a specific topic by a recognized expert. The first three chapters review critically various aspects of respiratory control, both chemical and neural, and the effects of anaesthetics on these mechanisms. There are descriptions of newer methods for investigating breathing patterns and extensive discussions on ventilatory response to carbon dioxide. In the third chapter there is a detailed account of the experimental work on localization of areas involved in neural regulation. To be fully comprehensible, a detailed knowledge of neurophysiology and neuroanatomy is expected, to a standard which is unlikely to have been acquired by many anaesthetists. Mitchell and Berger have attempted the formidable task of collecting together in a brief chapter the widely scattered facts on central respiratory control. They have done this adequately, but it is unfortunate that the few known effects of anaesthetic agents on neural traffic within the cerebrum have not been incorporated. Pulmonary gas exchange is of major concern to anaesthetists whose concepts are based largely on the compartmental models of Riley, Rahn and Fehn. These early models are discussed critically by Wagner in the light of present day facts, and more recent techniques of investigation, such as that using several inert gases, are incorporated into the same models. The use of computer programs to predict abnormalities of distribution in the lung are given much space, but many anaesthetists will question the significance of changes in V/Q ratio from 0.0404 to 0.0373 on gas exchange in their patients. However, the following chapter by Don is model writing, comprehensive and clinically relevant. The interrelationship of closing capacity, functional residual capacity and arterial oxygenation is explicitly explained. Both clinical and research staff would benefit from a careful study of this chapter, not only from the content, but also from its clarity of expression. The next chapter continues this high standard, describing the action of biologically active drugs and amines on airway muscle. It also includes practical methods for dealing with bronchospasm associated with anaesthesia. The final chapter deals with the increasingly appreciated sequelae of intubation and inadequate humidification. In this section there are salutary warnings to all who trespass within the airway. Like all multi-author books, this one does vary in style and clarity between chapters, but this is a minor criticism in the face of such a wealth of information. This is a good up-to-date collection of articles written by world renowned leaders in their respective fields. However, the book cannot
be read casually; the multitude of facts must be assimilated, digested and chewed over with colleagues for probably many hours. The authors do not give wordy explanations in their texts, but assume that the reader has a working knowledge of the various topics. Happily, there are comprehensive reference lists at the end of each chapter. The book can be recommended to all who are involved in studying or modifying respiratory function, whether in the operating theatre, the intensive therapy unit, clinic or laboratory. G Hul(mds