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ANESTHESIA FOR SURGERY OF THE HEART
VoL
xxxn
COLLEGE NEWS
363
ANESTHESIA FOR SURGERY OF THE HEART, by Kenneth K. Keown, M.D. A monograph in American Lectures in Anesthesiology. Charles C Thomas, Springfield, Illinois, 1956, Foreword by Charles P. Bailey, 109 pages, $3.75. The publication of this little book represents a milestone in the development of cardio-anesthesiology. No one could have been better qualified to write this book than Dr. Keown. His personal experience in this field, which started at the time the first successful modern mitral commissurotomy was done in 1948, includes the supervision at present of almost 1,000 patients undergoing heart operations per year. In this rapidly expanding specialty his short, succinct and sagacious monograph will serve as a source of much detailed counsel, not only for the safe handling of cardiac patients through their critical operative stress, but also for a cooperative understanding and a basis for concerted team action by both the surgeon and anesthesiologist. The importance of such cooperation in the complex physiopathological changes is shown in the author's discussion of the tetralogy of Fallot: "Still another trying time is the period spent in closing the pericardial sac. Because more blood reaches the lungs, following the Brock operation, particularly if an immediate left to right shunt exists, the left ventricle dilates. Extreme cooperation between surgeons and anesthesiologist must be exercised or the heart action will fail because of the effect of the tamponade. The blood pressure, pulse rate and left ventricular output must be closely observed for signs of inadequacy. Direct vision of the heart by the surgeon is inadequate to ascertain the early effects of the pericardial closure. He must rely upon his colleague, the anesthesiologist, for his critical evaluation." Specific advice for the anesthesiologist, based on wide experience, is given throughout the pages. Thus: "If the preoperative palpatory systolic pressure, as ascertained with the patient unsedated, but in the same position as on the table, is less than 90 mm. Hg., no preoperative barbiturate is given." In addition to a fine section on the cardiac irregularities and their diagnosis and management during anesthesia, there is in the chapter on each cardiac lesion, a lucid discussion of such data as the preoperative cardiac catheterization reports, particularly those points which are germaine to a good understanding of the physiologic burden the patient is to carry through the operation. In summary, this relatively inexpensive monograph is highly recommended for the practitioner and surgeon as well as for the anesthesiologist who wishes to give his patient the best chance possible for a successful surgical result. J. Maxwell Chamberlain, M.D. KLINISCH-RoNTGENOLOGISCHE DIFFERENTIALDIAGNOSTIK DER LUNGENKRANKHEITEN, by L. Dunner, M.D. Ferdinand Enke, Stuttgart, Germany, 1954. This book is devoted to the clinical and roentgenological 'aspects of differential diagnosis of lung disease. The clinical portion of the text is quite meager. Noteworthy is the lack of inclusion of important laboratory procedures which are part and parcel of the clinical-roentgenological evaluation of problem cases. The 269 pages devoted to chest x-ray films and text are taken up largely by 198 brief case reports. The organization of the contents follows the conventional pattern of morphological description of lobar pneumonia, abscess, cavities, bronchiectasis, atelectasis, miliary disease, - carcinoma, round foci, hilar processes, pneumothorax, fibrosis and pleurisy. There is little if any attention paid to the pulmonary manifestations of metabolic, collagen and other systemic diseases which may be associated with pulmonary lesions. Although the chest x-ray films are reproduced as negatives of the original, they are sufficiently clear and detailed not to offer difficulties in interpretation. However, many pages contain only one or two illustrations with the remainder of the page blank. The empty spaces could have been filled profitably with description of the conditions under consideration. The author does not claim more for the book than it offers. In the present state of knowledge of differential diagnosis of pulmonary diseases, especially the many obscure conditions currently being encountered in routine chest x-ray surveys and even hospital admissions, a book of this type does not offer enough. Eli H. Rubin, M.D.
xxxn
COLLEGE NEWS
363
ANESTHESIA FOR SURGERY OF THE HEART, by Kenneth K. Keown, M.D. A monograph in American Lectures in Anesthesiology. Charles C Thomas, Springfield, Illinois, 1956, Foreword by Charles P. Bailey, 109 pages, $3.75. The publication of this little book represents a milestone in the development of cardio-anesthesiology. No one could have been better qualified to write this book than Dr. Keown. His personal experience in this field, which started at the time the first successful modern mitral commissurotomy was done in 1948, includes the supervision at present of almost 1,000 patients undergoing heart operations per year. In this rapidly expanding specialty his short, succinct and sagacious monograph will serve as a source of much detailed counsel, not only for the safe handling of cardiac patients through their critical operative stress, but also for a cooperative understanding and a basis for concerted team action by both the surgeon and anesthesiologist. The importance of such cooperation in the complex physiopathological changes is shown in the author's discussion of the tetralogy of Fallot: "Still another trying time is the period spent in closing the pericardial sac. Because more blood reaches the lungs, following the Brock operation, particularly if an immediate left to right shunt exists, the left ventricle dilates. Extreme cooperation between surgeons and anesthesiologist must be exercised or the heart action will fail because of the effect of the tamponade. The blood pressure, pulse rate and left ventricular output must be closely observed for signs of inadequacy. Direct vision of the heart by the surgeon is inadequate to ascertain the early effects of the pericardial closure. He must rely upon his colleague, the anesthesiologist, for his critical evaluation." Specific advice for the anesthesiologist, based on wide experience, is given throughout the pages. Thus: "If the preoperative palpatory systolic pressure, as ascertained with the patient unsedated, but in the same position as on the table, is less than 90 mm. Hg., no preoperative barbiturate is given." In addition to a fine section on the cardiac irregularities and their diagnosis and management during anesthesia, there is in the chapter on each cardiac lesion, a lucid discussion of such data as the preoperative cardiac catheterization reports, particularly those points which are germaine to a good understanding of the physiologic burden the patient is to carry through the operation. In summary, this relatively inexpensive monograph is highly recommended for the practitioner and surgeon as well as for the anesthesiologist who wishes to give his patient the best chance possible for a successful surgical result. J. Maxwell Chamberlain, M.D. KLINISCH-RoNTGENOLOGISCHE DIFFERENTIALDIAGNOSTIK DER LUNGENKRANKHEITEN, by L. Dunner, M.D. Ferdinand Enke, Stuttgart, Germany, 1954. This book is devoted to the clinical and roentgenological 'aspects of differential diagnosis of lung disease. The clinical portion of the text is quite meager. Noteworthy is the lack of inclusion of important laboratory procedures which are part and parcel of the clinical-roentgenological evaluation of problem cases. The 269 pages devoted to chest x-ray films and text are taken up largely by 198 brief case reports. The organization of the contents follows the conventional pattern of morphological description of lobar pneumonia, abscess, cavities, bronchiectasis, atelectasis, miliary disease, - carcinoma, round foci, hilar processes, pneumothorax, fibrosis and pleurisy. There is little if any attention paid to the pulmonary manifestations of metabolic, collagen and other systemic diseases which may be associated with pulmonary lesions. Although the chest x-ray films are reproduced as negatives of the original, they are sufficiently clear and detailed not to offer difficulties in interpretation. However, many pages contain only one or two illustrations with the remainder of the page blank. The empty spaces could have been filled profitably with description of the conditions under consideration. The author does not claim more for the book than it offers. In the present state of knowledge of differential diagnosis of pulmonary diseases, especially the many obscure conditions currently being encountered in routine chest x-ray surveys and even hospital admissions, a book of this type does not offer enough. Eli H. Rubin, M.D.