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C. M. Palmer, R. d'Angelo and M. J. Paech, Handbook of Obstetric Anaesthesia
Book Reviews
Handbook of Obstetric Anaesthesia. C. M. Palmer, R. d'Angelo and M. J. Paech. Published by BIOS Scientific Publishers Ltd, Oxford. Pp. 266; indexed; illustrated. Price £60.00. ISBN 1-85996-232-7. This book is designed as a guide to practical obstetric anaesthesia and aims to be a quick reference for trainees and consultant anaesthetists working in this area. The contents section shows clearly the chapters together with their relevant subsections, and this simplifies matters for the anaesthetist seeking help on a particular topic. The content is easily readable and there are a plethora of tables, charts and diagrams in each section which summarize the accompanying text. This makes for quick, easy reference. The sections are nicely balanced and cover essentially all areas of relevance to the obstetric anaesthetist. At 260 pages, it is easy to read through and use to revise concepts before examinations. There is a good introductory section that summarizes the development of obstetric anaesthesia. Thereafter, there are excellent chapters on obstetric physiology, neonatal physiology, and neuroanatomy and neuropharmacology which anyone revising for examinations would find invaluable. The chapter on antenatal
monitoring fails to mention fetal blood vessel ultrasonography and fetal scalp electrodes. Chapters 5-8 present anaesthesia for vaginal delivery, anaesthesia for Caesarean section, and methods of postoperative analgesia. These chapters are less succinct but the subjects are difficult to summarize. In this area, the book does not offer much advantage over other books already in circulation. Also in this section, much of the discussion is relevant to US practice and not especially to UK practice. The chapters on pregnancy-induced hypertension and coexisting disease are excellent, as is the section on complications of obstetric anaesthesia and analgesia, which has a useful summary of postpartum nerve dysfunction. A chapter on obesity is particularly welcome. The sections on neonatal resuscitation and medicolegal considerations are well worthwhile. This book largely succeeds as an easy reference guide for obstetric anaesthetists, but at £60.00 it is probably too expensive for the trainee to buy. It is also mainly aimed at the North American market, and has almost exclusively North American references. Not all sections translate well into British practice. However, it is a useful reference book to have in the department for trainees to revise from and refer to. I can recommend it for this purpose. B. Loughnan Harrow UK
Critical Care Focus. Number 8: Blood and Blood Transfusion. Helen F. Galley. Published by BMJ Books, London. Pp. 85; indexed; illustrated. Price £14.95. ISBN 0727916572. This is another in a series of short books produced in association with the Intensive Care Society. These are not comprehensive textbooks, but comprise concise chapters on specific topics relevant to the critically ill. The seven chapters in this volume cover the function of blood and administration of blood products in the critically ill. Two chapters describe recent large, influential studies in intensive care and will be of considerable interest to the practising intensivist. Martin Tweeddale gives a balanced description of the Transfusion Requirements in Critical Care study, that showed that restrictive transfusion practice was associated with similar mortality to liberal use of red cells. The results of this study are widely known and its recommendations have been adopted by many intensive care units. What I liked about the chapter was the description of the background and lead-up to the study, the detail about study design, and the hints of what actually happened during the study itself, particularly in relation to exclusions. These are less apparent from the formal publications. Pierre-Francois Laterre contributes a similarly balanced description of the PROWESS study, which showed reduction in mortality in patients with severe sepsis treated with human recombinant activated protein C. The background information is a concise description of the confusing area of inflammation-coagulation interaction during sepsis, which clinicians will find helpful. The discussion of the problems of translating study findings to the wider ICU population, particularly with reference to bleeding risk, was also good. The other chapters cover a mixture of topics. Machin gives a nice overview of haemostatic problems in the ICU, with particular reference to platelet function. There is plenty of practical advice and I thought the section on heparin-induced thrombocytopenia was a useful summary of a subject that causes considerable confusion. The chapter on Transfusion Associated Lung Injury (TRALI) is a well-written account of a poorly understood condition that is probably often missed. The authors make comparisons with recent advances in the understanding of
531
Downloaded from http://bja.oxfordjournals.org/ at Ernst Mayr Library of the Museum Comp Zoology, Harvard University on April 21, 2015
The title 'Diseases imported from abroad' for the tropical medicine section irked me somewhat. Abroad is a relative term. The inclusion of HIV infection in this section would seem bizarre to those of us based in British cities. The HIV infection we see is locally acquired rather than imported! The chapter hardly mentions tuberculosis, which is becoming ever more important. The section on neck sprains is, similarly, too short. X-rays are advised for all patients, although evidence-based guidelines exist which identify patients who do not necessarily need an x-ray. It must be difficult with a core handbook such as this, to compromise between the constraints of being pocket-sized and being comprehensive. I did not find the format attractive. The text is dense and key information seems hidden in the middle of pages. More diagrams and algorithms would give the presentation a more contemporary feel. The crucial points would be more obvious. Most junior doctors would value some spaces to include scribbles, so as to cross reference the book's recommendations with local practice. There will inevitably be areas of conflict between a core handbook, such as this, and locally developed guidelines. I identified numerous differences with my departmental guidelines, mainly in drug therapies. There is always a problem keeping a published text up-to-date and the anti-tetanus policy has already been changed in the UK to include diphtheria immunization. Locally developed departmental guidelines may lessen the need for a handbook such as this. I expect that most young UK consultants relied on previous editions of this book, or similar texts, to keep them on the right track when they were senior house officers for the first time in A&E. Nowadays, in most teaching hospitals, junior doctors are better supported. I was disappointed, therefore, that the importance of calling early for senior support was not emphasized enough in this book. Thankfully, modern emergency care is based on experienced emergency physicians, not junior doctors working from handbooks. This book is a good core handbook of emergency care. Junior doctors will find it reassuring to have a copy of this book in their pockets when starting those first long night shifts in the emergency department. They will not go far wrong with this book, once they remember to call for help too. U. Geary Liverpool UK
Handbook of Obstetric Anaesthesia. C. M. Palmer, R. d'Angelo and M. J. Paech. Published by BIOS Scientific Publishers Ltd, Oxford. Pp. 266; indexed; illustrated. Price £60.00. ISBN 1-85996-232-7. This book is designed as a guide to practical obstetric anaesthesia and aims to be a quick reference for trainees and consultant anaesthetists working in this area. The contents section shows clearly the chapters together with their relevant subsections, and this simplifies matters for the anaesthetist seeking help on a particular topic. The content is easily readable and there are a plethora of tables, charts and diagrams in each section which summarize the accompanying text. This makes for quick, easy reference. The sections are nicely balanced and cover essentially all areas of relevance to the obstetric anaesthetist. At 260 pages, it is easy to read through and use to revise concepts before examinations. There is a good introductory section that summarizes the development of obstetric anaesthesia. Thereafter, there are excellent chapters on obstetric physiology, neonatal physiology, and neuroanatomy and neuropharmacology which anyone revising for examinations would find invaluable. The chapter on antenatal
monitoring fails to mention fetal blood vessel ultrasonography and fetal scalp electrodes. Chapters 5-8 present anaesthesia for vaginal delivery, anaesthesia for Caesarean section, and methods of postoperative analgesia. These chapters are less succinct but the subjects are difficult to summarize. In this area, the book does not offer much advantage over other books already in circulation. Also in this section, much of the discussion is relevant to US practice and not especially to UK practice. The chapters on pregnancy-induced hypertension and coexisting disease are excellent, as is the section on complications of obstetric anaesthesia and analgesia, which has a useful summary of postpartum nerve dysfunction. A chapter on obesity is particularly welcome. The sections on neonatal resuscitation and medicolegal considerations are well worthwhile. This book largely succeeds as an easy reference guide for obstetric anaesthetists, but at £60.00 it is probably too expensive for the trainee to buy. It is also mainly aimed at the North American market, and has almost exclusively North American references. Not all sections translate well into British practice. However, it is a useful reference book to have in the department for trainees to revise from and refer to. I can recommend it for this purpose. B. Loughnan Harrow UK
Critical Care Focus. Number 8: Blood and Blood Transfusion. Helen F. Galley. Published by BMJ Books, London. Pp. 85; indexed; illustrated. Price £14.95. ISBN 0727916572. This is another in a series of short books produced in association with the Intensive Care Society. These are not comprehensive textbooks, but comprise concise chapters on specific topics relevant to the critically ill. The seven chapters in this volume cover the function of blood and administration of blood products in the critically ill. Two chapters describe recent large, influential studies in intensive care and will be of considerable interest to the practising intensivist. Martin Tweeddale gives a balanced description of the Transfusion Requirements in Critical Care study, that showed that restrictive transfusion practice was associated with similar mortality to liberal use of red cells. The results of this study are widely known and its recommendations have been adopted by many intensive care units. What I liked about the chapter was the description of the background and lead-up to the study, the detail about study design, and the hints of what actually happened during the study itself, particularly in relation to exclusions. These are less apparent from the formal publications. Pierre-Francois Laterre contributes a similarly balanced description of the PROWESS study, which showed reduction in mortality in patients with severe sepsis treated with human recombinant activated protein C. The background information is a concise description of the confusing area of inflammation-coagulation interaction during sepsis, which clinicians will find helpful. The discussion of the problems of translating study findings to the wider ICU population, particularly with reference to bleeding risk, was also good. The other chapters cover a mixture of topics. Machin gives a nice overview of haemostatic problems in the ICU, with particular reference to platelet function. There is plenty of practical advice and I thought the section on heparin-induced thrombocytopenia was a useful summary of a subject that causes considerable confusion. The chapter on Transfusion Associated Lung Injury (TRALI) is a well-written account of a poorly understood condition that is probably often missed. The authors make comparisons with recent advances in the understanding of
531
Downloaded from http://bja.oxfordjournals.org/ at Ernst Mayr Library of the Museum Comp Zoology, Harvard University on April 21, 2015
The title 'Diseases imported from abroad' for the tropical medicine section irked me somewhat. Abroad is a relative term. The inclusion of HIV infection in this section would seem bizarre to those of us based in British cities. The HIV infection we see is locally acquired rather than imported! The chapter hardly mentions tuberculosis, which is becoming ever more important. The section on neck sprains is, similarly, too short. X-rays are advised for all patients, although evidence-based guidelines exist which identify patients who do not necessarily need an x-ray. It must be difficult with a core handbook such as this, to compromise between the constraints of being pocket-sized and being comprehensive. I did not find the format attractive. The text is dense and key information seems hidden in the middle of pages. More diagrams and algorithms would give the presentation a more contemporary feel. The crucial points would be more obvious. Most junior doctors would value some spaces to include scribbles, so as to cross reference the book's recommendations with local practice. There will inevitably be areas of conflict between a core handbook, such as this, and locally developed guidelines. I identified numerous differences with my departmental guidelines, mainly in drug therapies. There is always a problem keeping a published text up-to-date and the anti-tetanus policy has already been changed in the UK to include diphtheria immunization. Locally developed departmental guidelines may lessen the need for a handbook such as this. I expect that most young UK consultants relied on previous editions of this book, or similar texts, to keep them on the right track when they were senior house officers for the first time in A&E. Nowadays, in most teaching hospitals, junior doctors are better supported. I was disappointed, therefore, that the importance of calling early for senior support was not emphasized enough in this book. Thankfully, modern emergency care is based on experienced emergency physicians, not junior doctors working from handbooks. This book is a good core handbook of emergency care. Junior doctors will find it reassuring to have a copy of this book in their pockets when starting those first long night shifts in the emergency department. They will not go far wrong with this book, once they remember to call for help too. U. Geary Liverpool UK