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Cardiac catheterization, angiography, and intervention (ed 4)
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BOOK REVIEWS terns unique to the patient. Preoperative assessment relative to outcome is also limited by the fact that surgery often does not restore “normal” physiology. Nevertheless, this is a good discussion of preoperative manifestations, illustrative of the specificity by the brevity, and of the specific lesions with the associated risks by authors who have tremendous clinical exposure. The references are quite recent. It often seems discussions related to noncardiac thoracic surgery are treated like a distant relative in importance, as it appears in chapter 4. The information for intrathoracic procedures is quite good for approaching lung resections, but lacks depth for procedures such as esophageal or diaphragmatic surgeries, or pleuroscopies. There are a limited number of references, the more recent examined predictors for outcome. The final chapter about preoperative cardiovascular medications is a huge subject to cover as completely in as few pages as the author manages. Interspersed are statements that add some zest lacking in previous chapters. For instance: “My opinion is _,” for example, “there may be some indications for preoperative prophylactic digitalization.” Such as? This style may inspire the readers to ask more questions. Now that patients are coming into the hospital on the day of surgery (including those for cardiac surgery), estimation of hemodynamic control by preoperative medication such as the P-blocker, calcium entry blocker, or antihypertensive medication may be less precise. This was noted by the author in referring to the studies that report calcium entry drugs are nonprotective in coronary artery disease patients under anesthesia. Still there are facts, questions, and unsettled controversies noted within to which we all need to give some thought as a means of utilizing current drug therapy to optimize the patients’ hemodynamics. As a review, this monograph is well worth the small price for trainees and practitioners alike. Norman J. Starr, MD
Chairman Department of Cardiothoracic Anesthesiology Cleveland Clinic Foundation Cleveland, OH
Cardiac Catheterization, Angiograpby, and Intervention (ed 4). Edited by William Grossman and Donald Bairn. Philadelphia, PA,
Lea & Febinger, 1991, $59.50,698 pp. Cardiac Catheterization, Angiography, and Intervention is a comprehensive textbook that is required reading for virtually all physiciantrainees in the cardiac catheterization laboratory. The 4th edition of this popular book was edited by two acknowledged experts in the specialty, Drs William Grossman and Donald Bairn, of Harvard Medical School and Beth Israel Hospital. This book is directed primarily toward cardiologists, not anesthesiologists. However, 20 of the 36 chapters contain information of critical importance to the cardiovascular anesthesiologist. The chapters that deal with hemodynamics are the strongest, and precisely the ones that are most important for the anesthesiologist. Each chapter is written in user-friendly language. Chapters 13 through 30 (excluding chapters 20 and 25 to 27) describe techniques for the performance of coronary arteriography, ventriculography, pulmonary angiography, stress testing, laser angioplasty, balloon valvuloplasty, and other procedures that are of peripheral interest to the cardiovascular anesthesiologist, except for the complications that are peculiar to these procedures. Coronary angioplasty, atherectomy, and stents are covered in two additional chapters that provide an overview of these increasingly important technologies. Much of the information in these chapters
regarding the indications, equipment, and techniques is also of little interest to the anesthesiologist. The lo-page chapter on the balloon-tipped, flow-directed catheters, by Drs Ganz and Swan, is well written and should serve as a good introduction. An excellent chapter on pressure measurement, written by Dr Grossman, details the basic principles for obtaining useful pressure waveforms and for recognizing and correcting sources of error and artefact. This chapter is valuable for any professional who is required to interpret intracardiac pressures. The subjects of cardiac output, vascular resistance, shunt detection, and systolic and diastolic function of the myocardium are each covered in separate chapters that are authoritative, well written, and pertinent to the anesthesiologist. One chapter is devoted to mechanical circulatory assist devices used in the cardiac catheterization laboratory, including the intraaortic balloon pump, percutaneous cardiopulmonary bypass, and the Nimbus hemopump. This chapter provides a thorough discussion of the physiology, techniques, equipment, and indications for these devices. The last 6 chapters in this book consist of “profiles” of specific disease states: valvular heart disease, coronary disease, pulmonary embolus, cardiomyopathies, pericardial diseases, and congenital heart disease. The examples correlate the clinical, angiographic, and hemodynamic findings in individual patients for each of the disease states in a clear and concise manner. These chapters are valuable for putting into perspective the information that was presented in the earlier chapters. In summary, this book contains a “mixed bag” for the cardiovascular anesthesiologist: about half the information is of no or little practical use, and half is very important. The reader is not likely to encounter the subject of cardiac hemodynamics presented in a more authoritative, readable, and practical manner than this book provides. Frederick A. Heupler, Jr, MD
Director Cardiac Catheterization Laboratory The Cleveland Clinic Foundation Cleveland, OH Manual of Medical Care of the Surgical Patient (ed 4). Edited by Timothy R. Coussons, Patrick A. McKee, and G. Rainey Williams.
Boston, MA, Little, Brown, 1990, $24.50,323 pp. This spiral manual is intended to be a resource for physicians involved in the perioperative medical care of the surgical patient. It concentrates on the identification of medical problems in the perioperative period, the evaluation of severity, management, and the impact on morbidity and mortality. Each organ system is addressed in a separate chapter. Important topics of significance in the perioperative period including anesthesia, hypertension, infection, nutrition, age, acquired immunodeficiency syndrome (AIDS), trauma, and drugs are also covered. Each chapter is followed by a list of recommended reference books and articles. The first chapter briefly presents the various anesthetic techniques and drugs and highlights the major problems associated with their use. It defines the purpose of the preoperative visit, particularly with respect to identification of preexisting medical conditions that may influence outcome. It also reviews the commonly performed tests and their indication as well as monitoring modalities. The chapter on the cardiac system discusses preoperative evaluation, prediction of risk, and ways to optimize preoperative status. The effects of anesthesia and surgery (cardiac as well as noncardisc) on hemodynamic stability and myocardial oxygen balance in the perioperative period are reviewed. The diagnosis and manage-
BOOK REVIEWS terns unique to the patient. Preoperative assessment relative to outcome is also limited by the fact that surgery often does not restore “normal” physiology. Nevertheless, this is a good discussion of preoperative manifestations, illustrative of the specificity by the brevity, and of the specific lesions with the associated risks by authors who have tremendous clinical exposure. The references are quite recent. It often seems discussions related to noncardiac thoracic surgery are treated like a distant relative in importance, as it appears in chapter 4. The information for intrathoracic procedures is quite good for approaching lung resections, but lacks depth for procedures such as esophageal or diaphragmatic surgeries, or pleuroscopies. There are a limited number of references, the more recent examined predictors for outcome. The final chapter about preoperative cardiovascular medications is a huge subject to cover as completely in as few pages as the author manages. Interspersed are statements that add some zest lacking in previous chapters. For instance: “My opinion is _,” for example, “there may be some indications for preoperative prophylactic digitalization.” Such as? This style may inspire the readers to ask more questions. Now that patients are coming into the hospital on the day of surgery (including those for cardiac surgery), estimation of hemodynamic control by preoperative medication such as the P-blocker, calcium entry blocker, or antihypertensive medication may be less precise. This was noted by the author in referring to the studies that report calcium entry drugs are nonprotective in coronary artery disease patients under anesthesia. Still there are facts, questions, and unsettled controversies noted within to which we all need to give some thought as a means of utilizing current drug therapy to optimize the patients’ hemodynamics. As a review, this monograph is well worth the small price for trainees and practitioners alike. Norman J. Starr, MD
Chairman Department of Cardiothoracic Anesthesiology Cleveland Clinic Foundation Cleveland, OH
Cardiac Catheterization, Angiograpby, and Intervention (ed 4). Edited by William Grossman and Donald Bairn. Philadelphia, PA,
Lea & Febinger, 1991, $59.50,698 pp. Cardiac Catheterization, Angiography, and Intervention is a comprehensive textbook that is required reading for virtually all physiciantrainees in the cardiac catheterization laboratory. The 4th edition of this popular book was edited by two acknowledged experts in the specialty, Drs William Grossman and Donald Bairn, of Harvard Medical School and Beth Israel Hospital. This book is directed primarily toward cardiologists, not anesthesiologists. However, 20 of the 36 chapters contain information of critical importance to the cardiovascular anesthesiologist. The chapters that deal with hemodynamics are the strongest, and precisely the ones that are most important for the anesthesiologist. Each chapter is written in user-friendly language. Chapters 13 through 30 (excluding chapters 20 and 25 to 27) describe techniques for the performance of coronary arteriography, ventriculography, pulmonary angiography, stress testing, laser angioplasty, balloon valvuloplasty, and other procedures that are of peripheral interest to the cardiovascular anesthesiologist, except for the complications that are peculiar to these procedures. Coronary angioplasty, atherectomy, and stents are covered in two additional chapters that provide an overview of these increasingly important technologies. Much of the information in these chapters
regarding the indications, equipment, and techniques is also of little interest to the anesthesiologist. The lo-page chapter on the balloon-tipped, flow-directed catheters, by Drs Ganz and Swan, is well written and should serve as a good introduction. An excellent chapter on pressure measurement, written by Dr Grossman, details the basic principles for obtaining useful pressure waveforms and for recognizing and correcting sources of error and artefact. This chapter is valuable for any professional who is required to interpret intracardiac pressures. The subjects of cardiac output, vascular resistance, shunt detection, and systolic and diastolic function of the myocardium are each covered in separate chapters that are authoritative, well written, and pertinent to the anesthesiologist. One chapter is devoted to mechanical circulatory assist devices used in the cardiac catheterization laboratory, including the intraaortic balloon pump, percutaneous cardiopulmonary bypass, and the Nimbus hemopump. This chapter provides a thorough discussion of the physiology, techniques, equipment, and indications for these devices. The last 6 chapters in this book consist of “profiles” of specific disease states: valvular heart disease, coronary disease, pulmonary embolus, cardiomyopathies, pericardial diseases, and congenital heart disease. The examples correlate the clinical, angiographic, and hemodynamic findings in individual patients for each of the disease states in a clear and concise manner. These chapters are valuable for putting into perspective the information that was presented in the earlier chapters. In summary, this book contains a “mixed bag” for the cardiovascular anesthesiologist: about half the information is of no or little practical use, and half is very important. The reader is not likely to encounter the subject of cardiac hemodynamics presented in a more authoritative, readable, and practical manner than this book provides. Frederick A. Heupler, Jr, MD
Director Cardiac Catheterization Laboratory The Cleveland Clinic Foundation Cleveland, OH Manual of Medical Care of the Surgical Patient (ed 4). Edited by Timothy R. Coussons, Patrick A. McKee, and G. Rainey Williams.
Boston, MA, Little, Brown, 1990, $24.50,323 pp. This spiral manual is intended to be a resource for physicians involved in the perioperative medical care of the surgical patient. It concentrates on the identification of medical problems in the perioperative period, the evaluation of severity, management, and the impact on morbidity and mortality. Each organ system is addressed in a separate chapter. Important topics of significance in the perioperative period including anesthesia, hypertension, infection, nutrition, age, acquired immunodeficiency syndrome (AIDS), trauma, and drugs are also covered. Each chapter is followed by a list of recommended reference books and articles. The first chapter briefly presents the various anesthetic techniques and drugs and highlights the major problems associated with their use. It defines the purpose of the preoperative visit, particularly with respect to identification of preexisting medical conditions that may influence outcome. It also reviews the commonly performed tests and their indication as well as monitoring modalities. The chapter on the cardiac system discusses preoperative evaluation, prediction of risk, and ways to optimize preoperative status. The effects of anesthesia and surgery (cardiac as well as noncardisc) on hemodynamic stability and myocardial oxygen balance in the perioperative period are reviewed. The diagnosis and manage-