Clinical neuroanesthesia second edition

Clinical neuroanesthesia second edition

Regional Anesthesia and Pain Medicine 23(6): 623-624, 1998 Book Reviews The M a n a g e m e n t of Pain ISBN 0-443-07679-0 Michael Ashburn Churchill...

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Regional Anesthesia and Pain Medicine 23(6): 623-624, 1998

Book Reviews

The M a n a g e m e n t of Pain ISBN 0-443-07679-0 Michael Ashburn Churchill Livingstone, New York, I998, 681 pp., $95.00

thermore, the book is quite lengthy, lacks proper organization, and at times, fails to "get to the point". This book is definitely not for the academicians but rather is a clinician's manual for selected topics. Prabaal (Bobby) Dey, M.D. Hospital of the University of Pennsylvania Philadelphia, Pennsylvania

The Management of Pain provides the reader with an updated text of current concepts in the field of pain medicine, including topics not commonly addressed in other pain management texts. It also provides a comprehensive and informative primer. The book is designed as a reference tool for the practitioner as well as a comprehensive treatise in the field of pain medicine. Unfortunately, the chapters are somewhat lengthy and at times not well organized. The book is organized into five sections, which are further subdivided into multiple chapters. The initial section deals with fundamental concepts in pain management. This section is somewhat lacking because it does not address in detail the basic physiologic and pathophysiologic elements of pain. The book is mainly designed for the clinician and practitioner (as it states in preface). However, no book is truly complete without a proper biological discussion of pain as it relates to h u m a n physiology. Practitioners without formal training in pain management should be cautioned against purchasing this text and believing that they can practice pain medicine. Further sections discuss chronic pain, with chapters on implantation therapy, a chapter on terminal disease which addresses pain management in the HIV-positive patient, an acute pain section which discusses the organization of an acute pain service, and a section devoted to pediatric pain management. This book provides excellent discussions of varying topics related to pain management at the turn of the century, but lacks the emphasis on physiology, pathophysiology, diagnosis, and treatment plans that we all need to embrace. The book does, however, offer very good insight into selected topics not widely discussed in other pain management texts. The readability is quite cumbersome because of the lack of uniform writing style among chapters. Fur-

Accepted for publicationJune 1, 1998. Clinical N e u r o a n e s t h e s i a Second Edition ISBN 0-443-07928-5 Roy F. Cucchiara, M.D., Susan Black, M.D., and John D. Michenfelder, M.D., editors Churchill Livingstone, New York, 1998, 701 pp., $125.00 As a practicing anesthesiologist formerly in the private sector, entering the academic environment to pursue advanced clinical training in neuroanesthesia has been challenging. However, I found this textbook an integral part of the materials I needed to enhance my knowledge of neuroanesthesia, and I believe that other anesthesia practitioners in a variety of practice settings will agree. Published as a second edition, Clinical Neuroanesthesia now brings together contributors from the Mayo Clinic in Rochester, Minnesota, and the University of Florida, in Gainesville, Florida, in addition to contributors from other institutions. As in the first edition, there are two main sections in the textbook: Scientific Foundations and Clinical Applications. In the second edition, the basic science portion includes new emphasis on neuroanatomy and cerebrospinal fluid dynamics. Also, new sections in the clinical applications chapters discuss spinal cord and vertebral surgery, trauma, pediatrics, and transesophageal echocardiography. These additions enhance the updated chapters on topics such as intracranial tumors and aneurysms, neuromuscular disease, and pain management. In addition, the clinical application chapters are strengthened by the use of actual case volumes at the Mayo Clinic and Uniw~rsity of Florida, as well as the au-



Regional Anesthesia and Pain Medicine Vol. 23 No. 6 November-December 1998

thorship of experienced and dedicated clinicians. Overall, through collectively gathering this information, the textbook provides a broad foundation for the understanding of neurologic disease as it pertains to neurosurgery and anesthesiology. The book consists of 701 pages divided into 2i chapters. The first five chapters, exclusive of references, are justifiably lengthy at 3 0 - 4 0 pages. These chapters provide a clear and logical scientific foundation for particularly daunting topics such as cerebral blood flow, metabolism, cerebrospinal fluid dynamics, and brain protection. The following 16 chapters provide concise applications of these basic principles to practice situations and include topics such as cerebral aneurysms, vertebral and spinal cord surgery, neurologic monitoring, and neurointensive care. Although at first glance this textbook appears deceptively simple, its clarity and concise nature are its strengths. The text lends itself to a variety of reading and study situations, and, whether there be a mere 5 minutes or several hours of available time, important concepts can be understood and retained. In part, I credit this to the authors' choice of diagrams, drawings, and reproductions of neuroradiologic images. The clear reproductions and schematic illustrations are memorable and include subjects such as anatomy of brain and spinal cord circulation, surgical field anatomy, and proper patient positioning. These appear with a frequency throughout the text which reinforces concepts and encourages further study. Also, the use of occasional vermilion-tinted font in combination with the traditional black creates emphasis on the sections, allowing one to scan ahead to anticipate upcoming topics. In particular, the scientific applications chapter on cerebrospinal fluid dynamics deftly describes the formation and circulation of cerebrospinal fluid and the subsequent consequences of any derangement of the processes. Well-chosen illustrations of the arachnoid villi and choroid plexus enhance the text. In the chapter on cerebral protection, the consequences of cerebral ischemia and reperfusion are discussed as are prevention, therapy, and effects of commonly used anesthetic agents. Intracellular processes such as intracellular calcium transport processes and NMDA ion channel complexes are clearly illustrated. Schematic diagrams demonstrate the relationships between destructive mediators such as free radicals, prostaglandins, and leukotrienes as ischemic processes that lead to cellular injury and death. A chapter on clinical fluid management proceeds in a logical fashion, describing the

physiologic characteristics of brain fluid homeostasis and, addresses injury and subsequent electrolyte imbalances. Concepts are reinforced by illustrations of fluid and electrolyte compartments, Starling's law, and the differential pore size at the brain capillary tight junctions. The section on vertebral and spinal cord surgery includes anatomy of the circulation and descriptions of surgical procedures such as anterior cervical fusion and transoral odontoid resection. Considerations for scoliosis surgery are also detailed. All told, the above is only a cursory description of the extent of the material contained throughout the book. The one area that I would recommend formally adding is a section describing neuroanat omy and pathology with correlations to the patient's neurologic examination. Throughout this past year, I have routinely referred to basic neuroanat om y and neurology texts to review the clinical findings as they pertain to the location and severity of the patient's disease. This information is useful in the preoperative and postoperative periods. As anesthesiologists, it behooves us to have a thorough knowledge of the patient's neurologic status because these patients emerge from anesthesia and require our assessment and care. A dedicated discussion of this subject would be helpful. I found myself carrying this book back and forth from home to office with more ease than other textbooks of this genre. This was mainly because of the nature of the material. However, the book's portability was enhanced by its manageable size of approximately 8 by 10 by 1 I/2 inches. I consider this a distinct advantage for the different reading and studying situations one finds at home and at work. On a practical level, I referred to this text for actual case management and for preparation for conferences for anesthesia residents, i.e., electroencephalography monitoring. This book was also helpful in its ability to provide detailed but focused discussions of otherwise complicated material. It is a beneficial resource for the anesthesia practitioner caring for neurosurgical patients, from student to seasoned practitioner. At a quiet study table or during a hectic workday schedule, this textbook has much to offer. Patricia C. Schupfer, M.D. Department of Anesthesia University of Iowa College of Medicine Iowa City, Iowa Accepted for publication May 27, 1998.