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Clinics inAnaesthesiology, January 1984; Vol. 2 No. 1: Intravenous Anaeslhesiology. Edited by Sear J. Published by W. B. Saunders & Co. Pp. 266; indexed. Price £12.50.
BOOK REVIEWS
457
An Introduction to Neurosurgery. By B. Jennett and S. Galbraith. Published by Wm Heinemann Medical Books Ltd, London. Pp. 360; indexed; illustrated. Price £17.00.
P. S. Sebel
Anaesthesia: Lecture Notes for Students. ByM. AnisandM. Salim. Published by AFM College Press. Pp. 135; illustrated.
(the late) D. Gordon McDowall
Clinics inAnaesthesiology, January 1984; Vol. 2 No. 1: Intravenous Anaeslhesiology. Edited by J. Sear. Published by W. B. Saunders & Co. Pp. 266; indexed. Price £12.50. From the title of this multi-author book, one might expect a slant towards American anaesthetic practice. However, most of the contributors are British, with authors from the U.S.A., Canada and Australia. The book is divided into two parts, eight chapters on the Clinical Pharmacology and Practice of Intravenous Anaesthesia and five chapters on Applied Pharmacology. There is a certain amount of confusion in terminology used throughout the book. There are intravenous anaesthetics, there are hypnotic agents, which appear to be benzodiazepines and non-barbiturates, and narcotics, which are in fact opioid analgesics. There is also some duplication in the chapters, telling us at least three times that Althesin is a mixture of two steroids and even more times that di-isopropylphenol is either being reformulated in a lipid emulsion or that there is a need to reformulate it (depending on where the chapter is written). This duplication does, however, mean that the chapters stand alone and can be read separately. The book is up to date and is extensively referenced up to 1983, including the problem about etomidate producing cortisol suppression. There is the obligatory chapter on pharmacokinetics, and pharmacodynamics which, in this book, is confined to the barbiturates. This chapter, on p. 29, launches into half times and
These Lecture Notes have been compiled by the authors from lectures given at the Army Medical College, Rawalpindi, Pakistan, although the sections on History of Anesthesia and Pain are written respectively by J. Alfred Lee and John Bonica. The authors wisely point out in their Preface that, because of this variety in authorship, "the expressions and spellings, therefore, vary". Nevertheless, there is a major disparity of style in various parts of the book and there would seem little excuse for the wide variations in spelling that occur within individual chapters. The content of the book may well be appropriate for its initially intended audience, but its appropriateness in the wider context is open to doubt. Much of the equipment and some of the techniques described are now of only historic interest to the U.K. student. On the other hand, there are fundamental items of equipment and anaesthetic methods to which no reference is made. Some of the pharmacology is useful in that it is clearly described without too much detail and might help medical students obtain an initial overview of the subject, but agents which in the U.K. are no longer used occupy too much space and new agents are omitted. Thus, divinyl ether and ethyl chloride are both given space, but there is no mention of either enflurane or isoflurane. In the section on myoneural blocking drugs, tubocurarine and gallamine are the only non-depolarizing drugs mentioned! Moreover, the absence of an index makes it difficult to use as a reference. One accepts that this book is deliberately produced on a lowcost basis, but the type-setting, production of the diagrams and
Downloaded from http://bja.oxfordjournals.org/ at Carleton University on July 30, 2015
This book, according to the cover, is directed at specialists in fields other than neurosurgery who need to know something of the subject, and neurosurgical trainees and nurses are particularly mentioned, although anaesthetists are not. The reviewer is not able to comment on the needs of trainee neurosurgeons, but the level of discussion in the book makes it suitable for only the most senior of neurosurgical nurses. It is a useful text for anaesthetists whose work involves neurosurgery; for example the classification of types of intracranial tumour and the description of prognosis and operating difficulty of aneurysms at various sites are helpful. The discussion of intracranial pressure and its problems is adequate for the anaesthetic trainee and has the advantage over some anaesthetic texts that it includes the clinical features of increased intracranial pressure. The section on localizing clinical signs provides a useful revision of the neurophysiology and neuroanatomy underlying interpretation of such signs. The chapter on head injury provides a good overview of the problem, but the account of intensive care of severe head injury is not sufficiently detailed for the anaesthetic trainee. There is, for example, no mention of the cerebral function monitor or of evoked potentials, nor of the need for plasma phenytoin concentrations in the management of post-traumatic epilepsy. There are quite a few type-setting errors and some misleading mistakes, for example on p.232, under "Hyperventilation", hypercapnia is said to induce severe vasoconstriction, and there is a lack of consistency in the use of non-proprietary and proprietary names for drugs. Despite these quibbles, at £17.00 the book represents good value for the anaesthetist who wants to have an informed understanding of the clinical problems of the patients he will meet when working in neurosurgical anaesthesia.
clearance. It is not until p.225 that the appropriate equations are presented in the chapter on Minimum Infusion Rate, which may be confusing for the uninitiated. When reviewing the usefulness of this book, it must be considered against other books on related topics. It is very up to date, and has much more information on the non-barbiturate agents than Dundee and Wyant's 1974 edition of Intravenous Anaesthesia. There is also some overlap with the April 1983 volume of Clinics in Anaeslhesiology, which covers "Narcotic Anaesthesia" in a less comprehensive manner than the present volume. The pharmacology of fentanyl is dealt with in more detail in the earlier volume, but only covered in a short chapter on infusions in this current volume. All the chapters in this volume are by experts in their field and reflect personal view-points of specific areas related to i.v. anaesthesia. Particularly impressive are the chapters on minimum infusion rate and adverse reactions. There is also a useful chapter on evaluation of i.v. anaesthetics in volunteers which describes in detail the setting up of a Phase I study for a new agent. With the current unavailability of Althesin and propanidid and the uncertain future of etomidate infusions, some of the material in this book assumes a historical perspective. The book is in hard back, and the only one available that covers the field. It is well referenced and contains much relevant recent information at a very reasonable price. In the absence of a new edition of Dundee and Wyant's book, it is to be highly recommended, although it lacks the overall cohesiveness of the earlier text. It is therefore a must for any department and an excellent source of information for examination candidates.
457
An Introduction to Neurosurgery. By B. Jennett and S. Galbraith. Published by Wm Heinemann Medical Books Ltd, London. Pp. 360; indexed; illustrated. Price £17.00.
P. S. Sebel
Anaesthesia: Lecture Notes for Students. ByM. AnisandM. Salim. Published by AFM College Press. Pp. 135; illustrated.
(the late) D. Gordon McDowall
Clinics inAnaesthesiology, January 1984; Vol. 2 No. 1: Intravenous Anaeslhesiology. Edited by J. Sear. Published by W. B. Saunders & Co. Pp. 266; indexed. Price £12.50. From the title of this multi-author book, one might expect a slant towards American anaesthetic practice. However, most of the contributors are British, with authors from the U.S.A., Canada and Australia. The book is divided into two parts, eight chapters on the Clinical Pharmacology and Practice of Intravenous Anaesthesia and five chapters on Applied Pharmacology. There is a certain amount of confusion in terminology used throughout the book. There are intravenous anaesthetics, there are hypnotic agents, which appear to be benzodiazepines and non-barbiturates, and narcotics, which are in fact opioid analgesics. There is also some duplication in the chapters, telling us at least three times that Althesin is a mixture of two steroids and even more times that di-isopropylphenol is either being reformulated in a lipid emulsion or that there is a need to reformulate it (depending on where the chapter is written). This duplication does, however, mean that the chapters stand alone and can be read separately. The book is up to date and is extensively referenced up to 1983, including the problem about etomidate producing cortisol suppression. There is the obligatory chapter on pharmacokinetics, and pharmacodynamics which, in this book, is confined to the barbiturates. This chapter, on p. 29, launches into half times and
These Lecture Notes have been compiled by the authors from lectures given at the Army Medical College, Rawalpindi, Pakistan, although the sections on History of Anesthesia and Pain are written respectively by J. Alfred Lee and John Bonica. The authors wisely point out in their Preface that, because of this variety in authorship, "the expressions and spellings, therefore, vary". Nevertheless, there is a major disparity of style in various parts of the book and there would seem little excuse for the wide variations in spelling that occur within individual chapters. The content of the book may well be appropriate for its initially intended audience, but its appropriateness in the wider context is open to doubt. Much of the equipment and some of the techniques described are now of only historic interest to the U.K. student. On the other hand, there are fundamental items of equipment and anaesthetic methods to which no reference is made. Some of the pharmacology is useful in that it is clearly described without too much detail and might help medical students obtain an initial overview of the subject, but agents which in the U.K. are no longer used occupy too much space and new agents are omitted. Thus, divinyl ether and ethyl chloride are both given space, but there is no mention of either enflurane or isoflurane. In the section on myoneural blocking drugs, tubocurarine and gallamine are the only non-depolarizing drugs mentioned! Moreover, the absence of an index makes it difficult to use as a reference. One accepts that this book is deliberately produced on a lowcost basis, but the type-setting, production of the diagrams and
Downloaded from http://bja.oxfordjournals.org/ at Carleton University on July 30, 2015
This book, according to the cover, is directed at specialists in fields other than neurosurgery who need to know something of the subject, and neurosurgical trainees and nurses are particularly mentioned, although anaesthetists are not. The reviewer is not able to comment on the needs of trainee neurosurgeons, but the level of discussion in the book makes it suitable for only the most senior of neurosurgical nurses. It is a useful text for anaesthetists whose work involves neurosurgery; for example the classification of types of intracranial tumour and the description of prognosis and operating difficulty of aneurysms at various sites are helpful. The discussion of intracranial pressure and its problems is adequate for the anaesthetic trainee and has the advantage over some anaesthetic texts that it includes the clinical features of increased intracranial pressure. The section on localizing clinical signs provides a useful revision of the neurophysiology and neuroanatomy underlying interpretation of such signs. The chapter on head injury provides a good overview of the problem, but the account of intensive care of severe head injury is not sufficiently detailed for the anaesthetic trainee. There is, for example, no mention of the cerebral function monitor or of evoked potentials, nor of the need for plasma phenytoin concentrations in the management of post-traumatic epilepsy. There are quite a few type-setting errors and some misleading mistakes, for example on p.232, under "Hyperventilation", hypercapnia is said to induce severe vasoconstriction, and there is a lack of consistency in the use of non-proprietary and proprietary names for drugs. Despite these quibbles, at £17.00 the book represents good value for the anaesthetist who wants to have an informed understanding of the clinical problems of the patients he will meet when working in neurosurgical anaesthesia.
clearance. It is not until p.225 that the appropriate equations are presented in the chapter on Minimum Infusion Rate, which may be confusing for the uninitiated. When reviewing the usefulness of this book, it must be considered against other books on related topics. It is very up to date, and has much more information on the non-barbiturate agents than Dundee and Wyant's 1974 edition of Intravenous Anaesthesia. There is also some overlap with the April 1983 volume of Clinics in Anaeslhesiology, which covers "Narcotic Anaesthesia" in a less comprehensive manner than the present volume. The pharmacology of fentanyl is dealt with in more detail in the earlier volume, but only covered in a short chapter on infusions in this current volume. All the chapters in this volume are by experts in their field and reflect personal view-points of specific areas related to i.v. anaesthesia. Particularly impressive are the chapters on minimum infusion rate and adverse reactions. There is also a useful chapter on evaluation of i.v. anaesthetics in volunteers which describes in detail the setting up of a Phase I study for a new agent. With the current unavailability of Althesin and propanidid and the uncertain future of etomidate infusions, some of the material in this book assumes a historical perspective. The book is in hard back, and the only one available that covers the field. It is well referenced and contains much relevant recent information at a very reasonable price. In the absence of a new edition of Dundee and Wyant's book, it is to be highly recommended, although it lacks the overall cohesiveness of the earlier text. It is therefore a must for any department and an excellent source of information for examination candidates.