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Essentials of Artificial Ventilation of the Lungs
EFFECTS OF ALTHESIN IN THE ANAESTHETIZED BABOON 21 por ciento a los 90 seg; a partir de entonces, el flujo carotideo volvi6 a los valores de control, no siendo bastante diferente del control a los cuatro minutos despue's de la inyecci6n. La presidn del liquido cefalorraquideo cambi6 paralelamente con las modificaciones del flujo sanguineo carotideo. El flujo de la sustapcia gris, medido mediante la depuraci6n de xen6n, disminuy6 en mas de un 40 por ciento, y la retention de oxigeno por la sustancia gris descendi6 en un porcentaje similar. El ekctroencefalograma mostr6 periodos de sileocio electrico,
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con un restabletimiento gradual despue's de 3-4 minutos. 100 ^1/kg de altesina produjeron cambios mayores en el flujo sanguineo carotideo y presion del liquido cefalorraquideo, pero la interpretation de los resultados fue mis diftcil porque con esta dosis mas elevada hubo hipotensidn. Los autores concluyen que la altesina reduce marcadamente la retencitfn cerebral de oxigeno y que la depresi6n metabolica conduce a un descenso secundario del flujo sanguineo cerebral y presidn del liquido cefalorraquideo.
Essentials of Artificial Ventilation of the Lungs. 3rd edition. Edited by A. R. Hunter. Published by Churchill Livingstone, 1972. Pp. 95; illus; indexed; price £1.50. This is a valuable little book written particularly for the keen student, casualty house surgeon and house officer anaesthetist. It is well produced with helpful illustrations and the fact that it has reached 3 editions is proof of its usefulness. The first chapter is concerned with the maintenance of the airway and takes a firm but balanced view of such problems as when to carry out tracheostomy and the types of tubes to use. There is also a clear diagram of the possible hazards of tracheostomy and endotracheal suction. Methods of artificial ventilation and the principles of the common ventilators used in Great Britain are covered. The old arguments on methods of classification of ventilators are summarised clearly. Dr Hunter concludes that it is only with a full functional analysis of a ventilator that an anaesthetist can predict performance in the presence of leaks, airway obstruction, spontaneous respiratory efforts from the patient, etc. The individual machines are covered briefly but those looking for full accounts should, of course, consult Mushin, RendellBaker and Thompson's "Artificial Ventilation of the Lungs" (2nd edition, 1969). However, the principles of the machines are analyzed and this enables an evaluation of their usefulness and problems in given circumstances. It is surprising to find the Bennett ventilator omitted but perhaps the choice between it and the Bird has always depended on personal preference and chance. Both machines require more attention than the volume
cycled variety but their use has made management of inadequate respiration in the postoperative period much easier. The chapter on the use of ventilators covers the dangers of the Radford Nomogram, of negative pressure in the expiratory phase and of patient-triggering. Aridbase balance is covered from the point of view of the Astrup technique, Pco, electrodes and older techniques and a simple basis for treatment of metabolic problems is given. The practical information on feeding, particularly tube feeding, is of value as a counterbalance to the usual emphasis on the intravenous route. Other practical points about sedation and management of diarrhoea are discussed and should encourage discussion even in established Intensive Care Units. Most of the diseases causing respiratory insufficiency are briefly mentioned, providing sufficient information for the undergraduate or as an introduction for the trainee anaesthetist. Finally there is an interesting chapter on "brain death" which collates information from scattered sources. This subject must be frequently in the minds of doctors involved in artificial ventilation and there is clearly room for much more scientific study. This chapter is the main change in the book since the previous edition and is most worthwhile. Altogether this is a book which can be read by doctors occasionally concerned with the subject. It should also be available in all recovery wards and intensive care units for non-medical staff. Lastly it should be among the first books read by the trainee anaesthetist for it will certainly show him the fascination of the long term care of unconscious patients. R. S. J. Clarke
Downloaded from http://bja.oxfordjournals.org/ at New York University on May 22, 2015
BOOK REVIEW
757
con un restabletimiento gradual despue's de 3-4 minutos. 100 ^1/kg de altesina produjeron cambios mayores en el flujo sanguineo carotideo y presion del liquido cefalorraquideo, pero la interpretation de los resultados fue mis diftcil porque con esta dosis mas elevada hubo hipotensidn. Los autores concluyen que la altesina reduce marcadamente la retencitfn cerebral de oxigeno y que la depresi6n metabolica conduce a un descenso secundario del flujo sanguineo cerebral y presidn del liquido cefalorraquideo.
Essentials of Artificial Ventilation of the Lungs. 3rd edition. Edited by A. R. Hunter. Published by Churchill Livingstone, 1972. Pp. 95; illus; indexed; price £1.50. This is a valuable little book written particularly for the keen student, casualty house surgeon and house officer anaesthetist. It is well produced with helpful illustrations and the fact that it has reached 3 editions is proof of its usefulness. The first chapter is concerned with the maintenance of the airway and takes a firm but balanced view of such problems as when to carry out tracheostomy and the types of tubes to use. There is also a clear diagram of the possible hazards of tracheostomy and endotracheal suction. Methods of artificial ventilation and the principles of the common ventilators used in Great Britain are covered. The old arguments on methods of classification of ventilators are summarised clearly. Dr Hunter concludes that it is only with a full functional analysis of a ventilator that an anaesthetist can predict performance in the presence of leaks, airway obstruction, spontaneous respiratory efforts from the patient, etc. The individual machines are covered briefly but those looking for full accounts should, of course, consult Mushin, RendellBaker and Thompson's "Artificial Ventilation of the Lungs" (2nd edition, 1969). However, the principles of the machines are analyzed and this enables an evaluation of their usefulness and problems in given circumstances. It is surprising to find the Bennett ventilator omitted but perhaps the choice between it and the Bird has always depended on personal preference and chance. Both machines require more attention than the volume
cycled variety but their use has made management of inadequate respiration in the postoperative period much easier. The chapter on the use of ventilators covers the dangers of the Radford Nomogram, of negative pressure in the expiratory phase and of patient-triggering. Aridbase balance is covered from the point of view of the Astrup technique, Pco, electrodes and older techniques and a simple basis for treatment of metabolic problems is given. The practical information on feeding, particularly tube feeding, is of value as a counterbalance to the usual emphasis on the intravenous route. Other practical points about sedation and management of diarrhoea are discussed and should encourage discussion even in established Intensive Care Units. Most of the diseases causing respiratory insufficiency are briefly mentioned, providing sufficient information for the undergraduate or as an introduction for the trainee anaesthetist. Finally there is an interesting chapter on "brain death" which collates information from scattered sources. This subject must be frequently in the minds of doctors involved in artificial ventilation and there is clearly room for much more scientific study. This chapter is the main change in the book since the previous edition and is most worthwhile. Altogether this is a book which can be read by doctors occasionally concerned with the subject. It should also be available in all recovery wards and intensive care units for non-medical staff. Lastly it should be among the first books read by the trainee anaesthetist for it will certainly show him the fascination of the long term care of unconscious patients. R. S. J. Clarke
Downloaded from http://bja.oxfordjournals.org/ at New York University on May 22, 2015
BOOK REVIEW