European Advances in Intensive Care. International Anesthesiology Clinics. Vol. 2, No. 2. Edited by Geiger K. Published(1983) by Little, Brown and Co., Boston, U.S.A. Pp. 192; indexed; illustrated.

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Fundamentals of Tracheal Intubation. By James T. Roberts. Published by Grune and Stratton. Pp.160; illustrated; indexed. Price £16.00. Since Gillespie's classic has been unavailable for so long, and since, in the two most expensive British textbooks of anaesthetics, discussion of endotracheal intubation is virtually nonexistent, I had hoped to welcome this monograph, but sadly it is a disappointment. Neither its readership nor its purpose are clearly defined. The foreword tells us that it is not meant for anaesthetists or nurse anaesthetists but for non-anaesthetic, emergency room and intensive care personnel; but the author in his preface says that it is designed to help anaesthetists as well as physicians. As it is, it is hardly suitable for either. The occasional intubator who has to act quickly to save life does not need the scrappy historical introduction, nor the descriptions of awake elective or double-lumen endobronchial intubation, while the anaesthetist requires more than this strangely inconsistent book provides. For example, there is a good account of the anatomy of the air passages, but no mention at all of the mandible or the cervical spine; hence the important work of White and Kander, and more recent developments, are miming In fact there are no references to any paper on the various aspects of endotracheal intubation that has appeared in the British journals during recent years, and even the classic account of the oral, pharyngeal and laryngeal axes by Bannister and Macbeth does not receive a correct attribution. Similarly, the anatomy of the infant larynx is described, but paediatric intubation, while hovering in the background, is not discussed. There is a chapter on pharmacological aids to intubation which contains such inappropriate advice that again it begs the whole question of the purpose of the book. The hypertensive response to intubation—which in itself is barely discussed—is mentioned as a danger in the comatose patient, and there follows a list of preventive measures which includes deep general anaesthesia, superior laryngeal nerve blocks plus transtracheal topical anaesthesia, or sodium nitroprusside. Some of the advice for Hmling with other problems is very cursory and could be dangerous in untrained or inexperienced hands. The book could be better structured. Important information that should be together is separated; for example advice on the pre-intubation examination of the patient is badly organized. A useful suggestion for those not already doing it is that difficult intubations should be fully documented; the author reproduces a comprehensive pro forma. There are some errors of history, and some misprints. Sar-

turner should be Sertumer, and he isolated morphine in 1806, not 1805. To say that he did it "following the death of Joseph Priestley" is a pretty good example of a turn ttquitur. Similarly, Charles Kite's work dates from 1787, not 1705. Those who appreciate the jokey "Laws" that head the chapters will miss the essential one around which the anaesthetist continuously reorganizes his hie: Pilsen's Law, which states "It always takes longer." I hope I am not being unfairly critical. The book obviously represents the fruit of years of experience, and contains much valuable practical advice of the sort that is usually conveyed by word of mouth in the anaesthetic room. It may be that it has a useful place in the conditions of hospital practice that pertain to the United States. The requirements of the British anaesthetist are better served by the excellent chapter in the Synopsis. David Zuck

European Advances m Intensive Cart. International Anestiiesiology Clinics. Vol. 2, No. 2. Edited by K. Geiger. Published (1983) by Little, Brown and Co., Boston,U.S.A. Pp. 192;indexed; illustrated. This curiously but geographically accurately titled volume consists of 10 chapters, mainly from continental anaesthetic authors. Eight of the chapters concern cardiovascular and respiratory topics, with two chapters on nutritional support and psychological srqnHar. Because of limitations of space the editor made no attempt to embrace a wide range of subject matter. Transvascular Fluid Balance is the theme of the initial chapter and the relevant experimental background was thoughtfully and clearly presented by two Norwegian phsyiologists, Drs Hauge and Nicolaysen. The lack of a sensitive and reliable method of measurement of lung water in clinical practice was seen by the authors as a major restriction at present, although recent technical advances from the United States may improve this situation. I found the chapter on Hypoxaemia Due to Drugs by Professor Sykes uncharacteristically dull and " • ^ ™ > , but the following chapter on The Effects of Catecholamines on Pulmonary Shunt was interesting, well-illustrated and clinically orientated. The unpredictability of these drugs was highlighted, emphasizing the need for detailed monitoring when such drugs are used in the critically ill. High-frequency Positive Pressure Ventilation (Sjostrant) has obviously yet to find its precise role in anaesthesia and intensive care. The position is complicated by the fact that rHniral evaluation is proceeding against a background of progressively more sophisticated technology. HFPPV is used routinely in the author's centre for endoscopy and for the treatment of bronchopleural fistulae. However, the future prospects of improved patient tolerance of mechanical ventilation with less need for trdation is ^firing The topic of Differential Lung Ventilation is well reviewed by the editor of the volume, although the chapter might have benefited from more discussion of the practical details such as type and size of tubes, methods of placement, fixation, precautions and type of ventilator. The last of the three chapters dealing with ventilation concerns the application of Lowfrequency Positive Pressure Ventilation with Extracorporeal CO? Removal, presented by the Milan group headed by Professor Gamnoni. The case for the use of this new technique is, as always, impressively argued. Nevertheless, an overall survival rate in \ of 60% in such critically ill patients with ARDS is notable

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This book was written for advanced students of human physiology and probably succeeds well in covering these specific topics for such an audience. However, the publishers also hope it will appeal to postgraduate medical students and anaesthetists, and it will not succeed in this aim. The rliniml importance of many of the chapters is hard to get, with the exception of a short and dear chapter on Respiratory Control in Man. No mention of anaesthetic agents is made in several important fields such as peripheral chemoreceptors and Paintal, in his chapter on lung and airway receptors, consistently refers to bupivacaine. The book cannot be recommended for anaesthetists unless they also happen to be advanced students of respiratory physiological control systems, in which case it would be a useful introduction to the limited range of topics that it covers. G.B. Dntmtnond

BRITISH JOURNAL OF ANAESTHESIA

BOOK REVIEWS

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are informative and the illustrations are superb, but perhaps the reader would do better to learn the principles of chestradiologyor monitoring from textbooks devoted to these subjects. The most relevant chapter in this section is undoubtedly that by E.G. Honig on preoperative evaluation. It is a pity that he restricts himself exclusively to pulmonary Hti^a«^ and that he starts his chapter with a description of postoperative complications, but these minor details are over-shadowed by the excellent review of clinical and physiological assessment. Particularly outstanding are the one-page diagrams identifying the radiological and electrocardiographic features associated with chronic airflow limitation, and the careful evaluation of the role of lung function tests as a means of predicting outcome after pulmonary resection. This is a refreshing alternative to an earlier account of the same subject in Chapter 2. Part HI consists of two chapters on cardiopulmonary physiology. Both are written by Jonathan Benumof who, in just under 70 pages, provides a magnificent account of the pulmonary circulation and the changes which accompany thoracotomy and onelung anaesthesia. Even if all else is rejected, this section is a "must" for all practising thoracic anaesthetists. Particularly in the section on one-lung anaesthesia, a topic on which Benumof himself has contributed much original work, the ^rriiing new advances are seen in careful perspective and are set apart from conventional practice so that the reader cannot be deluded into confusing the established with the experimental or investigatory. Part IV is the longest divison and consists of nine chapters Thoracic Anesthesia. Edited by J.A. Kaplan. Published by Churchill Livingstone. Pp.762; indexed; illustrated; Price Hmling with specific anaesthetic considerations. The balance here can only be described as remarkable and one wonders what £55.00. editorial direction was given to the contributors. Anaesthesia for diagnostic procedures gives an excellent account of matters relatTransatlantic differences in the practice of medicine by some notable contrasts in the corresponding literature. As a ing to the airway, but oesophagoscopy is Hi«mi«i-H in a few lines. generalization, American textbooks are large and comprehensive, Anaesthesia for pulmonary surgery is largely an account of the whereas the monograph is more a feature of the U.K. scene. This pharmacology of drugs used during anaesthesia, much of it distinction must be acknowledged by the authors of reviews, a standard information available in any textbook of general anaestask made more difficult if the fundamental difference in ap- thesia. Some specific conditions such as broncho - pleural fistula proach is compounded by the reviewer's own contribution on the and lung cysts are dealt with here, but in less detail than one same subject. Thus, J.A. Kaplan's Thoracic Anesthesia, a multi- might expect by comparison with other sections. A well-illustrated chapter on endobronchial intubation is folauthor book of approximately 750 pages, weighing just over 2 kg lowed by one of no less than 17 pages on bronchopulmonary and costing £55, must be judged with these points in mind. It opens with not one, but two forewords and a preface, lavage—a procedure required only rarely. By contrast, the next followed by a contents list which divides the book into five parts. chapter contains a section on oesophageal surgery which coven Part I is an overview- a brief history which somehow manages not preoperative assessment and preparation as well as perioperative to mention the name of Sir Ivan Magjll, followed by a general management, and yet which is only 10 pages long. The mediastinum and myasthenia gravis are also discussed here. The final account of thoracic surgical procedures written by a surgeon. Here the balance is surprising—an account of lung abscess and three chapters in this section deal with thoracic trauma, paediatfungal infections, but mention of bronchiectasis only in the rics and the insertion of pacemakers. It is surprising to see the last tables. In an attempt at brevity, there are various unexplained and in a text dealing with thoracic surgery, especially as it is primarily unrecognizable abbreviations and a few irritating errors in the an account of the physiology and physics of pacing. The chapter figures. Some of the information is mirimHingj partly because on trauma is an account of shock, resuscitation and complications personal views and results loom large. For example, there can be of trauma as well as specific aspects of damage to the thoracic few centres here which would consider pericardectomy for viscera. Similarly, the chapter on paediatric and neonatal thoracic uraemia or neoplastic disease, or combined surgery for lung surgery strays into the realms of cardiac surgery and the physiology of fetal and early neonatal life, as well as dealing with condiresection and coronary revascularization. Part II is much longer—just over 200 pages—and consists of tions such as tracheo—oesophageal fistula and diaphragmatic four chapters dealing with assessment. Chest radiology and intra- hernia. The content of these three chapters is good but their operative monitoring are the two longest, accounting between relevance, especially at this length, is questionable. The final section is 150 pages dealing with postoperative them for nearly 150 pages. Most of their content is only of the most peripheral relevance to thoracic surgery: for example, the intensive care. The first of its four chapter is titled "Complicaphysical principles of monitoring apparatus or tables which list tions of thoracic surgery", but then proceeds to devote 23 of its 33 the mechanisms which can cause pulmonary oedema, the antece- pages to the management of circulatory failure and disorders of dents of the respiratory distress syndrome and synonyms for it. cardiac rhythm. Pulmonary hypertension and the medical manThat is not to say that these chapters are devoid of value—they agement of cor pulmonale complicating chronic airflow limitation

and the technique clearly requires clinical evaluation in other centres. Dr Donaldson's instructive and competent chapter on the assessment of ventricular function in acutely ill patients is a good mixture, describing the techniques available and their application and limitations in a wide spectrum of Hiniral conditons. An up-to-date and well balanced review of Oxygen-carrying Blood Substitutes (Professor Messmer) will be appreciated at a stage when this technology seems poised to make a significant impact on patient care, particularly when ready access to blood and blood products is less than optimal. The chapter dealing with Nutritional Support (Dr Gcorgjeff) is somewhat too brief to be interesting and certainly represents aratherpersonal view of the subject. The final chapter on Psycho-social Sequelae of Intensive Care (Dr Benzer) is also short, but perhaps this was just as well since I did not detect any new or original concepts, with the possible exception of the use of medical students as patient "companions" providing "a valuable link between the physician and the patient". My overall impression is of a volume which contains a number of useful reviews of interest to rfiniriann in the intensive care field, but which does not quite match its somewhat grand title. /. McA. Ledingham