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Fundamental Principles and Practice of Anaesthesia
British Journal of Anaesthesia 89 (6): 940±4 (2002)
Book Reviews The Electronic Anesthesiology Library (TEAL) on CD-ROM (Volume 7: 1997±2001). Published by Lippincott, Williams and Wilkins, Philadelphia. ISBN 0-7817-3616-1.
1 Prys-Roberts C. The Electronic Anesthesiology Library (TEAL) on CD-ROM (Volume 3: 1993±1997). Br J Anaesth 1999; 82: 155±6 2 Kenny GNC. CD Review: The Electronic Anesthesiology Library 1996±2000. TEAL CD-ROM. Br J Anaesth 2001; 87: 944 3 Parsons D. T.E.A.L. The Electronic Anesthesiology Library on CD-ROM, 1991±1995. Can J Anesth 1997; 44: 341
Fundamental Principles and Practice of Anaesthesia. P. Hutton, G. M. Cooper, F. M. James III, J. F. Butterworth IV (editors). Published by Martin Dunitz, London. Pp. 1072; indexed; illustrated. Price £95.00. ISBN 1-899066-57-8. This is a major textbook primarily aimed at the trainee anaesthetist, and covers core knowledge in anaesthesia. The book is divided into sections, approaching the material from three aspects. The ®rst section is `Basic Anaesthetic Practice'. This covers the process of giving anaesthesia for surgery, and management of the normal patient perioperatively and postoperatively. It also provides a basic outline of intensive care medicine. The second section is entitled `Integrated Basic Sciences' and covers biochemistry, physiology, pharmacology, and physics with clinical measurement. A third section `The Presenting Patient', covers the clinical assessment and management of various categories of patient undergoing anaesthesia, who could potentially cause problems. Finally, a miscellaneous section, `Special Subjects: Physiology and Pharmacology' presents theoretical or practical topics, which do not ®t readily into the other sections. The book is edited from both sides of the Atlantic, but the majority of the contributors are from the UK and the book has a de®nite English, rather than transatlantic `¯avour'. It is, however, designed to provide the basic knowledge suitable for anaesthesia postgraduate examinations across the world, including those held in the UK, Ireland, USA, Canada, Hong Kong, and Australasia. Initial impressions are of a book of just over a thousand pages, covering every topic that trainees and indeed established
Ó The Board of Management and Trustees of the British Journal of Anaesthesia 2002
Downloaded from http://bja.oxfordjournals.org/ at University of Southern Queensland on June 22, 2015
This is the latest TEAL CD of a series that has become established as a key resource within active anaesthetic departments. This is a review of the latest 5-yr CD version, although there is, allegedly, a 10-yr DVD version as well. The contents and access are familiar to anyone who has used the previous volumes of the CD. There do not appear to be any major changes in the software, which uses a Windows and Mac compatible format and allows several ways of searching the database of journal content. As with all educational material, it has both good and bad points. Its main advantage over internet accessible library or search facilities is the ability to access complete papers (of Anesthesiology, the British Journal of Anaesthesia, Anesthesia and Analgesia, and the Canadian Journal of Anaesthesia) rather than the more ubiquitous Medline format of a title and abstract. The ability to print and save entire papers or just appropriate graphs to illustrate a lecture or presentation is one of the strongest points of this package. The `Knowledge Finder' software is easy to install if you have not used it before, and is almost intuitive enough to begin searching the 5-yr database. There is a handbook in the front of the jewel case, which contains enough information to make the most of the search tools. Sadly, there is no way to copy the software and the databases onto a computer without having the CD in place. Previous reviews1±3 have mentioned the variety of search strategies available. There is an option to simply review the tables of contents of the journals, but whilst this is effective, it is little better than using the bound paper versions. The other two search methods are more rapidÐone uses a `fuzzy logic' to match free text to appropriate papers, the other uses the more familiar dictionary approach with, for instance, keywords or authors. The results are displayed as a page of summaries. The information is concise and is ranked according to the nearest match to the search strategy. The matching appears to be prioritized to the nearest text match and then in reverse chronological order. This sometimes makes apparently very similar papers appear out of sequence. To move from the summaries page to view the complete papers is achieved by double clicking or hitting a button with two eyes and no explanation! The page with the complete paper can also display a thumbnail area with all the illustrations, graphs and tables from the paper. This is a very valuable tool; it is of great use when the need is to ®nd that particular graph that explains the concept so well for a presentation. Finding it (requiring moving through the windows toolbar and ®nding the ®gures-tables window) is worth the effort. The page with the complete paper on has a few more interesting features. The cursor becomes a hand once over the text, but unlike other programs it does not scroll the text, it highlights the text for editing. Even this is a little tricky because it often misses the parts you want. There are several buttons with no explanation that with some simple experimentation appear to increase or decrease the line spacingÐwhy? Moving between the selected papers can be achieved by using the next/previous buttons. They can also be selected using the left and right buttons, but using the up/down ones moves to the next reference in the database. This is a little disconcerting the ®rst time it happens, and just irritating after that.
The ®nal irritation is the inability to copy the key elements of the reference into any of the `reference' software packages. Surely the majority of purchasers of this CD will intend to use the results of their searches in one literary form or anotherÐbe it a review article, the discussion section of a paper, or even a PowerPoint slide presentation. What do I really think about this CD? It remains a very valuable resource for a department, and is useful for individuals who need to both search for and read complete papers. It is this that allows it to stand against the internet search systems. I certainly would not be without this volume or the previous ones. However, the costs involved in buying the CD are high, and the inability to copy it to one's `working' laptop is a signi®cant problem. It is high time the software was updated. Would I recommend that you buy it? Yes. I would recommend that your department has one, and that it is under lock and key. The inability to load a working copy on at least one machine is a major risk when the CD is `lost'. The 5-yr database is complete and, unless you lose a copy, it would make sense to get a new CD every 5 yr. C. Dodds Middlesbrough, UK
Book reviews
In the `Cardiovascular Physiology and Pharmacology' chapter, physiology and pharmacology mesh together naturally. The consideration of anti-arrhythmic drugs and inotropes ®t well into the overall scheme. The reader really does get an impression that the whole is greater than the sum of its separate parts. Similarly, in discussion of renal physiology, the inclusion of pharmacological implications adds an extra dimension. However, in the chapter on liver biochemistry and physiology, although a very good discussion of drug metabolism is presented, the drug regimens often applied to liver failure patients are not mentioned. In general, this integrated approach to biochemistry, physiology and pharmacology is very successful, adding an extra dimension to the reader's understanding. The result is analogous to the difference between Grant's regional approach to anatomy vs Gray's systemic approach. Sometimes an understanding of the regional anatomy is more useful in practice than an understanding of the separate systems of nerves, muscles and bones. In contrast, the physics, clinical measurement and statistics are presented as separate sections. These chapters are well presented with good coverage of all topics. A thorough section on clinical measurement and safety, together with a clear but concise section on statistics completes what is a very commendable basic sciences package. `The Presenting Patient' is a section reminding readers of their roots as medical practitioners. It outlines the anaesthetic implications of various common disease states, which potentially cause problems in patients presenting for anaesthesia. This is effectively a handbook for practising anaesthetists who are likely to be faced with such patients. Excellent summaries and guidelines are provided for the assessment and management of common presentations, including such conditions as ischaemic heart disease, diabetes mellitus, renal failure, hepatic failure, obesity, and many more. These are all problems that trainees (and indeed all anaesthetists) are more than likely to encounter in everyday practice. The section is well written, concise, and based on good clinical practice. `Special Subjects' has a wealth of topics in it, ranging from accounts of how to perform procedures such as insertion of jugular CVP lines, to more topical material such as a brief account of cell adhesion molecules. This section, apart from providing a home for miscellaneous topics, will also enable the volume to `keep up to date' against the ever-changing background of medical fashion. Here is a book which has multiple roles. It provides the new trainee with a basic introduction to anaesthetic practice and the role of the anaesthetist. It is also a textbook of basic sciences written from the anaesthetic point of view by practising anaesthetists, to provide core knowledge for postgraduate examinations and further learning. `The Presenting Patient' section is a valuable guide and aide memoire for the assessment of patients and the management of common clinical problems that arise in everyday anaesthetic practice. It is a book that sets out to be all things to all anaesthetists in training, not only for our own trainees in the UK and Ireland, but throughout the Englishspeaking world. The dif®culties facing such a project are substantial. It has to obtain the right spectrum and depth of coverage, presenting complex basic sciences in a clear, organized fashion, but in a way relevant to anaesthesia. It should provide clear uncluttered guidelines in clinical matters without becoming over prescriptive, and yet encourage trainees to develop their clinical skills using basic sciences, thus avoiding clinical practice based on mindless algorithms. I believe the editors have achieved these ambitions and produced an admirable foundation text. The volume is inevitably substantial and the concentration of material is sometimes daunting, but it truly is a resource containing the basics of our speciality. I would have no hesitation in
941
Downloaded from http://bja.oxfordjournals.org/ at University of Southern Queensland on June 22, 2015
specialists, might wish to look up. Topics are approached from both the practical and theoretical points of view. Text, tables and diagrams are clearly presented and well laid out. In spite of multiple contributors, there is a notable uniformity throughout the text, which pays tribute to the editing. The text is well organized, clearly written and with a minimum of opinion, hypothesis and references. It presents the basics of each topic without ambiguity, and includes some references at the end of each chapter, for further reading where required. The compactness of the format often belies the information content, which can be very concentrated. The book is extremely well supported with photographs (both colour and black and white), line diagrams and tables, all of which are of a high quality. Background colouring to highlight the line diagrams and tables is in various tones of purple, which certainly make the diagrams stand out, in fact strikingly so! However the reader's eyes soon become accustomed to this effect. Splits of diagrams from the relevant text are inevitable in all text books, and will obviously increase with large numbers of diagrams and photographs. Fundamental Principles and Practice is exceptionally well illustrated, but the reader sometimes pays the price with increased page turning to view the diagrams or tables referred to. Personally, I found some of the labelling in the diagrams a little too ®ne for easy reading. Photographs, although compact, are of excellent quality and illustrate the accompanying text well; even the x-rays and CT scans making their point clearly. `Basic Anaesthetic Practice' effectively constitutes a manual of good practice for the anaesthetic trainee, starting with basic decision-making and working through the process of giving an anaesthetic for surgery. Excellent chapters are given on postoperative care and airway management. The text is always centred around good anaesthetic practice, but is not prescriptive and avoids the pitfalls of becoming too didactic or providing `anaesthetic recipes'. Although the authors do not hesitate to delve into the detailed underlying anatomy or physiology where appropriate, the discussion never becomes so esoteric that the reader loses sight of the practical clinical implications. The chapter on high-dependency and intensive care is only 23 pages long, but manages to highlight all of the main issues of clinical importance very competently. Within these pages the authors manage to cover scoring systems not only for patient severity, but also for sedation, liver failure, and acute lung injury. Different organ system failures are discussed, with a brief but clear presentation of underlying pathophysiology, and a basic rationale for management. Even sections outlining the primary issues in ethics, death and dying, and communication in intensive care, are included. These few pages will be an invaluable aid to new trainees fresh to intensive care medicine. This ®rst section presents the principles of sound clinical practice, underpinned with detailed basic sciences where appropriate, and is highly successful. `Integrated Basic Sciences' takes a novel approach to biochemistry, physiology and pharmacology, which are traditionally presented as separate disciplines. The emphasis is laid on integration of the basic sciences within each topic. Topics are approached by trying to present a seamless discussion, moving from the atomic/molecular level through to tissue/organ level, with relevant pharmacology woven into the account. Thus the opening chapter in this section spans basic physical chemistry, biochemistry, intermediate metabolism, cell division, and genetics. This is challenging coverage for the reader as the material is concentrated into 30 pages. Depth of discussion in not necessarily sacri®ced in the interests of covering ground, and this is not easy reading. However, the overview provided gives the various components, which are usually covered individually, a new perspective seen within the background context of the cell.
Book reviews
recommending this book to trainees and senior colleagues alike. It contains all you need and more to become and remain a `proper' anaesthetist! I have no doubt that successive editions will go from strength to strength. E. S. Lin Leicester, UK Clinical Data Interpretation in Anaesthesia and Intensive Care. S. Bonner and C. Dodds (editors). Published by Churchill Livingstone, London. Pp. 278; indexed; illustrated. Price £24.99. ISBN 0-443-06453-9.
This short volume reviews a wide range of quality issues from an American perspective. The undoubted increase in patient safety in the last 20 yr has had many causes, but one may perhaps ¯ag up two principal ones. The analysis of accidents, incidents, and patient deaths, promoted so successfully by the National CEPOD studies in the UK, and the Anesthesia Patient Safety Foundation in the USA, has introduced many changes in working practice. The second major contribution to patient safety has been improved monitoring standards; it is well within living memory that one had no continuous monitoring availableÐan intermittent sphygmomanometer, a ®nger on the pulse, and a view of the moving bag to tell us of the condition of a patient covered by drapes. John Eichhorn provides an excellent review of the role of monitoring in reducing risk in anaesthesia, and some of the dif®culties in making an evidence-based assessment of the exact contribution that it has made to increasing safety. There are a number of shorter articles on quality management, which I found a little uninspiringÐneither convincing me that I should change my practice, nor that of our institution. The data are US-based and re¯ect the political set-up in the USA rather than the UK. There are a number of points with which we are readily familiar, such as the importance of informed consent, good documentation, con®dentiality etc., which are, of course, universal truisms, but I suppose a quality review could not be complete without mentioning them. There is, however, no solution provided to the dif®culties of coping with inadequate information systems, missing notes, patients being admitted after lists have started etc., which all beset today's UK anaesthetists. A chapter on paediatric sedation outside the operating room re¯ects a practice rather different from that commonly found in the UK. As an example, midazolam 0.5 mg kg±1 was given to a child at home before a procedure; the child fell asleep in a car seat, became obstructed and died. An interesting article on the dif®cult problem of outcome research in anaesthesia discusses study design, meta-analyses, and other ways of analysing data. I found this a useful chapter, though perhaps not quite as inspiring as the leading speakers in the UK would be. The closed claims project does appear to have contributed towards improving outcomes, in the sense that it made people more aware of just how expensive anaesthetic accidents can beÐbiasing thought towards risk management rather than error management. They also demonstrated the advances in patient safety contributed by monitoring, where only 9% of the claims from the 1990s were preventable by monitoring, in contrast to 39% of the claims from the 1970s. The book closes with short articles on anaesthesia simulation and expert witnesses. Overall, I am not clear of the bene®ts of books of this type, which are essentially assemblies of review articles. If I want to be better informed about a particular topic, I generally prefer to go straight to a literature search and read articles in the journals. However, this approach does perhaps provide a useful overview of the position at any one time, albeit from a transatlantic perspective. J. A. Lack Salisbury, UK
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Downloaded from http://bja.oxfordjournals.org/ at University of Southern Queensland on June 22, 2015
This book is a gem! Its aim is succinctly articulated in its Preface: `This book grew out of a desire to provide ongoing CPD in clinical data interpretation for both consultants as well as trainees, together with an insight into some newer methods of investigations, of relevance to anaesthesia.' It succeeds in this aim admirably. A large amount of information has been packed into a small book and yet the content remains accessible and relevant. The book is multi-author, each of the nine chapters having contributions from between one and four authors. The book covers a number of areas relevant to clinical practice in anaesthesia: respiratory disease, cardiology, neurosurgery, orthopaedics and trauma, general anaesthesia, intensive care medicine, obstetric anaesthesia, paediatric anaesthesia, and pain management. Each chapter begins with a short introduction to the tests on which the data is to be presented. These introductory sections are clear and useful and in one or two cases the authors seem to manage to describe clearly and usefully, in three or four pages, material which is frequently described in textbooks at much greater length with considerably less clarity. The descriptions of thrombelastography and blood gas analysis are cases in point. There follows a series of short questions on data interpretation, usually 25±30 in number, although there are only 10 on obstetric anaesthesia and 10 on pain management. The questions are short, usually occupying about half a page, and consist of a clinical scenario together with relevant clinical data such as a chest x-ray, ECG, set of blood gas results, or a cardiotocograph (CTG). The ®nal section of each chapter consists of the answers to the preceding questions plus explanations that are suf®cient without being overwhelming. References for further reading are given. The book has a few minor weaknesses. The obstetric section seems short, having only 10 questions, six of which are on the CTG. The pain management section focuses solely on chronic pain and, again, contains only 10 questions. The x-rays that are reproduced in many of the questions have frequently lost detail in being reduced to ®t into the book. However, with regard to this last issue, the authors and publishers presumably had to tread a line between producing a large expensive book full of high resolution images, and a smaller book with perhaps slightly less clear images at a reasonable price. I feel that they have made the right choice. This is a book that will ®t easily into a briefcase. One can dip into it in those short gaps that appear in the working day that can be long enough to be tedious but too short to retire to the of®ce or the library. It will be useful to trainees preparing for the ®nal fellowship examination. (The SpRs to whom I showed it all seemed to feel that it was an excellent little book.) It will also certainly be useful to consultants seeking digestible CPD material who wish to supplement their reading of the literature, particularly review articles, with material that has a strong clinical ¯avour. This book is packed with useful knowledge, but its great virtue is the elegance with which it places the application of that knowledge into context. S. J. Howell Leeds, UK
Problems in Anesthesia Series. L. A. Fleisher and D. S. Prough (editors-in-chief). Quality, Safety, Risk and Outcomes. L. Fleisher and D. Prough (editors). Published by Lippincott, Williams and Wilkins, Hagerstown, MD. Pp. 526, indexed. ISSN 08894698.
Book Reviews The Electronic Anesthesiology Library (TEAL) on CD-ROM (Volume 7: 1997±2001). Published by Lippincott, Williams and Wilkins, Philadelphia. ISBN 0-7817-3616-1.
1 Prys-Roberts C. The Electronic Anesthesiology Library (TEAL) on CD-ROM (Volume 3: 1993±1997). Br J Anaesth 1999; 82: 155±6 2 Kenny GNC. CD Review: The Electronic Anesthesiology Library 1996±2000. TEAL CD-ROM. Br J Anaesth 2001; 87: 944 3 Parsons D. T.E.A.L. The Electronic Anesthesiology Library on CD-ROM, 1991±1995. Can J Anesth 1997; 44: 341
Fundamental Principles and Practice of Anaesthesia. P. Hutton, G. M. Cooper, F. M. James III, J. F. Butterworth IV (editors). Published by Martin Dunitz, London. Pp. 1072; indexed; illustrated. Price £95.00. ISBN 1-899066-57-8. This is a major textbook primarily aimed at the trainee anaesthetist, and covers core knowledge in anaesthesia. The book is divided into sections, approaching the material from three aspects. The ®rst section is `Basic Anaesthetic Practice'. This covers the process of giving anaesthesia for surgery, and management of the normal patient perioperatively and postoperatively. It also provides a basic outline of intensive care medicine. The second section is entitled `Integrated Basic Sciences' and covers biochemistry, physiology, pharmacology, and physics with clinical measurement. A third section `The Presenting Patient', covers the clinical assessment and management of various categories of patient undergoing anaesthesia, who could potentially cause problems. Finally, a miscellaneous section, `Special Subjects: Physiology and Pharmacology' presents theoretical or practical topics, which do not ®t readily into the other sections. The book is edited from both sides of the Atlantic, but the majority of the contributors are from the UK and the book has a de®nite English, rather than transatlantic `¯avour'. It is, however, designed to provide the basic knowledge suitable for anaesthesia postgraduate examinations across the world, including those held in the UK, Ireland, USA, Canada, Hong Kong, and Australasia. Initial impressions are of a book of just over a thousand pages, covering every topic that trainees and indeed established
Ó The Board of Management and Trustees of the British Journal of Anaesthesia 2002
Downloaded from http://bja.oxfordjournals.org/ at University of Southern Queensland on June 22, 2015
This is the latest TEAL CD of a series that has become established as a key resource within active anaesthetic departments. This is a review of the latest 5-yr CD version, although there is, allegedly, a 10-yr DVD version as well. The contents and access are familiar to anyone who has used the previous volumes of the CD. There do not appear to be any major changes in the software, which uses a Windows and Mac compatible format and allows several ways of searching the database of journal content. As with all educational material, it has both good and bad points. Its main advantage over internet accessible library or search facilities is the ability to access complete papers (of Anesthesiology, the British Journal of Anaesthesia, Anesthesia and Analgesia, and the Canadian Journal of Anaesthesia) rather than the more ubiquitous Medline format of a title and abstract. The ability to print and save entire papers or just appropriate graphs to illustrate a lecture or presentation is one of the strongest points of this package. The `Knowledge Finder' software is easy to install if you have not used it before, and is almost intuitive enough to begin searching the 5-yr database. There is a handbook in the front of the jewel case, which contains enough information to make the most of the search tools. Sadly, there is no way to copy the software and the databases onto a computer without having the CD in place. Previous reviews1±3 have mentioned the variety of search strategies available. There is an option to simply review the tables of contents of the journals, but whilst this is effective, it is little better than using the bound paper versions. The other two search methods are more rapidÐone uses a `fuzzy logic' to match free text to appropriate papers, the other uses the more familiar dictionary approach with, for instance, keywords or authors. The results are displayed as a page of summaries. The information is concise and is ranked according to the nearest match to the search strategy. The matching appears to be prioritized to the nearest text match and then in reverse chronological order. This sometimes makes apparently very similar papers appear out of sequence. To move from the summaries page to view the complete papers is achieved by double clicking or hitting a button with two eyes and no explanation! The page with the complete paper can also display a thumbnail area with all the illustrations, graphs and tables from the paper. This is a very valuable tool; it is of great use when the need is to ®nd that particular graph that explains the concept so well for a presentation. Finding it (requiring moving through the windows toolbar and ®nding the ®gures-tables window) is worth the effort. The page with the complete paper on has a few more interesting features. The cursor becomes a hand once over the text, but unlike other programs it does not scroll the text, it highlights the text for editing. Even this is a little tricky because it often misses the parts you want. There are several buttons with no explanation that with some simple experimentation appear to increase or decrease the line spacingÐwhy? Moving between the selected papers can be achieved by using the next/previous buttons. They can also be selected using the left and right buttons, but using the up/down ones moves to the next reference in the database. This is a little disconcerting the ®rst time it happens, and just irritating after that.
The ®nal irritation is the inability to copy the key elements of the reference into any of the `reference' software packages. Surely the majority of purchasers of this CD will intend to use the results of their searches in one literary form or anotherÐbe it a review article, the discussion section of a paper, or even a PowerPoint slide presentation. What do I really think about this CD? It remains a very valuable resource for a department, and is useful for individuals who need to both search for and read complete papers. It is this that allows it to stand against the internet search systems. I certainly would not be without this volume or the previous ones. However, the costs involved in buying the CD are high, and the inability to copy it to one's `working' laptop is a signi®cant problem. It is high time the software was updated. Would I recommend that you buy it? Yes. I would recommend that your department has one, and that it is under lock and key. The inability to load a working copy on at least one machine is a major risk when the CD is `lost'. The 5-yr database is complete and, unless you lose a copy, it would make sense to get a new CD every 5 yr. C. Dodds Middlesbrough, UK
Book reviews
In the `Cardiovascular Physiology and Pharmacology' chapter, physiology and pharmacology mesh together naturally. The consideration of anti-arrhythmic drugs and inotropes ®t well into the overall scheme. The reader really does get an impression that the whole is greater than the sum of its separate parts. Similarly, in discussion of renal physiology, the inclusion of pharmacological implications adds an extra dimension. However, in the chapter on liver biochemistry and physiology, although a very good discussion of drug metabolism is presented, the drug regimens often applied to liver failure patients are not mentioned. In general, this integrated approach to biochemistry, physiology and pharmacology is very successful, adding an extra dimension to the reader's understanding. The result is analogous to the difference between Grant's regional approach to anatomy vs Gray's systemic approach. Sometimes an understanding of the regional anatomy is more useful in practice than an understanding of the separate systems of nerves, muscles and bones. In contrast, the physics, clinical measurement and statistics are presented as separate sections. These chapters are well presented with good coverage of all topics. A thorough section on clinical measurement and safety, together with a clear but concise section on statistics completes what is a very commendable basic sciences package. `The Presenting Patient' is a section reminding readers of their roots as medical practitioners. It outlines the anaesthetic implications of various common disease states, which potentially cause problems in patients presenting for anaesthesia. This is effectively a handbook for practising anaesthetists who are likely to be faced with such patients. Excellent summaries and guidelines are provided for the assessment and management of common presentations, including such conditions as ischaemic heart disease, diabetes mellitus, renal failure, hepatic failure, obesity, and many more. These are all problems that trainees (and indeed all anaesthetists) are more than likely to encounter in everyday practice. The section is well written, concise, and based on good clinical practice. `Special Subjects' has a wealth of topics in it, ranging from accounts of how to perform procedures such as insertion of jugular CVP lines, to more topical material such as a brief account of cell adhesion molecules. This section, apart from providing a home for miscellaneous topics, will also enable the volume to `keep up to date' against the ever-changing background of medical fashion. Here is a book which has multiple roles. It provides the new trainee with a basic introduction to anaesthetic practice and the role of the anaesthetist. It is also a textbook of basic sciences written from the anaesthetic point of view by practising anaesthetists, to provide core knowledge for postgraduate examinations and further learning. `The Presenting Patient' section is a valuable guide and aide memoire for the assessment of patients and the management of common clinical problems that arise in everyday anaesthetic practice. It is a book that sets out to be all things to all anaesthetists in training, not only for our own trainees in the UK and Ireland, but throughout the Englishspeaking world. The dif®culties facing such a project are substantial. It has to obtain the right spectrum and depth of coverage, presenting complex basic sciences in a clear, organized fashion, but in a way relevant to anaesthesia. It should provide clear uncluttered guidelines in clinical matters without becoming over prescriptive, and yet encourage trainees to develop their clinical skills using basic sciences, thus avoiding clinical practice based on mindless algorithms. I believe the editors have achieved these ambitions and produced an admirable foundation text. The volume is inevitably substantial and the concentration of material is sometimes daunting, but it truly is a resource containing the basics of our speciality. I would have no hesitation in
941
Downloaded from http://bja.oxfordjournals.org/ at University of Southern Queensland on June 22, 2015
specialists, might wish to look up. Topics are approached from both the practical and theoretical points of view. Text, tables and diagrams are clearly presented and well laid out. In spite of multiple contributors, there is a notable uniformity throughout the text, which pays tribute to the editing. The text is well organized, clearly written and with a minimum of opinion, hypothesis and references. It presents the basics of each topic without ambiguity, and includes some references at the end of each chapter, for further reading where required. The compactness of the format often belies the information content, which can be very concentrated. The book is extremely well supported with photographs (both colour and black and white), line diagrams and tables, all of which are of a high quality. Background colouring to highlight the line diagrams and tables is in various tones of purple, which certainly make the diagrams stand out, in fact strikingly so! However the reader's eyes soon become accustomed to this effect. Splits of diagrams from the relevant text are inevitable in all text books, and will obviously increase with large numbers of diagrams and photographs. Fundamental Principles and Practice is exceptionally well illustrated, but the reader sometimes pays the price with increased page turning to view the diagrams or tables referred to. Personally, I found some of the labelling in the diagrams a little too ®ne for easy reading. Photographs, although compact, are of excellent quality and illustrate the accompanying text well; even the x-rays and CT scans making their point clearly. `Basic Anaesthetic Practice' effectively constitutes a manual of good practice for the anaesthetic trainee, starting with basic decision-making and working through the process of giving an anaesthetic for surgery. Excellent chapters are given on postoperative care and airway management. The text is always centred around good anaesthetic practice, but is not prescriptive and avoids the pitfalls of becoming too didactic or providing `anaesthetic recipes'. Although the authors do not hesitate to delve into the detailed underlying anatomy or physiology where appropriate, the discussion never becomes so esoteric that the reader loses sight of the practical clinical implications. The chapter on high-dependency and intensive care is only 23 pages long, but manages to highlight all of the main issues of clinical importance very competently. Within these pages the authors manage to cover scoring systems not only for patient severity, but also for sedation, liver failure, and acute lung injury. Different organ system failures are discussed, with a brief but clear presentation of underlying pathophysiology, and a basic rationale for management. Even sections outlining the primary issues in ethics, death and dying, and communication in intensive care, are included. These few pages will be an invaluable aid to new trainees fresh to intensive care medicine. This ®rst section presents the principles of sound clinical practice, underpinned with detailed basic sciences where appropriate, and is highly successful. `Integrated Basic Sciences' takes a novel approach to biochemistry, physiology and pharmacology, which are traditionally presented as separate disciplines. The emphasis is laid on integration of the basic sciences within each topic. Topics are approached by trying to present a seamless discussion, moving from the atomic/molecular level through to tissue/organ level, with relevant pharmacology woven into the account. Thus the opening chapter in this section spans basic physical chemistry, biochemistry, intermediate metabolism, cell division, and genetics. This is challenging coverage for the reader as the material is concentrated into 30 pages. Depth of discussion in not necessarily sacri®ced in the interests of covering ground, and this is not easy reading. However, the overview provided gives the various components, which are usually covered individually, a new perspective seen within the background context of the cell.
Book reviews
recommending this book to trainees and senior colleagues alike. It contains all you need and more to become and remain a `proper' anaesthetist! I have no doubt that successive editions will go from strength to strength. E. S. Lin Leicester, UK Clinical Data Interpretation in Anaesthesia and Intensive Care. S. Bonner and C. Dodds (editors). Published by Churchill Livingstone, London. Pp. 278; indexed; illustrated. Price £24.99. ISBN 0-443-06453-9.
This short volume reviews a wide range of quality issues from an American perspective. The undoubted increase in patient safety in the last 20 yr has had many causes, but one may perhaps ¯ag up two principal ones. The analysis of accidents, incidents, and patient deaths, promoted so successfully by the National CEPOD studies in the UK, and the Anesthesia Patient Safety Foundation in the USA, has introduced many changes in working practice. The second major contribution to patient safety has been improved monitoring standards; it is well within living memory that one had no continuous monitoring availableÐan intermittent sphygmomanometer, a ®nger on the pulse, and a view of the moving bag to tell us of the condition of a patient covered by drapes. John Eichhorn provides an excellent review of the role of monitoring in reducing risk in anaesthesia, and some of the dif®culties in making an evidence-based assessment of the exact contribution that it has made to increasing safety. There are a number of shorter articles on quality management, which I found a little uninspiringÐneither convincing me that I should change my practice, nor that of our institution. The data are US-based and re¯ect the political set-up in the USA rather than the UK. There are a number of points with which we are readily familiar, such as the importance of informed consent, good documentation, con®dentiality etc., which are, of course, universal truisms, but I suppose a quality review could not be complete without mentioning them. There is, however, no solution provided to the dif®culties of coping with inadequate information systems, missing notes, patients being admitted after lists have started etc., which all beset today's UK anaesthetists. A chapter on paediatric sedation outside the operating room re¯ects a practice rather different from that commonly found in the UK. As an example, midazolam 0.5 mg kg±1 was given to a child at home before a procedure; the child fell asleep in a car seat, became obstructed and died. An interesting article on the dif®cult problem of outcome research in anaesthesia discusses study design, meta-analyses, and other ways of analysing data. I found this a useful chapter, though perhaps not quite as inspiring as the leading speakers in the UK would be. The closed claims project does appear to have contributed towards improving outcomes, in the sense that it made people more aware of just how expensive anaesthetic accidents can beÐbiasing thought towards risk management rather than error management. They also demonstrated the advances in patient safety contributed by monitoring, where only 9% of the claims from the 1990s were preventable by monitoring, in contrast to 39% of the claims from the 1970s. The book closes with short articles on anaesthesia simulation and expert witnesses. Overall, I am not clear of the bene®ts of books of this type, which are essentially assemblies of review articles. If I want to be better informed about a particular topic, I generally prefer to go straight to a literature search and read articles in the journals. However, this approach does perhaps provide a useful overview of the position at any one time, albeit from a transatlantic perspective. J. A. Lack Salisbury, UK
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Downloaded from http://bja.oxfordjournals.org/ at University of Southern Queensland on June 22, 2015
This book is a gem! Its aim is succinctly articulated in its Preface: `This book grew out of a desire to provide ongoing CPD in clinical data interpretation for both consultants as well as trainees, together with an insight into some newer methods of investigations, of relevance to anaesthesia.' It succeeds in this aim admirably. A large amount of information has been packed into a small book and yet the content remains accessible and relevant. The book is multi-author, each of the nine chapters having contributions from between one and four authors. The book covers a number of areas relevant to clinical practice in anaesthesia: respiratory disease, cardiology, neurosurgery, orthopaedics and trauma, general anaesthesia, intensive care medicine, obstetric anaesthesia, paediatric anaesthesia, and pain management. Each chapter begins with a short introduction to the tests on which the data is to be presented. These introductory sections are clear and useful and in one or two cases the authors seem to manage to describe clearly and usefully, in three or four pages, material which is frequently described in textbooks at much greater length with considerably less clarity. The descriptions of thrombelastography and blood gas analysis are cases in point. There follows a series of short questions on data interpretation, usually 25±30 in number, although there are only 10 on obstetric anaesthesia and 10 on pain management. The questions are short, usually occupying about half a page, and consist of a clinical scenario together with relevant clinical data such as a chest x-ray, ECG, set of blood gas results, or a cardiotocograph (CTG). The ®nal section of each chapter consists of the answers to the preceding questions plus explanations that are suf®cient without being overwhelming. References for further reading are given. The book has a few minor weaknesses. The obstetric section seems short, having only 10 questions, six of which are on the CTG. The pain management section focuses solely on chronic pain and, again, contains only 10 questions. The x-rays that are reproduced in many of the questions have frequently lost detail in being reduced to ®t into the book. However, with regard to this last issue, the authors and publishers presumably had to tread a line between producing a large expensive book full of high resolution images, and a smaller book with perhaps slightly less clear images at a reasonable price. I feel that they have made the right choice. This is a book that will ®t easily into a briefcase. One can dip into it in those short gaps that appear in the working day that can be long enough to be tedious but too short to retire to the of®ce or the library. It will be useful to trainees preparing for the ®nal fellowship examination. (The SpRs to whom I showed it all seemed to feel that it was an excellent little book.) It will also certainly be useful to consultants seeking digestible CPD material who wish to supplement their reading of the literature, particularly review articles, with material that has a strong clinical ¯avour. This book is packed with useful knowledge, but its great virtue is the elegance with which it places the application of that knowledge into context. S. J. Howell Leeds, UK
Problems in Anesthesia Series. L. A. Fleisher and D. S. Prough (editors-in-chief). Quality, Safety, Risk and Outcomes. L. Fleisher and D. Prough (editors). Published by Lippincott, Williams and Wilkins, Hagerstown, MD. Pp. 526, indexed. ISSN 08894698.