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Monitoring in Anaesthesia. Edited by Saidman and Smith. Published by Butterworths, Sevenoaks. Pp. 556; illustrated; indexed. Price £50.
Br.J. Anaesth. (1985), 57, 1140-1142
BOOK REVIEWS Acute Pain. Edited by G. Smith and B. G. Covino. Published by The Butterworth Group. Pp. 283; indexed; illustrated. Price £32.50.
Clinical Antsthesiology. By B. R. Brown jr, C. D. Blitt and R. W. Vaughan. Published by the C. V. Mosby Company, St Louis, Toronto, Princeton. Pp. 401; indexed; illustrated.
Price £27. The introduction to this book states that it is designed for undergraduates to be read during their clinical clerkship in "anesthesiology." The authors have produced a very comprehensive and quite detailed account of clinical anaesthetic practice. There are chapters on pre-operative evaluation, pharmacology of anaesthetic drugs (including all the structural formulae), monitoring, induction of anaesthesia, the recovery period, regional anaesthesia etc., together with a chapter on subspecialties such as anaesthesia for paediatric and cardiac surgery as well as chapters on respiratory failure, and acute and chronic pain. The chapters are clearly divided into sections and the many sub-headings in the text make it an easy book to find one's way around. In the opening pages there are a brief historical introduction, a definition of the specialty and emphasis of the point that, in circumstances where there is no medically trained "anesthesiologist, " the surgeon is ultimately responsible for the " conduct of the anesthesia and for the actions of a nurse anesthetist." It is probably for this reason that the text contains detail which, for the British undergraduate, could be considered excessive.
Intensive Care. Edited by G. Gerson. Published by William Heinemann Medical Books. Pp. 312. Price £12.50. Dr Gerson states in his introduction that this book is intended as a practical guide for junior medical and nursing staff in intensive care. It is a slim volume and, as it attempts to cover all areas of intensive care, excluding burns and postoperative management, in 300 small pages, it is very brief and at times rather dogmatic. There are nine chapters, six of which cover the major organ systems and one each covering poisoning, shock and parenteral nutrition. They are generally well presented and clear, with the chapters on respiratory management and renal failure particularly good. However, I feel that where space is limited the devotion of one-fifth of the book to a chapter describing the management of myocardial infarction is unfortunate when only the scantiest information is provided on topics such as the control of infection in the I.C.U., the interpretation of the results of invasive haemodynamic monitoring, and the management of chest trauma. The book can be recommended to a junior about to enter the Intensive Care Unit for the first time, but to one determined to make a career in anaesthesia a longer, more stimulating text would, in all probability, repay the additional expense. Brian Gotoan Monitoring in Anaesthesia. Edited by Saidman and Smith. Published by Butterworths, Sevenoaks. Pp. 556; illustrated; indexed. Price £50. The second edition of Monitoring in Anaesthesia updates the very successful first edition and includes new chapters on the EEG, Paediatric Monitoring and Computers. Twenty-one expert authors including one from the U.K. discuss monitoring
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 7, 2015
Whilst there are many texts covering chronic pain, this book is the only one that comprehensively covers acute pain in general and acute postoperative pain in particular. The first chapters on the physiology and psychology of acute pain are a good introduction to the methods of acute pain relief which follow. These are covered in a logical manner and, despite the multi-authorship, there is a continuity of style which makes the whole book easy to read. "Measurement of Pain" and the "Neuroendocrinology of the Postoperative State" have their own chapters, but the effects of inadequate pain relief — sprinkled throughout several chapters — are difficult to find. Local anaesthetic techniques of acute pain control are extremely well covered. Analgesia for specific body areas is described in one chapter on somatic nerve blocks and is followed by a chapter on subarachnoid and extradural techniquei and their effects. Pharmacological methods of acute pain control spread across several chapters. The pharmacokinetics of the different agents and commonly-used routes of administration are presented clearly. Newer opioids are put in their place, in a chapter which includes a review of opioid receptor theory. The final chapter on non-pharmacological methods of pain relief completes an excellent book. All anaesthetists will find this book useful and it will be an invaluable addition to any library. A service all anaesthetists interested in the relief of acute, Bevere pain can perform is to recommend this book to their medical and surgical colleagues. Harry Owen
The contents, as one would expect from these authors, are first class, although I do have certain reservations. The text provides quite detailed practical instructions on techniques such as passing a Swan-Ganz catheter and performing a sciatic nerve block. The section on anaesthesia for cardiac surgery is 10 pages long! While not being sufficiently detailed for the postgraduate, to burden an undergraduate with all the information that is given here seems unnecessary. In addition, the final chapter consists of several anecdotal blow-by-blow accounts of anaesthetic administration which, by the very nature of the speciality, must be idiosyncratic. The language is very American and one feels that the authors could have got their points over in slightly less than the 400 pages they have taken. Sentences such as "utilisation of these devices by medical and nursing staff necessitates a significant dedication to education " tend to grate on the English ear. In short, this book provides an excellent introduction and overview of clinical anaesthetic practice but, in the U.K., would probably be more appropriate as an introductory text for the postgraduate than as an undergraduate textbook. At £27 a copy, it would probably be out of the finnnrial reach of most undergraduates, anyway. lam T. Campbell
BOOK REVIEWS
attention to monitoring the whole patient. There is a basic discussion of the working of computers and their application in charting control of anaesthesia, capnography and automatic arterial pressure devices. This chapter includes a useful glossary. The book ends with chapters on electrical safety, the very important topic of selection and maintenance of equipment and a look at future trends. It is suggested that the emphasis will change from acquisition of data to its analysis. Simpler, better measurements will be made, but these will only benefit the patients if the users become better educated in the fundamentals of new techniques. The book is in general well illustrated and referenced. The similarity between numbering of references and figures in the text is irritating, as is the occasional illogical arrangement of illustrations. These are minor criticisms of an otherwise excellent, well balanced text which deserves to be read by all practising anaesthetists. Sheila Willatts Chronic Obstructive Pulmonary Disease. Edited by H. D. Montenegro. Published by Churchill-Livingstone, Edinburgh. Pp. 282; illustrated; indexed. Price £33. This volume describes the latest developments in chronic bronchitis and emphysema which frequently overlap and are commonly described by the term chronic obstructive pulmonary disease (COPD). Although this disease is one of the main causes of mortality and morbidity in the Western world, there is a tendency to consider it the "poor relation" of chest medicine in view of the major limitations in treatment hitherto. If nothing else, this volume firmly debunks this approach and highlights the intellectual challenge which is currently present in research and treatment of COPD. It is one of an intended series on Respiratory Diseases which promises to be of interest to general and specialist clinicians, and advanced students. The first three chapters relate to mechanisms 1<*gHing to COPD, such as imbalance between connective tissue components, mainly proteases and protease inhibitors, abnormal mucociliary transport (with a description of the latest techniques available for its measurement) and hyperreactiviry of the airways. The last of these is responsible for the reversible component of COPD, and the authors provide an interesting update on this subject, which is, of course, of major relevance in asthma. There follow chapters on control of breathing and the mechanisms of dyspnoea. Although interesting, these are rather less directly relevant, apart from the role of respiratory muscle fatigue in acute exacerbations of COPD, which is discussed in detail, including clinical and laboratory methods of detection. A chapter is devoted to haemodynamic events, including recent concepts regarding compressive mechanical heart-lung interaction during positive pressure breathing, which should be of particular interest to anaesthetists and other intensive care staff. The final two chapters deal very well with two current controversial areas of therapy, namely corticosteroid therapy in patients with COPD, and the principles and practical applications of exercise training, breathing training and ventilatory muscle training The volume is well presented, with frequent current references and no unnecessary graphic illustrations. It is also always practical and, in nummary, is an excellent " state of the a n " volume for those who are interested in the most recent developments in the management of COPD. Chris J. Clark
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 7, 2015
of depth of anaesthesia, respiratory, cardiovascular and neurological function, body chemistry, neuromuscular blockade and occupational exposure. Monitoring in the recovery room and intensive care unit are also included; the final chapters deal with selection and maintenance of equipment, and future trends. The importance of monitoring is highlighted in the Foreword. "A mishap is no longer accepted as an 'act of God* but is found to be a fault for which someone is held liable." This rather dogmatic U.S. consumer view should not distract us from aspirations to greater safety and near zero mortality. Most chapters begin by explaining the underlying physiology of the system monitored and validate parameters actually measured. There is, in fact, far more basic physiology in both the chapters on monitoring of respiratory function and neuromuscular blockade, than on actual monitoring. In the chapter on body chemistry measurement, good arguments are given for quality control in laboratories. Where details are given they are usually of considerable practical value, for example, seven times the volume of the catheter needs to be flushed before the critical sample is drawn (from indwelling lines). Pleas for monitoring are a theme throughout the book. " In view of the possible mechanical mishaps which alter respiratory function this parameter should be monitored even prior to induction of anaesthesia." Continuous monitoring of oxygen delivery is advocated. It would seem that apnoca alarms are in greater use in the U.K. at present. There is logical progression from watching the reservoir bag to discussion of mass spectrometry. The definition of monitoring does not appear until the fourth chapter, on Invasive Monitoring of the Circulation, which also discusses indications for monitoring. Non-invasive monitoring includes a long discussion of systolic time intervals in which LVdP/df is discussed without consideration of its limitations. Calculations of systolic time intervals seems so complex that one could be forgiven for preferring invasive techniques! The futuristic view is presented where M-mode echocardiography is used to measure cardiovascular responses to anaesthetic induction agents. The chapter on monitoring the EEG and evoked potentials during anaesthesia contains rather an excess of t-yhniral detail and there is considerable overlap with the chapter on neurosurgical monitoring, which contains much valuable practical information. The sensitivity of techniques for detecting air embolus are usefully compared and intracranial pressure monitoring evaluated, whilst clinical neurological assessment is not underestimated. The chapters on maternal-fetal monitoring and occupational exposure are very clear. Fetal heart rate monitoring in at-risk infants is one of the most potentially valuable continuous monitoring techniques available. Considerable controversy exists at present regarding cost effectiveness. Special considerations in monitoring children during anaesthesia starts with "the experienced eye" and proceeds, totally unillustrated, to evaluate the significant variations in monitoring equipment and techniques in this age group. Monitoring occupational exposure draws on U.S. experience and recommendations and discusses the function of monitoring programmes and instruments for nitrous oxide analysis. The chapter on monitoring in the recovery room and surgical intensive care unit contains an interesting discussion of classifying patients by risk group and the philosophy of monitoring so as to reduce overproduction of data. It also draws
1141
BOOK REVIEWS Acute Pain. Edited by G. Smith and B. G. Covino. Published by The Butterworth Group. Pp. 283; indexed; illustrated. Price £32.50.
Clinical Antsthesiology. By B. R. Brown jr, C. D. Blitt and R. W. Vaughan. Published by the C. V. Mosby Company, St Louis, Toronto, Princeton. Pp. 401; indexed; illustrated.
Price £27. The introduction to this book states that it is designed for undergraduates to be read during their clinical clerkship in "anesthesiology." The authors have produced a very comprehensive and quite detailed account of clinical anaesthetic practice. There are chapters on pre-operative evaluation, pharmacology of anaesthetic drugs (including all the structural formulae), monitoring, induction of anaesthesia, the recovery period, regional anaesthesia etc., together with a chapter on subspecialties such as anaesthesia for paediatric and cardiac surgery as well as chapters on respiratory failure, and acute and chronic pain. The chapters are clearly divided into sections and the many sub-headings in the text make it an easy book to find one's way around. In the opening pages there are a brief historical introduction, a definition of the specialty and emphasis of the point that, in circumstances where there is no medically trained "anesthesiologist, " the surgeon is ultimately responsible for the " conduct of the anesthesia and for the actions of a nurse anesthetist." It is probably for this reason that the text contains detail which, for the British undergraduate, could be considered excessive.
Intensive Care. Edited by G. Gerson. Published by William Heinemann Medical Books. Pp. 312. Price £12.50. Dr Gerson states in his introduction that this book is intended as a practical guide for junior medical and nursing staff in intensive care. It is a slim volume and, as it attempts to cover all areas of intensive care, excluding burns and postoperative management, in 300 small pages, it is very brief and at times rather dogmatic. There are nine chapters, six of which cover the major organ systems and one each covering poisoning, shock and parenteral nutrition. They are generally well presented and clear, with the chapters on respiratory management and renal failure particularly good. However, I feel that where space is limited the devotion of one-fifth of the book to a chapter describing the management of myocardial infarction is unfortunate when only the scantiest information is provided on topics such as the control of infection in the I.C.U., the interpretation of the results of invasive haemodynamic monitoring, and the management of chest trauma. The book can be recommended to a junior about to enter the Intensive Care Unit for the first time, but to one determined to make a career in anaesthesia a longer, more stimulating text would, in all probability, repay the additional expense. Brian Gotoan Monitoring in Anaesthesia. Edited by Saidman and Smith. Published by Butterworths, Sevenoaks. Pp. 556; illustrated; indexed. Price £50. The second edition of Monitoring in Anaesthesia updates the very successful first edition and includes new chapters on the EEG, Paediatric Monitoring and Computers. Twenty-one expert authors including one from the U.K. discuss monitoring
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 7, 2015
Whilst there are many texts covering chronic pain, this book is the only one that comprehensively covers acute pain in general and acute postoperative pain in particular. The first chapters on the physiology and psychology of acute pain are a good introduction to the methods of acute pain relief which follow. These are covered in a logical manner and, despite the multi-authorship, there is a continuity of style which makes the whole book easy to read. "Measurement of Pain" and the "Neuroendocrinology of the Postoperative State" have their own chapters, but the effects of inadequate pain relief — sprinkled throughout several chapters — are difficult to find. Local anaesthetic techniques of acute pain control are extremely well covered. Analgesia for specific body areas is described in one chapter on somatic nerve blocks and is followed by a chapter on subarachnoid and extradural techniquei and their effects. Pharmacological methods of acute pain control spread across several chapters. The pharmacokinetics of the different agents and commonly-used routes of administration are presented clearly. Newer opioids are put in their place, in a chapter which includes a review of opioid receptor theory. The final chapter on non-pharmacological methods of pain relief completes an excellent book. All anaesthetists will find this book useful and it will be an invaluable addition to any library. A service all anaesthetists interested in the relief of acute, Bevere pain can perform is to recommend this book to their medical and surgical colleagues. Harry Owen
The contents, as one would expect from these authors, are first class, although I do have certain reservations. The text provides quite detailed practical instructions on techniques such as passing a Swan-Ganz catheter and performing a sciatic nerve block. The section on anaesthesia for cardiac surgery is 10 pages long! While not being sufficiently detailed for the postgraduate, to burden an undergraduate with all the information that is given here seems unnecessary. In addition, the final chapter consists of several anecdotal blow-by-blow accounts of anaesthetic administration which, by the very nature of the speciality, must be idiosyncratic. The language is very American and one feels that the authors could have got their points over in slightly less than the 400 pages they have taken. Sentences such as "utilisation of these devices by medical and nursing staff necessitates a significant dedication to education " tend to grate on the English ear. In short, this book provides an excellent introduction and overview of clinical anaesthetic practice but, in the U.K., would probably be more appropriate as an introductory text for the postgraduate than as an undergraduate textbook. At £27 a copy, it would probably be out of the finnnrial reach of most undergraduates, anyway. lam T. Campbell
BOOK REVIEWS
attention to monitoring the whole patient. There is a basic discussion of the working of computers and their application in charting control of anaesthesia, capnography and automatic arterial pressure devices. This chapter includes a useful glossary. The book ends with chapters on electrical safety, the very important topic of selection and maintenance of equipment and a look at future trends. It is suggested that the emphasis will change from acquisition of data to its analysis. Simpler, better measurements will be made, but these will only benefit the patients if the users become better educated in the fundamentals of new techniques. The book is in general well illustrated and referenced. The similarity between numbering of references and figures in the text is irritating, as is the occasional illogical arrangement of illustrations. These are minor criticisms of an otherwise excellent, well balanced text which deserves to be read by all practising anaesthetists. Sheila Willatts Chronic Obstructive Pulmonary Disease. Edited by H. D. Montenegro. Published by Churchill-Livingstone, Edinburgh. Pp. 282; illustrated; indexed. Price £33. This volume describes the latest developments in chronic bronchitis and emphysema which frequently overlap and are commonly described by the term chronic obstructive pulmonary disease (COPD). Although this disease is one of the main causes of mortality and morbidity in the Western world, there is a tendency to consider it the "poor relation" of chest medicine in view of the major limitations in treatment hitherto. If nothing else, this volume firmly debunks this approach and highlights the intellectual challenge which is currently present in research and treatment of COPD. It is one of an intended series on Respiratory Diseases which promises to be of interest to general and specialist clinicians, and advanced students. The first three chapters relate to mechanisms 1<*gHing to COPD, such as imbalance between connective tissue components, mainly proteases and protease inhibitors, abnormal mucociliary transport (with a description of the latest techniques available for its measurement) and hyperreactiviry of the airways. The last of these is responsible for the reversible component of COPD, and the authors provide an interesting update on this subject, which is, of course, of major relevance in asthma. There follow chapters on control of breathing and the mechanisms of dyspnoea. Although interesting, these are rather less directly relevant, apart from the role of respiratory muscle fatigue in acute exacerbations of COPD, which is discussed in detail, including clinical and laboratory methods of detection. A chapter is devoted to haemodynamic events, including recent concepts regarding compressive mechanical heart-lung interaction during positive pressure breathing, which should be of particular interest to anaesthetists and other intensive care staff. The final two chapters deal very well with two current controversial areas of therapy, namely corticosteroid therapy in patients with COPD, and the principles and practical applications of exercise training, breathing training and ventilatory muscle training The volume is well presented, with frequent current references and no unnecessary graphic illustrations. It is also always practical and, in nummary, is an excellent " state of the a n " volume for those who are interested in the most recent developments in the management of COPD. Chris J. Clark
Downloaded from http://bja.oxfordjournals.org/ at University of Manitoba on June 7, 2015
of depth of anaesthesia, respiratory, cardiovascular and neurological function, body chemistry, neuromuscular blockade and occupational exposure. Monitoring in the recovery room and intensive care unit are also included; the final chapters deal with selection and maintenance of equipment, and future trends. The importance of monitoring is highlighted in the Foreword. "A mishap is no longer accepted as an 'act of God* but is found to be a fault for which someone is held liable." This rather dogmatic U.S. consumer view should not distract us from aspirations to greater safety and near zero mortality. Most chapters begin by explaining the underlying physiology of the system monitored and validate parameters actually measured. There is, in fact, far more basic physiology in both the chapters on monitoring of respiratory function and neuromuscular blockade, than on actual monitoring. In the chapter on body chemistry measurement, good arguments are given for quality control in laboratories. Where details are given they are usually of considerable practical value, for example, seven times the volume of the catheter needs to be flushed before the critical sample is drawn (from indwelling lines). Pleas for monitoring are a theme throughout the book. " In view of the possible mechanical mishaps which alter respiratory function this parameter should be monitored even prior to induction of anaesthesia." Continuous monitoring of oxygen delivery is advocated. It would seem that apnoca alarms are in greater use in the U.K. at present. There is logical progression from watching the reservoir bag to discussion of mass spectrometry. The definition of monitoring does not appear until the fourth chapter, on Invasive Monitoring of the Circulation, which also discusses indications for monitoring. Non-invasive monitoring includes a long discussion of systolic time intervals in which LVdP/df is discussed without consideration of its limitations. Calculations of systolic time intervals seems so complex that one could be forgiven for preferring invasive techniques! The futuristic view is presented where M-mode echocardiography is used to measure cardiovascular responses to anaesthetic induction agents. The chapter on monitoring the EEG and evoked potentials during anaesthesia contains rather an excess of t-yhniral detail and there is considerable overlap with the chapter on neurosurgical monitoring, which contains much valuable practical information. The sensitivity of techniques for detecting air embolus are usefully compared and intracranial pressure monitoring evaluated, whilst clinical neurological assessment is not underestimated. The chapters on maternal-fetal monitoring and occupational exposure are very clear. Fetal heart rate monitoring in at-risk infants is one of the most potentially valuable continuous monitoring techniques available. Considerable controversy exists at present regarding cost effectiveness. Special considerations in monitoring children during anaesthesia starts with "the experienced eye" and proceeds, totally unillustrated, to evaluate the significant variations in monitoring equipment and techniques in this age group. Monitoring occupational exposure draws on U.S. experience and recommendations and discusses the function of monitoring programmes and instruments for nitrous oxide analysis. The chapter on monitoring in the recovery room and surgical intensive care unit contains an interesting discussion of classifying patients by risk group and the philosophy of monitoring so as to reduce overproduction of data. It also draws
1141