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Pharmacokinetics of Anaesthesia. by Prys-Roberts C. and Hug C. C.jr. Published (1984) by Blackwell Scientific Publications Oxford. Pp. 358; indexed; illustrated. Price £19.50.
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Pharmacokirutia of Anaathaia. Edited by C. Prys-Roberts and C. C. Hug jr. Published (1984) by Blackwell Scientific Publications, Oxford. Pp.358; indexed; illustrated. Price £19.50. Pharmacokinetics must surely rank as one of the most popular and widely researched subjects of the past decade. Its growth has been fuelled by a rapidly advancing and increasingly sophisticated technology, which now allows most drugs to be measured in nanomolar or picomolar concentrations. The characterization and prediction of drug behaviour has obvious implications in most fields of clinical practice; in anaesthesia, its potential importance is probably greater than in any other discipline. This multi-author book is a timely acknowledgement of the relationship between pharmacokinetics and current anaesthetic practice. It was conceived at (and is partially based on) a meeting of the Association of Anaesthetists in 1980, although five of its 15 chapters are written by transatlantic authors. In general, it is an excellent and up-to-date account of the current "state of the art". It is an extremely well-referenced book; more than 1000 original publications are cited, and a commendable proportion refer to papers published since 1980. Nevertheless, some of the opinions expressed may have been overtaken by events; for example, not all anaesthetists would now accept that " + -tubocurarine is the prefei'ied non-depolarizing neuromuscular blocking drug for patients with decreased renal function" (p. 250). Most of the book consists of reviews of the kinetics of drugs or groups of drugs that are used commonly in anaesthetic practice. Some of these reviews are outstanding; I was particularly im-
pressed with those on inhalation anaesthetics, benzodiazepines, narcotic analgesics and local anaesthetics. The book also contains chapters on the measurement of drug concentrations in tissue fluids, and drug preservatives and solvents. These are interesting and up-to-date accounts of subjects that have not been reviewed extensively. However, I thought that liquid scintillation counting might have been dealt with in a little more detail. Some of the other contributions were a little disappointing. The two opening Chapters deal with the general principles of pharmacokinetics, and drug—receptor reactions. I thought that the approach to both subjects was excessively and unnecessarily mathematical; surely, it is pharmacokinetic concepts and their application that are important inflnftetttvrf™,and not the detailed derivation of complex mathematical relationships. A number of errors are present in the Chapter on pharmacokinetic principles (for example r is expressed as t, V is omitted from one equation, and Ohm's law is incorrectly derived and defined). The Chapter on drug-receptor reactions may leave the habitual reader of the British Journal of Anaathaia with a sense of deji oil, since it was published in a similar form in this journal in 1979. The Chapter on the kinetics of barbiturates is also substantially identical with an account that has been published elsewhere. In my opinion, the effects of enzyme induction and inhibition on durg kinetics are not considered in sufficient detail. There are numerous typographical errors in the text, and one Chapter (dealing with beta-adrenoceptor antagonists) appears to be incorrectly entitled. Nevertheless, these can only be regarded as minor criticisms of an extremely useful book. Its bibliography should also ensure a wide readership, and it can be recommended to all who are interested in the pharmacokinetics of drugs that are used in anaesthesia. T. N. Calvty
Anaathtsia in Midvnftry. By Ruth Bevis. Published by BaiHiere Tindall. Pp. 171; indexed; illustrated. Price £5.50. Miss Bevis opens this book with a most readable short history of anaesthesia and analgesia in obstetrics. Some of the contents of the next chapter could, however, have been relegated to that history as I believe that nasal intubation, throat packs, mouth gags and props have no place in modern obstetric anaesthetic practice. Also, why show illustrations of four types of metal endotracheal tube connectors, when the more common plastic swivel connector is not even mentioned? In pharmacology, I feel that more should have been said about vasoconstrictors and their possible side-effects, especially in prenancy. Gallamine continues, wrongly I believe, to be blamed for crossing the placenta particularly well and faynHiniiiTn gets more generous mention than alcuronhun in what is otherwise a good chapter on drugs. It is incorrect to say that it is intended "that women with an epidural can be left almost indefinitely in full dilatation"—I am sure that the real intention is that with an extradural block, restriction of second stage to a mandatory 30 min is not necessary provided the fetus is adequately monitored. I disagree with three other statements made in this chapter: that fetal oxygenation decreases when maternal inspired oxygen concentration increases above 60%; that even in rare cases suxamethonium crosses the placenta; and that atropine may be used as a premedication in obstetrics. Apart from these points the author has given a good account of these difficult subjects, physiology and pharmacology.
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on August 27, 2015
follow, with a final couple of pages devoted to neurological injuries which can occur during thoracic surgery. With the exception of this last short section, it is difficult to accept that these topics are a necessary part of a textbook on non-cardiac thoracic surgery. The next chapter, on postoperative respiratory care, is more relevant, but here too the account describes postoperative care in general, rather than the special features which apply to thoracic surgical patients. A tiresome list of proprietary bronchodilators is out of place and could with advantage give way to a more detailed account of pleural drainage lystems. The next chapter is an essay on respiratory failure which deals exclusively with the adult respiratory distress syndrome—surely a rare complication of thoracic surgery and far less common than sputum retention, atelectasis, the over-full pneumonectomy space, etc. Finally, there is a chapter on techniques of ventilation and oxygeiiation—again very comprehensive, but containing very little of specific relevance to thoracic surgery, apart from a quaintly titled section on "Mechanical ventilation with interrupted airways disease" which proved to be an account of how to ventilate patients with an air-leak. It is perhaps inevitable that such a chapter should end with a brief account of extracorporeal membrane oxygenation, underlining yet again that this is a collection of essays on aspects of pulmonary medicine and surgery which has not been edited into a cohesive account of the role of the anaesthetist in the management of thoracic surgical patients. In summary then, here is a book of up-to-date topic reviews. Individually, many are excellent in both content and presentation, and the whole is beautifully produced, well referenced and has a good index. In these terms it is to be commended, but it cannot be described as a balanced account of thoracic anaesthesia. Margaret Branxkwaitt
BRITISH JOURNAL OF ANAESTHESIA
Pharmacokirutia of Anaathaia. Edited by C. Prys-Roberts and C. C. Hug jr. Published (1984) by Blackwell Scientific Publications, Oxford. Pp.358; indexed; illustrated. Price £19.50. Pharmacokinetics must surely rank as one of the most popular and widely researched subjects of the past decade. Its growth has been fuelled by a rapidly advancing and increasingly sophisticated technology, which now allows most drugs to be measured in nanomolar or picomolar concentrations. The characterization and prediction of drug behaviour has obvious implications in most fields of clinical practice; in anaesthesia, its potential importance is probably greater than in any other discipline. This multi-author book is a timely acknowledgement of the relationship between pharmacokinetics and current anaesthetic practice. It was conceived at (and is partially based on) a meeting of the Association of Anaesthetists in 1980, although five of its 15 chapters are written by transatlantic authors. In general, it is an excellent and up-to-date account of the current "state of the art". It is an extremely well-referenced book; more than 1000 original publications are cited, and a commendable proportion refer to papers published since 1980. Nevertheless, some of the opinions expressed may have been overtaken by events; for example, not all anaesthetists would now accept that " + -tubocurarine is the prefei'ied non-depolarizing neuromuscular blocking drug for patients with decreased renal function" (p. 250). Most of the book consists of reviews of the kinetics of drugs or groups of drugs that are used commonly in anaesthetic practice. Some of these reviews are outstanding; I was particularly im-
pressed with those on inhalation anaesthetics, benzodiazepines, narcotic analgesics and local anaesthetics. The book also contains chapters on the measurement of drug concentrations in tissue fluids, and drug preservatives and solvents. These are interesting and up-to-date accounts of subjects that have not been reviewed extensively. However, I thought that liquid scintillation counting might have been dealt with in a little more detail. Some of the other contributions were a little disappointing. The two opening Chapters deal with the general principles of pharmacokinetics, and drug—receptor reactions. I thought that the approach to both subjects was excessively and unnecessarily mathematical; surely, it is pharmacokinetic concepts and their application that are important inflnftetttvrf™,and not the detailed derivation of complex mathematical relationships. A number of errors are present in the Chapter on pharmacokinetic principles (for example r is expressed as t, V is omitted from one equation, and Ohm's law is incorrectly derived and defined). The Chapter on drug-receptor reactions may leave the habitual reader of the British Journal of Anaathaia with a sense of deji oil, since it was published in a similar form in this journal in 1979. The Chapter on the kinetics of barbiturates is also substantially identical with an account that has been published elsewhere. In my opinion, the effects of enzyme induction and inhibition on durg kinetics are not considered in sufficient detail. There are numerous typographical errors in the text, and one Chapter (dealing with beta-adrenoceptor antagonists) appears to be incorrectly entitled. Nevertheless, these can only be regarded as minor criticisms of an extremely useful book. Its bibliography should also ensure a wide readership, and it can be recommended to all who are interested in the pharmacokinetics of drugs that are used in anaesthesia. T. N. Calvty
Anaathtsia in Midvnftry. By Ruth Bevis. Published by BaiHiere Tindall. Pp. 171; indexed; illustrated. Price £5.50. Miss Bevis opens this book with a most readable short history of anaesthesia and analgesia in obstetrics. Some of the contents of the next chapter could, however, have been relegated to that history as I believe that nasal intubation, throat packs, mouth gags and props have no place in modern obstetric anaesthetic practice. Also, why show illustrations of four types of metal endotracheal tube connectors, when the more common plastic swivel connector is not even mentioned? In pharmacology, I feel that more should have been said about vasoconstrictors and their possible side-effects, especially in prenancy. Gallamine continues, wrongly I believe, to be blamed for crossing the placenta particularly well and faynHiniiiTn gets more generous mention than alcuronhun in what is otherwise a good chapter on drugs. It is incorrect to say that it is intended "that women with an epidural can be left almost indefinitely in full dilatation"—I am sure that the real intention is that with an extradural block, restriction of second stage to a mandatory 30 min is not necessary provided the fetus is adequately monitored. I disagree with three other statements made in this chapter: that fetal oxygenation decreases when maternal inspired oxygen concentration increases above 60%; that even in rare cases suxamethonium crosses the placenta; and that atropine may be used as a premedication in obstetrics. Apart from these points the author has given a good account of these difficult subjects, physiology and pharmacology.
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on August 27, 2015
follow, with a final couple of pages devoted to neurological injuries which can occur during thoracic surgery. With the exception of this last short section, it is difficult to accept that these topics are a necessary part of a textbook on non-cardiac thoracic surgery. The next chapter, on postoperative respiratory care, is more relevant, but here too the account describes postoperative care in general, rather than the special features which apply to thoracic surgical patients. A tiresome list of proprietary bronchodilators is out of place and could with advantage give way to a more detailed account of pleural drainage lystems. The next chapter is an essay on respiratory failure which deals exclusively with the adult respiratory distress syndrome—surely a rare complication of thoracic surgery and far less common than sputum retention, atelectasis, the over-full pneumonectomy space, etc. Finally, there is a chapter on techniques of ventilation and oxygeiiation—again very comprehensive, but containing very little of specific relevance to thoracic surgery, apart from a quaintly titled section on "Mechanical ventilation with interrupted airways disease" which proved to be an account of how to ventilate patients with an air-leak. It is perhaps inevitable that such a chapter should end with a brief account of extracorporeal membrane oxygenation, underlining yet again that this is a collection of essays on aspects of pulmonary medicine and surgery which has not been edited into a cohesive account of the role of the anaesthetist in the management of thoracic surgical patients. In summary then, here is a book of up-to-date topic reviews. Individually, many are excellent in both content and presentation, and the whole is beautifully produced, well referenced and has a good index. In these terms it is to be commended, but it cannot be described as a balanced account of thoracic anaesthesia. Margaret Branxkwaitt
BRITISH JOURNAL OF ANAESTHESIA