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Pulse Oximetry. Edited by Payne J. P. and Severinghaus J. W. Published by Springer-Verlag. Pp. 193 plus index; indexed; illustrated. Price £29.
Br. J. Anaesth. (1987), 59, 1063-1065
BOOK REVIEWS
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on June 4, 2015
Emergency Anaesthesia. Edited by A. P. Adams, P. B. Hewitt The results of artificial liver support from Montreal and and M. C. Rogers. Published by Edward Arnold, London. Kings College Hospital are detailed. Artificial cells have been Pp. 361 + index; indexed; illustrated. developed which retain "immobilized enzymes" without Professor Adams and his co-editors have gathered together a producing an immunological reaction. These have been used team of 32 anaesthetists and others from both sides of the in animal studies. This book is ideal for the general intensive care practitioner Atlantic to produce a pocket-book guide for the handling of anaesthetic procedures. It is aimed particularly at those in who sees liver failure rather infrequently. It clarifies training. As such a guide it more than fulfils its aims. The pathophysiology, evaluates alternative therapies and stresses introductory eight chapters cover the principles of emergency always the importance of objectivity. Scoring systems for anaesthesia and of resuscitation with useful information on i.v. coagulation abnormalities, degree of liver failure and outcome therapy, blood transfusion and the practical procedures after portc—caval shunting enable a true comparison of needed, together with the basic aspects of monitoring. The alternative therapies. There are minor criticisms. The section on haemodynamic subsequent chapters concern the individual systems and their associated emergency problems; two chapters consider the changes during charcoal haemoperfusion would benefit from mass casualty problem and those seen in developing countries. further explanation of derived variables, and a chapter devoted Each chapter begins with a useful contents list and is clearly to hepatic transplantation would be invaluable for anaeslaid out, ending with a reference list or suggestions for further thetists. The book would benefit by some concluding comreading. Were one to attempt to read the book at a sitting, then ments and indication of future evolution of management. Nevertheless, this is an excellent text which I would one might become worried about some repetition from one chapter to the next; however, if the book is read a section at unreservedly recommend to all anaesthetists and intensive a time, or as a true pocket guide to help with an unexpected therapy practitioners. emergency, this problem does not arise. Perhaps there is some S. M. Willatts overkill with the chapters on, say, renal failure and major vascular surgery, where the emphasis is on the handling of any patient with renal failure or in need of a vascular operation—the Pulse Oximetry. Edited by J. P. Payne and J. W. Severinghaus. Published by Springer-Verlag. Pp. 193 plus index; emergency aspects are less well handled. Nevertheless, the indexed; illustrated. Price £29. book as a whole is a good, comprehensive guide to current clinical practice and will join those bench books which should Hypoxaemia is the major cause of anaesthetic-related deaths. be available wherever emergency anaesthesia is practised. Because pulse oximetry is a rapid, continuous and non-invasive technique, it is set to revolutionize monitoring of patients J. Norman during anaesthesia and intensive care for, as Dr John Nunn says, "our starting point must be to recognise how very Liver Failure. Edited by R. Williams. Published by Churchill unsatisfactory are the unaided human senses in monitoring Livingstone. Pp. 230; indexed; illustrated. oxygen". Pulse Oximetry is the proceedings of a Symposium Liver Failure is the most recent addition to the series, Clinics held in Britain in 1985. This was the third meeting in the past in Critical Care Medicine. Eighteen international experts 21 years concerned with oxygen measurements sponsored by contribute 12 chapters on the most important current aspects the Health Care Division of the British Oxygen Company and of liver failure, and discuss their clinical findings and research held under the auspices of the Research Department of Anaesthetics of the Royal College of Surgeons of England. areas. The Editor, in his introduction, discusses the great This book makes interesting reading and starts with the importance of distinguishing between fulminant hepatic failure history of monitoring oxygenation by John Severinghaus, with a previously normal liver and acute decompensation in followed by an account of pulse oximetry and oxygen transport. patients with chronic liver disease. Possible mechanisms for The editors have sensibly added a section on definitions and mediation of hepatic encephalopathy are discussed followed by symbols, because different methods of determining the amount cerebral oedema, cardiovascular, pulmonary and renal dis- of saturation of haemoglobin with oxygen can produce turbances in liver failure. Whilst paracetamol overdose and different answers. If we could adjust our minds it might be viral hepatitis are still the major causes of fulminant hepatic better to read the display in terms of desaturation rather than failure, repeated halothane anaesthesia is a rare cause. A whole saturation. We are certainly going to have to do that in terms chapter is devoted to specific therapy for paracetamol overdose. of thinking again about saturation, as tension has predomiInfective complications, variceal haemorrhage and coagu- nantly occupied our thinking over the past 20 years or so. Pulse lation patterns in chronic liver disease are discussed, together oximetry—at two wavelengths—cannot distinguish between with practical aspects of their management. There is a review forms of haemoglobin such as methaemoglobin, sulphaemoglobin and carboxyhaemoglobin; there seems to be disof the extensive and controversial literature on the use of amino acids in hepatic failure. Despite the need for further work to agreement regarding possible interference from increased evaluate the role of branched-chain amino acids before definite bilirubin concentrations. The following chapters discuss the recommendations can be made, this chapter is a model of interrelation of oxygen tension, oxyhaemoglobin saturation and oxygen content and the rest of the book is given over to clarity.
1064
clinical experience and the use of other printed materials. The other use for the book will be for trainers—to assess their level of knowledge! J. Norman Handbook of Local Anesthesia.
By Stanley F. Malamed.
Published by the C. V. Mosby Company. Pp. 297; indexed; illustrated. This book is about local anaesthesia for dentistry. It is clearly the work of a great enthusiast who has gone to great lengths to produce a meticulously detailed and wide-ranging work that makes interesting reading whether you are a dentist or an anaesthetist. It starts by covering the neurophysiology of nerve conduction and the general principles of the pharmacology of local anaesthetic agents. The author discusses each of the commonly-used local anaesthetics in detail, and the vasoconstrictors. The next section on the armamentarium deals with equipment, syringes, needles, cartridges and so on, their use and care. The largest section of the book covers the techniques and is well illustrated with drawings and photographs. It starts by dealing with the medical assessment of patients and has a sensible discussion about common medical conditions and how these interact with dental treatment and local anaesthesia. My only major criticism of this book occurs in this area. The author states that amide-type local anaesthetics are absolutely contraindicated for malignant hyperpyrexia susceptible patients. He recommends ester-type local anaesthetics for such patients. This statement is erroneous and could lead to serious problems. There is no evidence that MHS patients are at risk from amide local anaesthetics and by recommending esters, which can cause serious allergy, these patients are being subjected to an unnecessary risk. This section goes on to discuss the general care of patients in the dental surgery and then covers the anatomy of the trigeminal nerve, the maxilla and the mandible. The two chapters on maxillary and mandibular anaesthesia cover many different blocks in great detail, with excellent illustrations. The final chapter in this section covers the application of local anaesthesia to the various dental specialties, including a useful section on paediatric 600 MCQs in Anaesthesia: Clinical Practice. By P. J. Simpson dentistry. and N. W. Goodman. Published by: Churchill LivingThe final section of the book deals with complications, both stone, Edinburgh. Pp. 232; not indexed or illustrated. local and systemic, and their management. The section on treatment of systemic toxicity is clear and lays the emphasis on Simpson and Goodman have previously produced a set of keeping the patient oxygenated, although no mention is made MCQ papers for the basic science of anaesthesia. This of tracheal intubation, despite the fact that, in the section on compilation of 10 papers with 60 questions in each follows the laryngeal oedema resulting from allergy, cricothyrotomy is same model, but is directed at clinical practice—in essence, at described. the Parts I and III of the F.F.A.R.C.S. The introduction offers the usual, necessary advice for all taking such examinations, in I found this an interesting and well produced book which terms of handling MCQ papers. The papers are a good mix covers its subject in sufficient detail to give its readers a and any candidate using them as a practice will get a reasonable thorough understanding of local anaesthesia for dentistry. I assessment of his or her likely mark. hope my own dentist has read it! The problem that candidates will have in using these sets will W. Macrae be in trying to make a distinction between the knowledge required for the Part I and that for the Part III examination. A Pockel-Book for Intensive Care. By J. Tinker and S. N. Each paper contains some questions on special anaesthesia Jones. Published by Edward Arnold (Publishers) Ltd, which will be more appropriate for the advanced trainee. London. Pp. 143; indexed; illustrated. Price £7.25. The main use of the book will thus be to enable candidates to assess their level of knowledge, especially if it is used as a This short work seeks to provide "useful practical information mock examination. One can also then learn from one's for medical and nursing staff working in intensive care units." mistakes. It would be a mistake to use the book as a prime The authors point out that it is not an addition to the range source of knowledge; that should come from good teaching, of works offering detailed instructions on clinical management.
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on June 4, 2015
accounts of the advantages or uses of pulse oximetry in almost every conceivable situation, including diving. There are one or two voices of dissent, such as Professor Andrew Thornton's conclusion that ear-lobe oximetry is not recommended for routine monitoring of dental patients undergoing general anaesthesia or sedation. However, pulse oximetry was not available to him at the time he performed his studies and he does say unequivocally that continuous monitoring of oxygen saturation has been a useful method for highlighting deficiencies of technique in dental anaesthesia. A feature of this book is the excellent discussion sections, which are interposed between groups of chapters. Here can be found the voice of sound common sense in Dr Ross Holland from New South Wales, who states that it is absolute garbage to assume that the only reason why things go wrong under anaesthesia and why people die, for example, is because of a mishap. He points out that, whereas this is true in 20% of patients (e.g. disconnection, misplaced tracheal tube, compromised airway), the other 80% who die in association with anaesthesia do so because somebody gave the wrong anaesthetic at the wrong time or they made an error of judgement and all the monitoring in the world would not have made any difference (e.g. inhalation of vomit). He emphasizes there is only one absolutely indispensable monitor and that is a trained, experienced person in the operating room. Let us hope that basic lessons from this work, such as those demonstrated by Drs Hanning and Abbott who detail the hypoxaemia that often occurs in the early stages of recovery from anaesthesia—that is during transportation from the operating theatre to the recovery room, and in the recovery room itself—will get home to anaesthetists. The major criticism of this work is that it appears to promote the sponsor's product the Biox oximeter. This is unfortunate as, given the title, the reader would have been greatly helped by an unbiased informed account of the merits and demerits (including differences in technology) of the other pulse oximeters which are available (e.g. Nellcor, Novametrix). Questions on the technology and performance of competitor's oximeters have largely gone unanswered. A. P. Adams
BRITISH JOURNAL OF ANAESTHESIA
BOOK REVIEWS
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on June 4, 2015
Emergency Anaesthesia. Edited by A. P. Adams, P. B. Hewitt The results of artificial liver support from Montreal and and M. C. Rogers. Published by Edward Arnold, London. Kings College Hospital are detailed. Artificial cells have been Pp. 361 + index; indexed; illustrated. developed which retain "immobilized enzymes" without Professor Adams and his co-editors have gathered together a producing an immunological reaction. These have been used team of 32 anaesthetists and others from both sides of the in animal studies. This book is ideal for the general intensive care practitioner Atlantic to produce a pocket-book guide for the handling of anaesthetic procedures. It is aimed particularly at those in who sees liver failure rather infrequently. It clarifies training. As such a guide it more than fulfils its aims. The pathophysiology, evaluates alternative therapies and stresses introductory eight chapters cover the principles of emergency always the importance of objectivity. Scoring systems for anaesthesia and of resuscitation with useful information on i.v. coagulation abnormalities, degree of liver failure and outcome therapy, blood transfusion and the practical procedures after portc—caval shunting enable a true comparison of needed, together with the basic aspects of monitoring. The alternative therapies. There are minor criticisms. The section on haemodynamic subsequent chapters concern the individual systems and their associated emergency problems; two chapters consider the changes during charcoal haemoperfusion would benefit from mass casualty problem and those seen in developing countries. further explanation of derived variables, and a chapter devoted Each chapter begins with a useful contents list and is clearly to hepatic transplantation would be invaluable for anaeslaid out, ending with a reference list or suggestions for further thetists. The book would benefit by some concluding comreading. Were one to attempt to read the book at a sitting, then ments and indication of future evolution of management. Nevertheless, this is an excellent text which I would one might become worried about some repetition from one chapter to the next; however, if the book is read a section at unreservedly recommend to all anaesthetists and intensive a time, or as a true pocket guide to help with an unexpected therapy practitioners. emergency, this problem does not arise. Perhaps there is some S. M. Willatts overkill with the chapters on, say, renal failure and major vascular surgery, where the emphasis is on the handling of any patient with renal failure or in need of a vascular operation—the Pulse Oximetry. Edited by J. P. Payne and J. W. Severinghaus. Published by Springer-Verlag. Pp. 193 plus index; emergency aspects are less well handled. Nevertheless, the indexed; illustrated. Price £29. book as a whole is a good, comprehensive guide to current clinical practice and will join those bench books which should Hypoxaemia is the major cause of anaesthetic-related deaths. be available wherever emergency anaesthesia is practised. Because pulse oximetry is a rapid, continuous and non-invasive technique, it is set to revolutionize monitoring of patients J. Norman during anaesthesia and intensive care for, as Dr John Nunn says, "our starting point must be to recognise how very Liver Failure. Edited by R. Williams. Published by Churchill unsatisfactory are the unaided human senses in monitoring Livingstone. Pp. 230; indexed; illustrated. oxygen". Pulse Oximetry is the proceedings of a Symposium Liver Failure is the most recent addition to the series, Clinics held in Britain in 1985. This was the third meeting in the past in Critical Care Medicine. Eighteen international experts 21 years concerned with oxygen measurements sponsored by contribute 12 chapters on the most important current aspects the Health Care Division of the British Oxygen Company and of liver failure, and discuss their clinical findings and research held under the auspices of the Research Department of Anaesthetics of the Royal College of Surgeons of England. areas. The Editor, in his introduction, discusses the great This book makes interesting reading and starts with the importance of distinguishing between fulminant hepatic failure history of monitoring oxygenation by John Severinghaus, with a previously normal liver and acute decompensation in followed by an account of pulse oximetry and oxygen transport. patients with chronic liver disease. Possible mechanisms for The editors have sensibly added a section on definitions and mediation of hepatic encephalopathy are discussed followed by symbols, because different methods of determining the amount cerebral oedema, cardiovascular, pulmonary and renal dis- of saturation of haemoglobin with oxygen can produce turbances in liver failure. Whilst paracetamol overdose and different answers. If we could adjust our minds it might be viral hepatitis are still the major causes of fulminant hepatic better to read the display in terms of desaturation rather than failure, repeated halothane anaesthesia is a rare cause. A whole saturation. We are certainly going to have to do that in terms chapter is devoted to specific therapy for paracetamol overdose. of thinking again about saturation, as tension has predomiInfective complications, variceal haemorrhage and coagu- nantly occupied our thinking over the past 20 years or so. Pulse lation patterns in chronic liver disease are discussed, together oximetry—at two wavelengths—cannot distinguish between with practical aspects of their management. There is a review forms of haemoglobin such as methaemoglobin, sulphaemoglobin and carboxyhaemoglobin; there seems to be disof the extensive and controversial literature on the use of amino acids in hepatic failure. Despite the need for further work to agreement regarding possible interference from increased evaluate the role of branched-chain amino acids before definite bilirubin concentrations. The following chapters discuss the recommendations can be made, this chapter is a model of interrelation of oxygen tension, oxyhaemoglobin saturation and oxygen content and the rest of the book is given over to clarity.
1064
clinical experience and the use of other printed materials. The other use for the book will be for trainers—to assess their level of knowledge! J. Norman Handbook of Local Anesthesia.
By Stanley F. Malamed.
Published by the C. V. Mosby Company. Pp. 297; indexed; illustrated. This book is about local anaesthesia for dentistry. It is clearly the work of a great enthusiast who has gone to great lengths to produce a meticulously detailed and wide-ranging work that makes interesting reading whether you are a dentist or an anaesthetist. It starts by covering the neurophysiology of nerve conduction and the general principles of the pharmacology of local anaesthetic agents. The author discusses each of the commonly-used local anaesthetics in detail, and the vasoconstrictors. The next section on the armamentarium deals with equipment, syringes, needles, cartridges and so on, their use and care. The largest section of the book covers the techniques and is well illustrated with drawings and photographs. It starts by dealing with the medical assessment of patients and has a sensible discussion about common medical conditions and how these interact with dental treatment and local anaesthesia. My only major criticism of this book occurs in this area. The author states that amide-type local anaesthetics are absolutely contraindicated for malignant hyperpyrexia susceptible patients. He recommends ester-type local anaesthetics for such patients. This statement is erroneous and could lead to serious problems. There is no evidence that MHS patients are at risk from amide local anaesthetics and by recommending esters, which can cause serious allergy, these patients are being subjected to an unnecessary risk. This section goes on to discuss the general care of patients in the dental surgery and then covers the anatomy of the trigeminal nerve, the maxilla and the mandible. The two chapters on maxillary and mandibular anaesthesia cover many different blocks in great detail, with excellent illustrations. The final chapter in this section covers the application of local anaesthesia to the various dental specialties, including a useful section on paediatric 600 MCQs in Anaesthesia: Clinical Practice. By P. J. Simpson dentistry. and N. W. Goodman. Published by: Churchill LivingThe final section of the book deals with complications, both stone, Edinburgh. Pp. 232; not indexed or illustrated. local and systemic, and their management. The section on treatment of systemic toxicity is clear and lays the emphasis on Simpson and Goodman have previously produced a set of keeping the patient oxygenated, although no mention is made MCQ papers for the basic science of anaesthesia. This of tracheal intubation, despite the fact that, in the section on compilation of 10 papers with 60 questions in each follows the laryngeal oedema resulting from allergy, cricothyrotomy is same model, but is directed at clinical practice—in essence, at described. the Parts I and III of the F.F.A.R.C.S. The introduction offers the usual, necessary advice for all taking such examinations, in I found this an interesting and well produced book which terms of handling MCQ papers. The papers are a good mix covers its subject in sufficient detail to give its readers a and any candidate using them as a practice will get a reasonable thorough understanding of local anaesthesia for dentistry. I assessment of his or her likely mark. hope my own dentist has read it! The problem that candidates will have in using these sets will W. Macrae be in trying to make a distinction between the knowledge required for the Part I and that for the Part III examination. A Pockel-Book for Intensive Care. By J. Tinker and S. N. Each paper contains some questions on special anaesthesia Jones. Published by Edward Arnold (Publishers) Ltd, which will be more appropriate for the advanced trainee. London. Pp. 143; indexed; illustrated. Price £7.25. The main use of the book will thus be to enable candidates to assess their level of knowledge, especially if it is used as a This short work seeks to provide "useful practical information mock examination. One can also then learn from one's for medical and nursing staff working in intensive care units." mistakes. It would be a mistake to use the book as a prime The authors point out that it is not an addition to the range source of knowledge; that should come from good teaching, of works offering detailed instructions on clinical management.
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on June 4, 2015
accounts of the advantages or uses of pulse oximetry in almost every conceivable situation, including diving. There are one or two voices of dissent, such as Professor Andrew Thornton's conclusion that ear-lobe oximetry is not recommended for routine monitoring of dental patients undergoing general anaesthesia or sedation. However, pulse oximetry was not available to him at the time he performed his studies and he does say unequivocally that continuous monitoring of oxygen saturation has been a useful method for highlighting deficiencies of technique in dental anaesthesia. A feature of this book is the excellent discussion sections, which are interposed between groups of chapters. Here can be found the voice of sound common sense in Dr Ross Holland from New South Wales, who states that it is absolute garbage to assume that the only reason why things go wrong under anaesthesia and why people die, for example, is because of a mishap. He points out that, whereas this is true in 20% of patients (e.g. disconnection, misplaced tracheal tube, compromised airway), the other 80% who die in association with anaesthesia do so because somebody gave the wrong anaesthetic at the wrong time or they made an error of judgement and all the monitoring in the world would not have made any difference (e.g. inhalation of vomit). He emphasizes there is only one absolutely indispensable monitor and that is a trained, experienced person in the operating room. Let us hope that basic lessons from this work, such as those demonstrated by Drs Hanning and Abbott who detail the hypoxaemia that often occurs in the early stages of recovery from anaesthesia—that is during transportation from the operating theatre to the recovery room, and in the recovery room itself—will get home to anaesthetists. The major criticism of this work is that it appears to promote the sponsor's product the Biox oximeter. This is unfortunate as, given the title, the reader would have been greatly helped by an unbiased informed account of the merits and demerits (including differences in technology) of the other pulse oximeters which are available (e.g. Nellcor, Novametrix). Questions on the technology and performance of competitor's oximeters have largely gone unanswered. A. P. Adams
BRITISH JOURNAL OF ANAESTHESIA