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Regional Differences in the Lung
BOOK REVIEWS
Persistent Pain. Modern Methods of Treatment, Vol. 1. Edited by Sampson Lipton. Published (1977) by Academic Press, Grune & Stratton, New York. Price £10.50. This book is the first of a series to be published under the editorial guidance of Dr Sam Lipton, who is well known for his work on pain relief. The contributors to Volume 1 are also well known amongst those with a special interest in pain problems and each has written a chapter which represents an attempt to distil knowledge in their own area of work with emphasis upon methods of treatment. The latter are described in considerable detail in some chapters, for example, those by Maher and Mehta on spinal and extradural analgesia, by Swerdlow on peripheral nerve blocking and by Gauze Mullen on percutaneous cordotomy are mines of practical information and should be of great help to the beginner, and even those who have had experience of the techniques described. Perhaps because the subject matter is so much greater and therefore poses difficulties for those attempting to condense it, or to take specific areas from it, the sections on drug treatment and psychiatric
management are less comprehensive. A chapter on acupuncture by Mann is a short, fascinating account of the subject which most readers should find helpful in understanding the nature and use of this treatment, although many will no doubt remain sceptical about its value when compared with Western alternatives. The diagnosis and treatment of headache, facial and dental pain form the subject matter for two chapters and indications for the use of surgical techniques, and their hazards, are described also. This book, which is for postgraduates rather than undergraduates, is a useful contribution to the literature on the practical management of pain problems, especially for those who wish to have existing information drawn together in one volume. The cost is moderate and a potential buyer should remember that it is the first of a series of five or six volumes. Michael R. Bond An Introduction to Neurosurgery, 3rd edn. By B. Jennett. Published (1977) by Heinemann Medical Books, London. Pp. 366; illustrated; indexed. Price £9.95. This is the third edition of what has become one of the classics. Of course there is far more in it than the anaesthetist in a district general hospital would wish to read. Equally, however, it is most desirable that such an anaesthetist should have available to him a book of reference to which he can turn when the occasional neurosurgical case does arise. This is the book for him, for it sets out succinctly all the basic information that is required. There is even a chapter on anaesthesia for intracranial surgery which could be read with advantage by every anaesthetist. It is pleasant to find a book of this size and professional value priced at less than £10. Every Anaesthetic Department library should certainly possess it. Those who practise neurosurgical anaesthesia should find it so valuable that they will want to possess a personal copy. A. R. Hunter Regional Differences in the Lung. By J. B. West. Published (1977) by Academic Press, London. Pp. 477 + xiv; illustrated; indexed. Price £26.25. The effect of gravity on the regional distribution of pulmonary blood flow was first discussed in a monograph by Johannes Orth, published in 1887. Although bronchospirometric techniques contributed much useful information during the first half of this century, it was the introduction of radioisotope techniques in 1955 which triggered off a series of remarkable advances in our knowledge of the regional differences within the lung. Techniques using radioisotopes are complex and require expensive equipment, so that most of the work has originated from relatively few centres. However, this has certainly not inhibited progress and, indeed, may have contributed to the orderly development of the subject. In the present volume, John West has attempted to provide a critical assessment of the current state of knowledge in this field. He first discusses non-radioactive and radioactive methods of measuring regional differences in the lung and contributes additional chapters on variations in regional blood flow, gas exchange and stress within the lung. Joseph Milic-Emili contributes a chapter on the regional distribution of ventilation and Emilio Agostoni
Downloaded from http://bja.oxfordjournals.org/ at University of Arizona on May 30, 2015
"we just do not know what causes cardiac dysrhythmias during general anaesthesia" is a sweeping statement which is totally unjustified by experience. Again, Orton's concept of a chemically denervated heart during anaesthesia is not one that appeals to every anaesthetist, but it has been discussed at some length in recent years and certainly should not be neglected in any consideration of the cardiovascular effects of general anaesthetic agents. A more serious criticism is that the author has virtually ignored the history of the development of his specialty and the philosophy behind that development. Without the continuity engendered by such an approach he runs the risk that his chapters will degenerate into a series of technical memoranda, and that would be a pity. It is sad, too, that a physiologist of Dr Kelman's stature seems unwilling to accept S.I. units. After all, they have been with us for more than 10 years; Parliament has ordained that they will be generally adopted in the United Kingdom and we now have a generation of students who know nothing else. Whether he likes it or not, the author must face the fact that S.I. units are here to stay, and snide remarks about the foolishness of the kilopascal should have no place in a scientific textbook. Perhaps Dr Kelman should direct his attention to the more pressing problem of technical jargon, some of which occurs from time to time in his text. Surely it is easier to write that a particular drug makes the heart beat faster than to write that it has a positive chronotropic effect on the heart; and there is also a better chance of being understood. There are some surprising deficiencies; the section on the Valsalva manoeuvre is so brief as to be misleading and the author appears to have failed to recognize the full significance of this test in the assessment of the individual patients' ability to respond to stress. The use of impedance cardiography and echo cardiography is not discussed. Even if the author has doubts about the validity of these techniques, • they are becoming more widely used and a critical review of their value is needed. Finally, despite the'se criticisms, this is a useful book and most anaesthetists, and others, will benefit by having a copy available J P. Payne
311
312
The third and fourth sections deal with the problems of shock and resuscitation, both within and outside the hospital environment. The topics include methods of resuscitation, i.v. fluid therapy and parenteral nutrition, haematological problems, infection and antibiotic therapy, and paediatric, endocrine and neurological problems. Finally, there is a short section on the training of anaesthetists and nurses and the medico-legal aspects of anaesthesia. Throughout the text are references to the organizational problems of anaesthesia, such as documentation, interdisciplinary pain clinics and the organization of rescue services. The book contains a large number of excellent diagrams and tables. There are references after each subsection and suggestions for further reading also. Norman W. Lees Downloaded from http://bja.oxfordjournals.org/ at University of Arizona on May 30, 2015
discusses the factors which determine transpulmonary pressure and so contribute to the changes in ventilation which occur with posture, lung volume and deformation of the chest wall. David Glaister deals with the effect of acceleration on the lung and Michael Hughes reviews the topics of pulmonary oedema and local control of blood flow and ventilation. Nicholas Anthonisen appropriately provides the last chapter, on "closing volume". It is impossible to single out any of these authors for special commendation for all are experts in their chosen fields and all have contributed superb reviews. They treat difficult concepts with consummate ease and they provide a comprehensive coverage of current thinking. It is rare to encounter a multi-author review which is so unified in style and concept, which reads so easily and yet which provides such a critical approach to the literature. The book is well produced and there are few typographical errors. However, your reviewer used 2% lignocaine, not 20%, when anaesthetizing patients for the early bronchoscopic measurements with the mass spectrometer! Whilst this book is intended for those with a serious interest in lung function, it provides a most useful guide to current thinking about lung function and it discusses many topics of direct importance to anaesthetists and those working in intensive care units. The price reflects the standard of presentation, but the book nevertheless represents excellent value for money. M. K. Sykes
BRITISH JOURNAL OF ANAESTHESIA
Tracheostomy and Artificial Ventilation in the Treatment of Respiratory Failure, 3rd edn. By By S. A. Feldman and B. E. Crawley. Published (1977) by Edward Arnold (Publ.), London. Pp. 208; indexed; illustrated. Price £5.95 (paperback); £12 (hardback).
The second edition of this popular handbook was published in 1971. Since that time there have been considerable advances in the management of patients in intensive care units. The trends are emphasized in a chapter by Dr A. Doughty of Kingston Hospital, who illustrates the changes in the pattern of disorders in patients entering the intensive Lehrbuch der Anaesthesiologie, Reanimation und Intensiv- care unit in a busy general hospital between 1967 and 1975. In this third edition, the authors have incorporated comtherapie, 4th edn, by H. Benzer, R. Frey, W. Hiigin and O. Mayrhofer. Published (1977, entirely in pletely new chapters on parenteral nutrition, oxygen therapy, German) by Springer-Verlag, Berlin. Pp. 803; nursing care and physiotherapy and they have revised the other chapters extensively. Within 208 pages there are 16 illustrated; indexed. Price $68.90. chapters by acknowledged experts in the field. Though This book is the fourth edition of one of the major German there is much of value within the appendix on physioanaesthetic textbooks. It aims to provide a broad yet therapy, it is rather disappointing, as the presentation detailed view of anaesthesia for both the trainee and departs from the general format of the book and is the least established specialist anaesthetist. The first section deals readable section. The nursing section is refreshingly with the scientific basis of anaesthesia; it begins with a practical and lays stress on the human psychological review of the physical principles underlying recording and problems involved in the intensive care environment and measuring equipment, anaesthetic safety problems such as the importance of efficient, reliable and sympathetic fire, electrical hazards and chronic exposure to anaesthetic communication with all involved, not least the patient. The agents. Next is a synopsis of the physiology of the respira- chapter on metabolic disturbances and parenteral nutrition tory, circulatory, neurological, metabolic, blood coagulation is excellent and adds considerable value to the book as it and endocrine systems. Finally, there is a review of the sets out in a clear manner the basic principles and the principles of drug action, premedication and the drugs routine to be adopted in the management of cases. currently in use in anaesthetic practice. With the new edition, the two editors have been faced The second section describes practical aspects of with the difficult transition to S.I. units and inevitably and anaesthesia beginning with the preoperative visit and understandably there are a few inconsistencies. The overall pulmonary function tests, and describes different anaes- standard of the text is high. The book is lightweight, thetic techniques including induced hypotension, artificial compact, full of facts, wisdom and sound practical advice ventilation, regional blocks, acupuncture and electro- to nurses, physiotherapists, doctors, and all who are analgesia and electro-anaesthesia. The special problems of intimately involved in the intensive care of patients. It has anaesthesia for dental, ENT, plastic and obstetric and already found a well-deserved place amongst books gynaecological surgery and anaesthesia for the elderly are regarded as essential reading for such personnel, and the third edition ensures that this role will continue. described in detail. J. A. Thornton
Primed in Great Britain by John Wright and Sons Ltd. at The Stonebridge Press, Bristol BS4 5NU
© Macmillan Journals Ltd 1978
Persistent Pain. Modern Methods of Treatment, Vol. 1. Edited by Sampson Lipton. Published (1977) by Academic Press, Grune & Stratton, New York. Price £10.50. This book is the first of a series to be published under the editorial guidance of Dr Sam Lipton, who is well known for his work on pain relief. The contributors to Volume 1 are also well known amongst those with a special interest in pain problems and each has written a chapter which represents an attempt to distil knowledge in their own area of work with emphasis upon methods of treatment. The latter are described in considerable detail in some chapters, for example, those by Maher and Mehta on spinal and extradural analgesia, by Swerdlow on peripheral nerve blocking and by Gauze Mullen on percutaneous cordotomy are mines of practical information and should be of great help to the beginner, and even those who have had experience of the techniques described. Perhaps because the subject matter is so much greater and therefore poses difficulties for those attempting to condense it, or to take specific areas from it, the sections on drug treatment and psychiatric
management are less comprehensive. A chapter on acupuncture by Mann is a short, fascinating account of the subject which most readers should find helpful in understanding the nature and use of this treatment, although many will no doubt remain sceptical about its value when compared with Western alternatives. The diagnosis and treatment of headache, facial and dental pain form the subject matter for two chapters and indications for the use of surgical techniques, and their hazards, are described also. This book, which is for postgraduates rather than undergraduates, is a useful contribution to the literature on the practical management of pain problems, especially for those who wish to have existing information drawn together in one volume. The cost is moderate and a potential buyer should remember that it is the first of a series of five or six volumes. Michael R. Bond An Introduction to Neurosurgery, 3rd edn. By B. Jennett. Published (1977) by Heinemann Medical Books, London. Pp. 366; illustrated; indexed. Price £9.95. This is the third edition of what has become one of the classics. Of course there is far more in it than the anaesthetist in a district general hospital would wish to read. Equally, however, it is most desirable that such an anaesthetist should have available to him a book of reference to which he can turn when the occasional neurosurgical case does arise. This is the book for him, for it sets out succinctly all the basic information that is required. There is even a chapter on anaesthesia for intracranial surgery which could be read with advantage by every anaesthetist. It is pleasant to find a book of this size and professional value priced at less than £10. Every Anaesthetic Department library should certainly possess it. Those who practise neurosurgical anaesthesia should find it so valuable that they will want to possess a personal copy. A. R. Hunter Regional Differences in the Lung. By J. B. West. Published (1977) by Academic Press, London. Pp. 477 + xiv; illustrated; indexed. Price £26.25. The effect of gravity on the regional distribution of pulmonary blood flow was first discussed in a monograph by Johannes Orth, published in 1887. Although bronchospirometric techniques contributed much useful information during the first half of this century, it was the introduction of radioisotope techniques in 1955 which triggered off a series of remarkable advances in our knowledge of the regional differences within the lung. Techniques using radioisotopes are complex and require expensive equipment, so that most of the work has originated from relatively few centres. However, this has certainly not inhibited progress and, indeed, may have contributed to the orderly development of the subject. In the present volume, John West has attempted to provide a critical assessment of the current state of knowledge in this field. He first discusses non-radioactive and radioactive methods of measuring regional differences in the lung and contributes additional chapters on variations in regional blood flow, gas exchange and stress within the lung. Joseph Milic-Emili contributes a chapter on the regional distribution of ventilation and Emilio Agostoni
Downloaded from http://bja.oxfordjournals.org/ at University of Arizona on May 30, 2015
"we just do not know what causes cardiac dysrhythmias during general anaesthesia" is a sweeping statement which is totally unjustified by experience. Again, Orton's concept of a chemically denervated heart during anaesthesia is not one that appeals to every anaesthetist, but it has been discussed at some length in recent years and certainly should not be neglected in any consideration of the cardiovascular effects of general anaesthetic agents. A more serious criticism is that the author has virtually ignored the history of the development of his specialty and the philosophy behind that development. Without the continuity engendered by such an approach he runs the risk that his chapters will degenerate into a series of technical memoranda, and that would be a pity. It is sad, too, that a physiologist of Dr Kelman's stature seems unwilling to accept S.I. units. After all, they have been with us for more than 10 years; Parliament has ordained that they will be generally adopted in the United Kingdom and we now have a generation of students who know nothing else. Whether he likes it or not, the author must face the fact that S.I. units are here to stay, and snide remarks about the foolishness of the kilopascal should have no place in a scientific textbook. Perhaps Dr Kelman should direct his attention to the more pressing problem of technical jargon, some of which occurs from time to time in his text. Surely it is easier to write that a particular drug makes the heart beat faster than to write that it has a positive chronotropic effect on the heart; and there is also a better chance of being understood. There are some surprising deficiencies; the section on the Valsalva manoeuvre is so brief as to be misleading and the author appears to have failed to recognize the full significance of this test in the assessment of the individual patients' ability to respond to stress. The use of impedance cardiography and echo cardiography is not discussed. Even if the author has doubts about the validity of these techniques, • they are becoming more widely used and a critical review of their value is needed. Finally, despite the'se criticisms, this is a useful book and most anaesthetists, and others, will benefit by having a copy available J P. Payne
311
312
The third and fourth sections deal with the problems of shock and resuscitation, both within and outside the hospital environment. The topics include methods of resuscitation, i.v. fluid therapy and parenteral nutrition, haematological problems, infection and antibiotic therapy, and paediatric, endocrine and neurological problems. Finally, there is a short section on the training of anaesthetists and nurses and the medico-legal aspects of anaesthesia. Throughout the text are references to the organizational problems of anaesthesia, such as documentation, interdisciplinary pain clinics and the organization of rescue services. The book contains a large number of excellent diagrams and tables. There are references after each subsection and suggestions for further reading also. Norman W. Lees Downloaded from http://bja.oxfordjournals.org/ at University of Arizona on May 30, 2015
discusses the factors which determine transpulmonary pressure and so contribute to the changes in ventilation which occur with posture, lung volume and deformation of the chest wall. David Glaister deals with the effect of acceleration on the lung and Michael Hughes reviews the topics of pulmonary oedema and local control of blood flow and ventilation. Nicholas Anthonisen appropriately provides the last chapter, on "closing volume". It is impossible to single out any of these authors for special commendation for all are experts in their chosen fields and all have contributed superb reviews. They treat difficult concepts with consummate ease and they provide a comprehensive coverage of current thinking. It is rare to encounter a multi-author review which is so unified in style and concept, which reads so easily and yet which provides such a critical approach to the literature. The book is well produced and there are few typographical errors. However, your reviewer used 2% lignocaine, not 20%, when anaesthetizing patients for the early bronchoscopic measurements with the mass spectrometer! Whilst this book is intended for those with a serious interest in lung function, it provides a most useful guide to current thinking about lung function and it discusses many topics of direct importance to anaesthetists and those working in intensive care units. The price reflects the standard of presentation, but the book nevertheless represents excellent value for money. M. K. Sykes
BRITISH JOURNAL OF ANAESTHESIA
Tracheostomy and Artificial Ventilation in the Treatment of Respiratory Failure, 3rd edn. By By S. A. Feldman and B. E. Crawley. Published (1977) by Edward Arnold (Publ.), London. Pp. 208; indexed; illustrated. Price £5.95 (paperback); £12 (hardback).
The second edition of this popular handbook was published in 1971. Since that time there have been considerable advances in the management of patients in intensive care units. The trends are emphasized in a chapter by Dr A. Doughty of Kingston Hospital, who illustrates the changes in the pattern of disorders in patients entering the intensive Lehrbuch der Anaesthesiologie, Reanimation und Intensiv- care unit in a busy general hospital between 1967 and 1975. In this third edition, the authors have incorporated comtherapie, 4th edn, by H. Benzer, R. Frey, W. Hiigin and O. Mayrhofer. Published (1977, entirely in pletely new chapters on parenteral nutrition, oxygen therapy, German) by Springer-Verlag, Berlin. Pp. 803; nursing care and physiotherapy and they have revised the other chapters extensively. Within 208 pages there are 16 illustrated; indexed. Price $68.90. chapters by acknowledged experts in the field. Though This book is the fourth edition of one of the major German there is much of value within the appendix on physioanaesthetic textbooks. It aims to provide a broad yet therapy, it is rather disappointing, as the presentation detailed view of anaesthesia for both the trainee and departs from the general format of the book and is the least established specialist anaesthetist. The first section deals readable section. The nursing section is refreshingly with the scientific basis of anaesthesia; it begins with a practical and lays stress on the human psychological review of the physical principles underlying recording and problems involved in the intensive care environment and measuring equipment, anaesthetic safety problems such as the importance of efficient, reliable and sympathetic fire, electrical hazards and chronic exposure to anaesthetic communication with all involved, not least the patient. The agents. Next is a synopsis of the physiology of the respira- chapter on metabolic disturbances and parenteral nutrition tory, circulatory, neurological, metabolic, blood coagulation is excellent and adds considerable value to the book as it and endocrine systems. Finally, there is a review of the sets out in a clear manner the basic principles and the principles of drug action, premedication and the drugs routine to be adopted in the management of cases. currently in use in anaesthetic practice. With the new edition, the two editors have been faced The second section describes practical aspects of with the difficult transition to S.I. units and inevitably and anaesthesia beginning with the preoperative visit and understandably there are a few inconsistencies. The overall pulmonary function tests, and describes different anaes- standard of the text is high. The book is lightweight, thetic techniques including induced hypotension, artificial compact, full of facts, wisdom and sound practical advice ventilation, regional blocks, acupuncture and electro- to nurses, physiotherapists, doctors, and all who are analgesia and electro-anaesthesia. The special problems of intimately involved in the intensive care of patients. It has anaesthesia for dental, ENT, plastic and obstetric and already found a well-deserved place amongst books gynaecological surgery and anaesthesia for the elderly are regarded as essential reading for such personnel, and the third edition ensures that this role will continue. described in detail. J. A. Thornton
Primed in Great Britain by John Wright and Sons Ltd. at The Stonebridge Press, Bristol BS4 5NU
© Macmillan Journals Ltd 1978