Techniques in Extracorporeal Circulation

Techniques in Extracorporeal Circulation

British Journal of Anaesthesia 93 (4): 600–2 (2004) Book Reviews Techniques in Extracorporeal Circulation, 4th Edn. P. H. Kay and C. M. Munsch (edito...

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British Journal of Anaesthesia 93 (4): 600–2 (2004)

Book Reviews Techniques in Extracorporeal Circulation, 4th Edn. P. H. Kay and C. M. Munsch (editors). Published by Arnold, London. Pp. 354; indexed; illustrated. Price £110.00. ISBN 0-340-80723-7. This is the fourth edition of this book. The editor of the first edition, published in 1976, was Marion Ionescu from Leeds, UK and the editorship has passed down with time through various members of that department. The book has 18 general chapters and three appendices that are specifically related to education and standards in perfusion practice. This reviewer particularly liked the device of having the key points as a call out at the start of each chapter. The volume is well illustrated with excellent figures and it is well indexed. The third edition of the ‘Leeds textbook of extracorporeal circulation’ was published in 1992. The editors of this fourth edition explain to the potential reader (purchaser) in their book cover note that since the 1992 edition new topics of robotic and offpump surgery have been added and other chapters have been thoroughly revised and updated. Have they achieved this objective? The answer is a resounding maybe, as the standard of the contents is very mixed. As examples, the authors of the second and third chapters add a note to say that they based their contribution on the previous edition. The Medtronic Company now writes the second chapter on principles and design of extracorporeal systems. Whoever wrote this section on behalf of the company believes that John Gibbon performed the first successful human procedure at the Massachusetts General Hospital (it was in Philadelphia as reported in the foreword from Professor Ken Taylor). This incorrect knowledge is symptomatic of other chapters in this book. It is also all the more surprising when the reader considers that Earl Bakken and his brother-in-law founded the Medtronic Company in a garage in Minneapolis. The company produced its first pacemakers as a response to the pioneering heart surgeons in that city who realized where Gibbon had made some errors. Photographs showing products from the new authors’ catalogue replace the illustrations from the Dideco Company used from the previous published chapter, but otherwise it is an excellent overview and this reviewer especially appreciated the section dealing with the newer surface technologies. The third chapter on pathophysiology of extracorporeal circulation demonstrates a real problem with this textbook in that it shows its age. The authors discuss vast tracts of myths and legends associated with adverse outcomes from the earlier days of heart surgery and cardiopulmonary bypass. Many of these concepts are difficult to justify with modern systems and techniques, and their clinical relevance is largely opaque. This reviewer found the section in this chapter on haemodilution particularly depressing. To advocate an all blood prime as best practice or at least the administration of ‘500–1000 ml of blood in the prime or to be infused during bypass’, and that this blood ‘should be less than 24 h old’ appears totally contrary to 21st century practice. Like many others, this chapter also appears extensively referenced at first sight. However, only 18 of the 150 references are from articles published after 1994 and only one is from the year 2000. This pattern of using older references supporting older ideas and views is repeated for many of the other chapters. There are three chapters written by anaesthetists that shine out as beacons. They are all well written and referenced. In particular, the chapter on the brain from the group in Duke has over 250 references of which nearly 160 are from publications after 1994, and 23 from after the year 2000. The chapters on anaesthesia for cardiac surgery and blood conservation are well written and contain a balanced and

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contemporary view of the practice of the day with up-to-date references. It is unfortunate that the section on cerebral protection in the chapter on anaesthesia overlaps much of the data presented by the Duke group, and the surgeon who wrote the new chapter on off-pump surgery was not informed that anaesthesia for that procedure was also well covered by others. Overall, this reviewer considers much of the book is too out of date to make it useful as a guiding text for students of contemporary clinical practice. Much of the information is repeated between the various chapters and is rarely critically reviewed or appraised. If your surgeon or perfusionist has a copy, it is certainly worth borrowing for a couple of hours to read the chapters written by the anaesthetists together with those on surfaces, extracorporeal membrane oxygenation and robotics. Perfusionists may want copies of the appendices related to standards of care but most of this can be found on appropriate Internet sites. D. Royston London, UK doi:10.1093/bja/aeh615

Color Atlas of Emergency Trauma. D. P. Mandavia, E. J. Newton and D. Demetriades (editors). Published by Cambridge University Press, Cambridge. Pp. 320; indexed; illustrated. Price £150.00. ISBN 0-52178148-5. I was delighted to receive this book for review. This Color Atlas of Emergency Trauma contains over 700 colour pictures of the results of trauma, operative and post-mortem specimens, radiographs, CT and MRI scans, and graphic drawings collected from the USC Medical Centre, the largest and busiest trauma centre in North America. The authors must be commended on the size and quality of the collection that reminds everyone of the extensive injuries that the human body is subjected to as a result of trauma. The question ‘How did they do that?’ arose on many occasions whilst I was reviewing this book. The book is divided into eight chapters, each 30 to 40 pages in length, dealing with the major body systems (head, facial, neck, thoracic, abdominal, musculoskeletal, spinal, skin and soft tissue). The chapters are subdivided into numbered sections dealing with the major injuries within these systems. There is an extensive index that makes finding a specific injury a simple task, and the systematic division does allow cross-referencing to associated injuries in the same system. Each chapter has a text introduction that includes a brief description of the appropriate clinical examination, investigations, general management and, most usefully, common mistakes and pitfalls. Each section within the chapter has a short, pertinent commentary. At some points, there are deviations into protocols and procedures but as there are no references in the text these have to be assumed to be by the authors or derived from the institution’s own practice. The colour pictures are excellent and are accompanied by appropriate radiographic illustrations. Most of the pictures and radiographs have the clinical lesion highlighted by an arrow or a circle. Unfortunately, it is not clear whether the accompanying radiograph image is of the same patient and in many cases it blatantly is not, despite them having consecutive numbering. This complicates the interpretation of the physical photograph and does not

The Board of Management and Trustees of the British Journal of Anaesthesia 2004