- Email: [email protected]
The Year in Anaesthesia and Critical Care; No 1
British Journal of Anaesthesia 95 (5): 722–4 (2005)
Book Reviews The Year in Anaesthesia and Critical Care; No 1. J. M. Hunter, T. M. Cook, H.-J. Priebe, M. M. R. F. Struys (editors). Published by Clinical Publishing (Atlas Medical Publishing Ltd), Oxford. Pp. 432; illustrated. Price £59.99. ISBN 1-904392-47-4.
J. W. Sear Oxford, UK E-mail: [email protected] doi:10.1093/bja/aei600
Topics in Anaesthesia and Critical Care: Infection Control in the Intensive Care Unit, 2nd Edn. H. K. F. van Saene, L. Silvestri and M. A. de Cal (editors). Published by Springer Verlag, Heidelberg. Pp. 640; indexed. Price £115.50, Euro 149.95. ISBN 88-470-0185-4. This is an extremely topical publication, in an area of Intensive Care that has come to the fore as of immense importance to microbiologist and intensivist alike. It is an impressive book of over 600 pages packed with useful information. It is worth having for the first section alone, which starts with a glossary of terms and then moves onto a superb re´sume´ of basic, essential microbiology, full of facts one once knew as well as many that one never knew. The section on antimicrobials is good for those doing exams and a very good reference to have available in an ITU as it covers most aspects of the available antimicrobials and current concepts in their use. Infection control surveillance techniques and antibiotic policies are all well covered. The chapter on molecular techniques for monitoring outbreaks is good for those with a leaning in that direction. However, for the rest of us the last paragraph says it all. The chapter on SDD (selective decontamination of the digestive tract) reviews the evidence base convincingly, discusses the rationale for use and provides definitive recipes to follow. It is clear, concise and an excellent source of references. It puts the cogent arguments for the concept clearly and addresses many of the criticisms. It is timely, as the ability to control infection is questionable, with MRSA and a myriad of other multi-resistant organisms on the up and up and when new approaches are required. Maybe it is time to look again in this direction and, if so, this is a good source of background information and potential inspiration. The section on ITU infection has some superb chapters. There are a few problems: why are mediastinitis and empyema in a chapter called ‘infections of the peritoneum’? It really does not matter and the content is excellent. Repetition is an issue in this section and it
Ó The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: [email protected]
Downloaded from http://bja.oxfordjournals.org/ at Purdue University Libraries ADMN on May 30, 2015
This new volume summarizing papers published in the year 2004 in anaesthesia and critical care is unashamedly focused on the need for continuing medical education and professional development (CEPD) in practising career-grade clinicians. It is described in the foreword by the president of the Royal College of Anaesthetists as a ‘new concept in book-based CEPD’. The book is not all-inclusive, but has concentrated on four areas of anaesthetic practice (described in the foreword as ‘key areas of recent development’), namely perioperative care (covering 114 pages); clinical pharmacology related to anaesthesia (75 pages); new technologies in anaesthesia (99 pages) and critical care (105 pages). The main publications in these areas are reviewed by ‘experts in the respective field’; a section summary provided; and then the four editors provide an overview with comment on the main findings and messages of each section of the book. In a short review it is impossible to offer a critique to cover all the topics covered but all offer something to all readers. The choice of how the referenced articles were selected is not commented on. Perhaps the future volumes might delve a little wider into the general medical journals (where often key advances seem to appear in the press) rather than focusing mainly on our own specialist journals. However, I can fully recommend the sections on ‘Perioperative Care’ and ‘Clinical Pharmacology’. The choice of subtopics within these two sections include several important aspects for all anaesthetists. In the section looking at perioperative anaesthetic management, the authors examine intravenous and blood transfusion therapies, and protection of the heart during non-cardiac surgery. Two important questions are focused on. The first is the controversy over the ideal fluid for volume replacement—is it crystalloid or colloid? And whether we should ‘flood’ the patient in the perioperative period or maintain them ‘dry’? Outcome data point towards the latter as being what we should target. The case for hypertonic volume replacement strategies is new; how can we best transfer outcome data from the Cochrane Review meta-analysis in trauma, critically ill, and burned patients to the benefit of our routine surgical practice? The second topic in this section addresses the issue of cardiac protection—the problem we face is enormous; but what strategy is really best? The evidence for preventative approaches (b-blockade; a2-agonists; neuraxial blockade; glycaemic control) are reviewed, as is the exciting area of anaesthetic and ischaemic pre-conditioning. As the concluding paragraph states, although single studies and meta-analyses suggest improved outcomes with both b-blockade and a2-agonists, there is real need for large, appropriately powered, randomized controlled trials to be reported before the widespread introduction of any of these therapies into general anaesthetic practice—one aspect missing from all data is a clear statement of the adverse effects of these therapies. In the section on Clinical Pharmacology, there is probably one of the best current accounts of the interaction between pharmacogenetics and anaesthesia. It is often forgotten that anaesthesia was one of the first specialties in medicine to recognize individual variability and genetic disease (with the observations of Kalow and delayed
recovery of neuromuscular blockade after succinylcholine in 1956). Effective drug delivery requires all anaesthetists to understand genetics, as well as the clinical applications of pharmacokinetics and pharmacodynamics. Does the book work? While I accept that many clinicians have only limited time to read the anaesthetic and related literature, there is much to commend to them in reading the source paper describing new innovations, technologies or drugs. However, this volume is well presented with good line drawings, figures and tables; and very few textual or syntax errors (to be expected of the three editors who are also members of the Board of the British Journal of Anaesthesia!). Despite my reservations, this book is a worthwhile addition to other ‘review’ books and CEPD journals but it should not be seen as an alternative to reading the journals! I look forward to seeing the series gestate and come of age!
Book Reviews The Year in Anaesthesia and Critical Care; No 1. J. M. Hunter, T. M. Cook, H.-J. Priebe, M. M. R. F. Struys (editors). Published by Clinical Publishing (Atlas Medical Publishing Ltd), Oxford. Pp. 432; illustrated. Price £59.99. ISBN 1-904392-47-4.
J. W. Sear Oxford, UK E-mail: [email protected] doi:10.1093/bja/aei600
Topics in Anaesthesia and Critical Care: Infection Control in the Intensive Care Unit, 2nd Edn. H. K. F. van Saene, L. Silvestri and M. A. de Cal (editors). Published by Springer Verlag, Heidelberg. Pp. 640; indexed. Price £115.50, Euro 149.95. ISBN 88-470-0185-4. This is an extremely topical publication, in an area of Intensive Care that has come to the fore as of immense importance to microbiologist and intensivist alike. It is an impressive book of over 600 pages packed with useful information. It is worth having for the first section alone, which starts with a glossary of terms and then moves onto a superb re´sume´ of basic, essential microbiology, full of facts one once knew as well as many that one never knew. The section on antimicrobials is good for those doing exams and a very good reference to have available in an ITU as it covers most aspects of the available antimicrobials and current concepts in their use. Infection control surveillance techniques and antibiotic policies are all well covered. The chapter on molecular techniques for monitoring outbreaks is good for those with a leaning in that direction. However, for the rest of us the last paragraph says it all. The chapter on SDD (selective decontamination of the digestive tract) reviews the evidence base convincingly, discusses the rationale for use and provides definitive recipes to follow. It is clear, concise and an excellent source of references. It puts the cogent arguments for the concept clearly and addresses many of the criticisms. It is timely, as the ability to control infection is questionable, with MRSA and a myriad of other multi-resistant organisms on the up and up and when new approaches are required. Maybe it is time to look again in this direction and, if so, this is a good source of background information and potential inspiration. The section on ITU infection has some superb chapters. There are a few problems: why are mediastinitis and empyema in a chapter called ‘infections of the peritoneum’? It really does not matter and the content is excellent. Repetition is an issue in this section and it
Ó The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: [email protected]
Downloaded from http://bja.oxfordjournals.org/ at Purdue University Libraries ADMN on May 30, 2015
This new volume summarizing papers published in the year 2004 in anaesthesia and critical care is unashamedly focused on the need for continuing medical education and professional development (CEPD) in practising career-grade clinicians. It is described in the foreword by the president of the Royal College of Anaesthetists as a ‘new concept in book-based CEPD’. The book is not all-inclusive, but has concentrated on four areas of anaesthetic practice (described in the foreword as ‘key areas of recent development’), namely perioperative care (covering 114 pages); clinical pharmacology related to anaesthesia (75 pages); new technologies in anaesthesia (99 pages) and critical care (105 pages). The main publications in these areas are reviewed by ‘experts in the respective field’; a section summary provided; and then the four editors provide an overview with comment on the main findings and messages of each section of the book. In a short review it is impossible to offer a critique to cover all the topics covered but all offer something to all readers. The choice of how the referenced articles were selected is not commented on. Perhaps the future volumes might delve a little wider into the general medical journals (where often key advances seem to appear in the press) rather than focusing mainly on our own specialist journals. However, I can fully recommend the sections on ‘Perioperative Care’ and ‘Clinical Pharmacology’. The choice of subtopics within these two sections include several important aspects for all anaesthetists. In the section looking at perioperative anaesthetic management, the authors examine intravenous and blood transfusion therapies, and protection of the heart during non-cardiac surgery. Two important questions are focused on. The first is the controversy over the ideal fluid for volume replacement—is it crystalloid or colloid? And whether we should ‘flood’ the patient in the perioperative period or maintain them ‘dry’? Outcome data point towards the latter as being what we should target. The case for hypertonic volume replacement strategies is new; how can we best transfer outcome data from the Cochrane Review meta-analysis in trauma, critically ill, and burned patients to the benefit of our routine surgical practice? The second topic in this section addresses the issue of cardiac protection—the problem we face is enormous; but what strategy is really best? The evidence for preventative approaches (b-blockade; a2-agonists; neuraxial blockade; glycaemic control) are reviewed, as is the exciting area of anaesthetic and ischaemic pre-conditioning. As the concluding paragraph states, although single studies and meta-analyses suggest improved outcomes with both b-blockade and a2-agonists, there is real need for large, appropriately powered, randomized controlled trials to be reported before the widespread introduction of any of these therapies into general anaesthetic practice—one aspect missing from all data is a clear statement of the adverse effects of these therapies. In the section on Clinical Pharmacology, there is probably one of the best current accounts of the interaction between pharmacogenetics and anaesthesia. It is often forgotten that anaesthesia was one of the first specialties in medicine to recognize individual variability and genetic disease (with the observations of Kalow and delayed
recovery of neuromuscular blockade after succinylcholine in 1956). Effective drug delivery requires all anaesthetists to understand genetics, as well as the clinical applications of pharmacokinetics and pharmacodynamics. Does the book work? While I accept that many clinicians have only limited time to read the anaesthetic and related literature, there is much to commend to them in reading the source paper describing new innovations, technologies or drugs. However, this volume is well presented with good line drawings, figures and tables; and very few textual or syntax errors (to be expected of the three editors who are also members of the Board of the British Journal of Anaesthesia!). Despite my reservations, this book is a worthwhile addition to other ‘review’ books and CEPD journals but it should not be seen as an alternative to reading the journals! I look forward to seeing the series gestate and come of age!