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Book Reviews

Clinical Cases in Anesthesia, 2nd ed. A.P. Reed (Ed.). Churchill Livingstone, 1995. 437 pages. ISBN: 0-443-08899-3.

Dr. Allan Reed's intent with the 2nd edition of Clinical Cases in Anesthesia is to produce an expanded version of his first text, whose initial design was to emphasize the fundamental elements of the many disease processes which patients present to the anaesthetist. Thi~ pathophysiology of the disease, the pharmacological impl.ications thereof, preoperative assess- ment, and fnally, anaesthetic considerations of illustrative cases are presented.

Dr. Reed and contributors do an excellent job. The case for- mat presentation is a welcome change. The information is con- cise and precise, with few wasted words. Much of it is present- ed in tabular form, which further speeds the reader along. An enormous amount of material is covered, from the basics of adult and neonatal resuscitation, aspiration, shock, the difficult airway, through to the discussion of cases one sees everyday, illustrating the pathophysiology and anaesthetic implications of ischaemic heart disease, chronic obstructive lung disease, increased intracranial pressure, vascular disease, labour and delivery and associated obstetrical scenarios such as maternal haemorrhage, placenta previa and pre-eclampsia. Illustrative cases of total hip replacement, otolaryngological procedures, paediatrics (gastroschisis, congenital diaphragmatic hernia, pyloric stenosis and tracheoesophageal fistula), regional and ambulatory anaesthesia are presented. As well, metabolic derangements including diabetes, hyperthyroidism, calcium metabolism abnormalities, phaeochromocytoma and coagu- Iopathies are included. Pain and recovery room problems are also presented.

There is a great deal of information packed into 421 very readable pages. I highly recommend this text to any anaes- thetist as a front-line book for a quick fix for information. It is not a recipe.book which outlines how to do it, rather, it pre- sents the information and offers options (sometimes controver- sial) of how to best tailor one's approach to the problem at hand. It is an excellent text for residents preparing for oral examinations.

Anne Moore MD FRCPC Montr6al, Qu6bec

Understanding Anesthesia Equipment. Construction, Care and Complications, 3rd ed. J.A. Dorsch, S.E. Dorsch. Williams & Wilkins, 1994. 797 pages. ISBN: 0-683-02616-X

When the first edition of "Dorsch & Dorsch" first appeared in 1975 it filled a gap in the anaesthesia literature. The third edi- lion represents a major updating of the entire texts relevant to today's anaesthesia technology. Specifically, the standards that guide the manufacture of anaesthesia machines and related monitors are clearly described with references to where the Canadian Standards Association differs from its American counterpart. Even the venerable breathing circuit chapters are

updated with detailed functional description of the Lack and Humphrey ADE circuits. The multitude of laryngoscopes are illustrated along with descriptions of various airway aids (tra- cheal tube exchanges, lighted stylets, fibreoptic laryngoscopes, laryngeal masks etc.). Several new chapters describe vigilance aids - namely, oximeters, respiratory gas analyzers (all current technologies), airway volume and pressure alarms, and neuro- muscular stimulators. The chapter on the anaesthesia machine checkout, based on the FDA recommendations, is worth care- ful reading. HIV and slow virus contamination has been added to the cfiapter on cleaning and sterilization of equipment. Equipment of historical interest has been omitted entirely. The excellefit index seems superfluous in that the text is so logical- ly laid out.

Almost every anaesthetist has, at one time, struggled through dry technical descriptives of anaesthesia equipment. As elinical anaesthesiologists Dorsch & Dorsch make this task much less painful. They are to be congratulated. This third edi- tion belongs in every Anaesthesia department and many per- sonal bookshelves.

David Maim MD FRCPC Vancouver, B.C.

Anaesthesia Databook, 2nd ed. Rosemary A. Mason. Churchill Livingstone, 1994. 661 pages. ISBN: 0-443-04763-4

The Anaesthesia Databook by Rosemary A. Mason is an excellent, extremely practical reference book. It is intended for the practising anaesthetist and, therefore, assumes basic under- lying knowledge and only concentrates on the important spe- cific points for each topic covered. I would think this would also serve as an invaluable aid to the senior resident approach- ing their orals and completion of training as well.

It is divided into four sections. The first goes through "med- ical conditions." The first pages provide an alphabetical index of every disorder contained in this section for quick reference. Each topic is attacked in an orderly concise fashion covering the following: preoperative abnormalities, anaesthetic prob- lems, and anaesthetic management. This is followed by a bib- liography with pertinent references in the anaesthetic literature for further review. The infonnation is well organized and pri- oritized as anaesthetic considerations should be and therefore leaves out all the extra text that usually bogs down the major text books.

The second section deals in a similar manner with "emer- gency conditions" during anaesthesia or immediate periopera- tive period. Here each one is addressed with a small descrip- tion of the problem followed by presentation, Diagnosis and Management.

The third Section deals with "miscellaneous" problems. These include new procedures - i.e., Laser, MRI and some specific patient problems - i.e., Jehovah witness, AIDS, Brain Death, and CPR in special situations - neonatal, paediatric and pregnancy).

The fourth'section includes "Rare and Unusual Syndromes."

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There is generally little data on these syndromes and therefore each may have only one or two references. They are once again addressed in an orderly fashion concentrating on the main attaesthetic concerns.

The fifth and final section lists a number of standard labora- tory values, normal therapeutic levels for drugs, in addition to other helpful lists including a section on values for paediatrics.

All in all it is a well thought out, organized quick reference tbr practising anaesthetists. It would be a handy reference in an accessible place in any OR.

M. Graham MD FRCPC Kingston, Ontario

Intensive Care. A Concise Textbook, 2nd ed. C.J. Hinds, D. Watson. Harcourt Brace & Company Ltd., 1996. 477 pages. 29.95 pounds (sterling). ISBN: 0-7020-1541-5.

This is the second edition of the textbook written by C.J. Hinds and D. Watson who are both consultants in intensive care and anaesthesia working at St. Bartholomew's Hospital in London, England. This textbook is intended as an introductory text primarily for physicians who are starting their training in critical care and also for paramedical professionals such as nurses and physiotherapists. The second edition has been expanded from the first by including five new chapters on gas- trointestinal disorders, obstetric intensive care, endocrine emergencies, transporting the critically ill and disturbances of body temperature.

Overall, the book is well written and easy to follow. It cov- ers all the major areas in critical care focusing on the patho- physiology and treatment of common diagnoses. It also offers practical and pertinent comments on the physical organization and set up of critical care units as well as triaging and trans- porting critically ill patients. The references are reasonably up to date and the authors present a balanced view of controver- sial areas of care. For example, the topic of achieving supra- normal goals in treating patients with sepsis is given a concise but fair presentation, without any prejudice.

In an introductory text it is impossible to cover all areas completely. 1 found the section on ventilatory management to have a greater emphasis on SIMV as a ventilatory mode as opposed to pressure support ventilation which is certainly the predominant weaning mode of ventilation in our institution.

Nevertheless, this text does offer a complete, concise review of intensive care medicine and is an excellent introductory text.

Stephen Kowalski MD FRCPC Winnipeg, Manitoba

lntraoperative Neuroprotection R.J. Andrews (Ed.). Williams & Wilkins, 1996. 535 pages. ISBN: 0-683-00228-7.

Although I admit that I was initially "put off" by the title, (I feel that "neuroprotection" is a very elusive and frequently overrated concept), my fears were quickly dispelled by Dr. Andrews' definition of intraoperative neuroprotection as: "the avoidance of a neurological deficit or other complication which is the result of a decision or action of the operating room team." Within this context, the textbook is divided into four sections which are devoted to the nature and mechanisms

of intraoperative nervous system injury, anaesthetic and non- anaesthetic means of neuroprotection, intraoperative monitor- ing of the nervous system, and surgical techniques. Although the first two sections will be of the greatest direct application for anaesthetists, the remaining sections provide an extremely useful introduction to novel techniques (e.g., image-guided intraoperative cranial localization). Some of the chapters clear- ly reflect the authors" bias and practice without acknowledging that considerable controversy surrounds the utility of certain techniques (e.g., the efficacy of establishing burst suppression with anaesthetic agents). However, taken as a whole, the pre- sentation is balanced. This is a clear, concise, well illustrated summary of current developments and directions in neuro- surgery and neuroanaesthesia which I found enjoyable and easy to read. It should find a welcome place in the libraries of anaesthetists treating patients with neurological disease.

David P. Archer MD FRCPC

Calgary, Alberta