Core Topics in Thoracic Anesthesia

Book details

Searl Cait P, Ahmed Sameena T:

Core Topics in Thoracic Anesthesia. Cambridge University Press; 2009, 230pp

ISBN 9780521867122

This book is aimed primarily at trainees gaining experience in thoracic anaesthesia. Admirably, the authors are also motivated by the desire to convey and pass on their own experience to those they teach. The content is divided into broad sections dealing with pre-operative considerations, anaesthesia for specific procedures and identified groups of patients (for example, by age, size and emergent/elective status), and post-operative management. Of the 30 chapters, 15 are solely or partly authored by the editors, which adds to continuity of style. The target audience probably dictates (and even mandates) a rather dictatorial and unevidenced approach. Thus, the contents of each chapter are supported by key references rather than an exhaustive bibliography. Your Reviewer does not practice thoracic anaesthesia but spends a good deal of his clinical practice reviewing patients with problems covered by the pre-operative and post-operative periods. The chapters on thoracic anatomy and respiratory physiology are brief, concise and generally well written. Appropriate emphasis is placed upon chronic respiratory diseases likely to impact upon peri-operative care, particularly pulmonary arterial hypertension, pulmonary fibrosis and occupational lung disease. Only occasionally do the authors spill over into the self-evident, such as when advising the reader to employ an anaesthetic technique unlikely to provoke bronchospasm in asthmatics.

Your Reviewer consulted colleagues who found the chapters on anaesthesia and the excellent illustrations contained therein of relevant equipment to be particularly robust. The use of decision trees and tables summarising the advantages and disadvantages of various techniques of anaesthesia and monitoring are a definite strength. Illustrations (such as those relating to video-assisted thoracoscopic surgery) were helpful but would have been enhanced by the (presumably expensive) use of colour. The division of the anaesthetic section into that dealing with oesophageal surgery, trauma, and pleural and chest wall procedures was helpful, as was the inclusion of a specific chapter on the (increasingly prevalent) morbidly obese patient.

The section dealing with the management of post-operative respiratory problems was generally well written, although some epidemiology of those conditions most likely to confront the unwary anaesthetist would have been welcome. Acute lung injury/acute respiratory distress syndrome is the commonest cause of death in the post-operative period in patients undergoing lung resection, but the section dealing with mechanical ventilation and non-ventilatory adjuncts is brief. By contrast, more than a full chapter is devoted to the use of extra corporeal membrane oxygenation and related technologies.

This book should appeal to the trainee spending 6 months or so in a cardiothoracic unit but not planning to specialise in this area of practice. In a new edition, the editors should pay some attention to the rather opaque style that dogs one or two chapters, but the fact that this Reviewer thinks that a second edition is likely gives some indication of its probable appeal.