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Resident, Department of Anesthesiology, Douglas B. Coursin, MD, Professor, Departments of Anesthesiology and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI dcoursin{at}wisc.edu
Anesthesia and Uncommon Diseases, 5th ed.
Fleisher LA, ed. Philadelphia: Elsevier-Saunders, 2005. ISBN 1-4160-2212-0. 672 pp, 145 illustrations, $125.00.
This review takes a slightly different approach by providing a bispectral commentary on this classic text, now under new editorship, and provides the perspective of a clean-shaven anesthesiologist in-training with the insights of a gray-bearded, senior practitioner. Lee Fleisher, the Robert D. Dripps Professor and Chair at the University of Pennsylvania, takes over the editorial reins from Dr. Jonathan Benumof, Professor, at the University of California, San Diego. Indeed, the mantle of editorial guidance has been safely transferred. Going from front cover to back, the book weighs in at 3 pounds, 12 ounces (1.7 kg) and measures 11.25 x 8.75 x 1.3 inches (29 x 22 x 3.3 cm), therefore not classifiable as a pocket reference. The print is large enough for the senior reviewer to read and both commentators appreciate the content outline at the beginning of each chapter and the host of illustrations. The book is logically formatted, well indexed, and enhanced by an expanded version.
Dr. Fleisher has drawn on the expert opinion of 45 authors from 21 centers to provide 21 chapters of guidance. There are 12 system-based chapters complemented by specialized coverage of obesity (clearly not an uncommon disease today), nutritional abnormalities, impact of herbal therapies, and a new chapter on mitochondrial pathologies. Additional chapters focus on the special needs of the parturient, child, and the elderly, as well as trauma and burn patients and those with infectious diseases or bioterrorist exposure. The systems-based chapters for the most part start with useful background information on classification and diagnosis followed by specific anesthetic guidance and perioperative priorities. Interestingly, there is often far more background for specific pathology than there is unique anesthetic management direction. The text is fairly consistently edited, which facilitates reading it from cover-to-cover, an approach not likely to be pursued routinely, however. Chapters are exhaustively referenced, ranging in number from 44–434 references, with an average of 160 and a mean of 239 references per chapter, a bit surprising for such a modest-sized text.
The newly included chapter on "The Pediatric Patient" does a solid job (the discussion on craniofacial anesthesia is outstanding) of covering a very broad field that previously received its own textbook on uncommon diseases (1). The chapter on "Uncommon Cardiac Disease" is particularly outstanding. Discussion of ischemic heart disease is limited only to less common presentations such as coronary vasospasm, vasculidities, and dissection. Lists of inflammatory and noninflammatory cardiomyopathies are exhaustive. So too are discussions of valvular and endocardial vegetations and tumors. Finally, the immunosuppressed and de-innervated heart in patients with AIDS or after cardiac transplant are each presented with pertinent anesthetic implications.
The 5th edition provides state-of-the-art care of common diseases like diabetes within the confines of less common aspects of the disorder. In the chapter on "Diseases of the Endocrine Patient," there is a fine discussion of rather routinely encountered patients with abnormalities of the parathyroids, thyroid, pituitary, adrenal, and pancreatic glands, although we were struck by the absence of discussion of carcinoid syndrome here or elsewhere in the text. Although diabetes is overwhelmingly the most common endocrinopathy, the authors include a noteworthy discussion on perioperative care of diabetic patients who all too frequently have secondary compromise of multiple organs. They also include timely comments on the rationale for glucose control, reasonable perioperative glycemic control goals, and techniques to achieve these end-points.
Because this text provides expert opinion on a wide variety of topics, one is bound to find advice with which one disagrees. The endocrine chapter provides guidelines for steroid supplementation that are more liberal than we routinely pursue. We do not regularly provide stress doses to perioperative patients who receive daily doses of inhaled corticosteroids. We also have concerns as do others about the often underrecognized perioperative entity referred to as "relative" adrenal insufficiency (2–4).
It was interesting to note that the chapter on "Pregnancy and Complications of Pregnancy" did not include comment on the uncommon entity of acute fatty liver of pregnancy reported to occur in 1:15,000 pregnancies. However, this is discussed in the comprehensive chapter on "Liver Disease." The text also does not index hemolytic uremic syndrome in either the "Hematology" or "Pregnancy and Complications of Pregnancy" chapters. The closely related entity, thrombotic thrombocytopenic purpura, however, is discussed in both.
We suggest a few changes in future editions, including a CD to accompany the book so that one could carry it around more easily. In addition, an online update on topics such as infectious diseases and bioterrorism would be helpful, especially with emerging diseases such as severe acute respiratory syndrome (SARS) and avian flu.
The textbook, formerly known as Katz and Kadis, Katz, Benumof, and Kadis, and then Benumof, has now evolved into a broader reference that includes an overview of pediatrics, nutritional, and mitochondrial pathologies. It is concise, easy to navigate, and exhaustively referenced. The book covers some fairly common pathologies, which may be beneficial depending on the reader's access to additional resources. The inclusion of a CD-Rom/PDA compressible version of the text in future additions will promote the book's accessibility. In closing, we have added Fleisher's Anesthesia and Uncommon Diseases to our libraries and recommend it to others as well.
References
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