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BOOK AND MULTIMEDIA REVIEWS

Handbook of Neuroanesthesia, 4th ed.

Clinical Professor, Anesthesiology; Mount Sinai Medical Center; New York, NY; elzfrost{at}aol.com

Handbook of Neuroanesthesia, 4th ed.

Newfield P, Cottrell JE. Philadelphia: Lippincott Williams & Wilkins, 2006. ISBN 0-7817-6245-6. 466 pages, 49.95.

Small in volume, large in pages and information, and very easy on the wallet are the makings of a most attractive text. Add to that, the book is now in the 4th edition, an achievement earned by few authors, indicating general acceptance over an almost 20-year period. One might conclude that a review is unnecessary as the book will surely stand on its own.

But let’s take a closer look! Of the 47 contributors, all but one are anesthesiologists, albeit from widely different regions. The exception is the neurosurgeon who wrote the Foreword, in which he strongly recommends the book to neurointensivists, neurologists, and neurosurgeons. In the Preface, Drs Cottrell and Newfield note that the book is offered in a spirit of cooperation, consultation, and collaboration as a concise compendium for all specialties involved in neurologic care. Perhaps a little more author diversity would be appropriate in future editions.

Handbook of Neuroanesthesia is divided into three sections: General Considerations, Anesthetic Management, and Postanesthesia and Intensive Care. Historically, a review of physiology and metabolism has comprised the first chapter. The tradition has been maintained with some updating, although in this chapter as in most of the book, the reader is referred to larger textbooks. The information provided in chapter 2 on the effects of anesthetic agents on the central nervous system is repeated in section 2 and in several other chapters. Propofol, a widely used and generally safe agent in neuroanesthesia, is mentioned repeatedly. Missing is any notation of the fatal effects it may have when used for long-term sedation (over 100 deaths have been reported since 1989) (1). Neurophysiologic Monitoring is succinctly covered as is Cerebral Protection. Unfortunately, there still does not appear to be any magic bullet to save the brain, and the internist’s advice to avoid hypotension, hypoxia, and arrhythmias (to which are now added hyperglycemia and hypothermia) holds. Pain management has not been addressed well in the neurosurgical patient. The final chapter of section 1 deals as much with strategies for the chronic pain patient as with the neurosurgical patient. No mention is made of the use of scalp block techniques to blunt the stress response to surgery and the reader is not given guidance in preparing a postoperative plan for care of the narcotic dependent, elderly, perhaps obese patient who has undergone complex spinal instrumentation.

Section 2 begins with advice on the care of the head-injured patient, much of which is repeated in the chapter dealing with Traumatic Brain Injury. Induced hypothermia has been much studied and discussed. While there appears to be little evidence that lowering the temperature improves outcome, emphasis should focus on the avoidance of hyperthermia, which is detrimental. Intracranial aneurysm surgery is covered both in a separate chapter and in a chapter dealing with interventional radiology. Much of the information offered is recent, but this reviewer has not seen sodium nitroprusside used for over 20 years. Note is made of the important and long sought findings of the International Hypothermic Aneurysm Study Trial, but the reference is omitted (2). This reviewer was rather concerned about a categorical statement in the chapter on spinal cord injury: "... corticosteroids administered after acute SCI are currently considered the standard of care." Review of the literature over the past 10 years does not seem to agree, citing the failure to improve function combined with many adverse effects (3–5). Anesthetic management of interventional neuroradiology and diagnostic neuroradiology has been divided to two chapters and, given the repetition, I am uncertain what benefit is obtained. Neuroradiology is rather forbidding, far away and in the basement without all our customary support services. It would have been informative to read about vertebroplasty and kyphoplasty, both relatively new procedures that can really test an anesthesiologist. Perhaps they will be described in future editions.

Finally section 3 deals with postoperative problems. In 1999, the American Society of Anesthesiologists, concerned about blindness associated with spine surgery, established a Postoperative Visual Loss Registry. There have been frequent updates, indicating that not only is the complication far from rare (about 0.2%), but anesthesiologists would be advised to include blindness as a risk disclosure (6). No mention is made of the Registry or of the conclusions drawn over the years. Rather, the author states that ischemic optic neuropathy is associated with intraoperative hypotension and ischemia (true), regardless of position (untrue) (page 340). Recent focus on hyperglycemia has been intense. Analysis of large studies shows that the risk of death and stroke in patients with high perioperative blood glucose is more than doubled (7). Should the readers then believe then that "the correlation between ... [hyperglycemia and stroke] ... may be a concomitant of more severe CNS damage" and the administration of glucose to humans is not proven to be detrimental?

In his Foreword, Dr Onesti recommends Handbook of Neuroanesthesia as essential reading for all anesthesiology residents and fellows. The reviewer would agree as long as those physicians are regularly attending teaching rounds and can sift basic teaching from current literature and evidence-based medicine. I would not recommend this text for the career neuroanesthesiologist.

REFERENCES

1. Wysowski DK, Pollock ML. Reports of death with the use of propofol (Diprivan) for onprocedural (long term) sedation and literature review. Anesthesiology 2006;105:1047–51.[Web of Science][Medline]
2. Todd MM, Hindman BJ, Clarke WR, Tomer JC. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med 2005;352;135–45.[Abstract/Free Full Text]
3. Hulbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg (Spine 1) 2000;93:1–7.
4. Coleman WP, Benzel D, Cahill DW, Ducker T, Geisler F, Green B, et al. A critical appraisal of the reporting of the national acute spinal cord injury studies (I and II) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000;13:185–99.[Web of Science][Medline]
5. Sayer FT, Kronvall E. Methylprednisolone treatment in acute spinal cord injury: the myth challenged through a structured analysis of the published literature. Spine J 2006;6:335–43.[Medline]
6. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry. Anesthesiology 2006;105;652–9.[Web of Science][Medline]
7. McGirt MJ, Woodworth GF, Brooke BS, Coon AL, Jain S, Buck D, et al. Hyperglycemia independently increases the risk of perioperative stroke, myocardial infarction and death after carotid endarterectomy. Neurosurgery 2006;58;1066–73.[Web of Science][Medline]

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