Anesth Analg 2007;104:1006-1007
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000260344.36322.F8
BOOK AND MULTIMEDIA REVIEWS
Section Editor:
Norig Ellison
Common Medical Problems and Anesthesia. In Anesthesiology Clinics, vol. 24, no. 3 (September 2006).
Vinayak C. Belamkar, MD, and
Francis X. Dillon, MD
Resident, Department of Anesthesia; Departments of Anesthesia and Medicine; Indiana University School of Medicine; Indianapolis, IN; fdillon{at}iupui.edu (Belamkar)
Assistant Professor of Clinical Anesthesia and Medicine; Departments of Anesthesia and Medicine; Indiana University School of Medicine; Indianapolis, IN; fdillon{at}iupui.edu (Dillon)
Common Medical Problems and Anesthesia. In Anesthesiology Clinics, vol. 24, no. 3 (September 2006).
Rosenbaum SH, ed. Philadelphia: W. B. Saunders Co. (a division of Elsevier Inc.). ISSN 0889-8537; ISBN 1-4160-3788-8. $180.00 (annual subscription for four issues), $84.00 (single issue).
The title, Common Medical Problems and Anesthesia, suggests a very broad scope for a book this size (250 pages). The guest editor acknowledges this and also states his goal to avoid choosing some of the more common cardiopulmonary topics. The selection is thus necessarily limited, but ultimately well balanced, and the reviews are generally very well done. A common criticism of quarterly issues such as this applies here: readers expect to be quickly and thoroughly informed about what to do and what not to do for patient with comorbidity X or during procedure Y, but not necessarily want to be comprehensively reacquainted with the underlying physiology and pharmacology.
The unusual topic of "Modeling Perioperative Risk: Can Numbers Speak Louder Than Words?" is the first article. The authors survey several classification schemes for patients before introducing their own: a complicated, proprietary, multidimensional code derived from ASA status, airway parameters, coexisting diseases and their severity, and surgical risk. Drawbacks of such systems are their cumbersome nature (clinicians may not bother using them), and lack of correlation with risks or outcomes (they may not convey any useful information). Certainly, such schemes should be explored in scholarly articles related to outcomes research. However, their appearance here, in a volume purported to be reviews of common medical problems, is unexpected and incongruous with the remainder of the volume.
The cardiac issues represented in this "Clinic" are ischemic heart disease (IHD), valvular heart disease, and atrial fibrillation (AF). The authors present generally excellent reviews of recent developments in the care of IHD and AF with well-organized, practical recommendations for patient care. However, the atrial fibrillation chapter is not very user-friendly to the anesthesiologist whose patient acutely goes into AF, or whose patient presents for elective cardioversion. Questions unanswered are: Is intraoperative cardioversion obsolete? Are there adjuvant drugs, e.g., ibutilide, which might make cardioversion more effective? Which agents might alone produce pharmacologic cardioversion (e.g., procainamide, quinidine)?
The chapter on renal disease has enough detail to satisfy even the intensivists among us. But a general anesthesiologist may find the information too detailed for routine perioperative care. The chapter on diabetes, describing current diagnostic criteria and chronic management issues very well, points out nicely the emerging emphasis on tighter control of hyperglycemia and its effect on outcome. Coagulation defects are reviewed in great detail but the organization of this large topic could be improved, especially in the discussion of therapy of bleeding and thrombophilia.
The morbid obesity review is timely, as average patient weight steadily drifts upward. The authors challenge the "full stomach" dogma and make a good evidence-based argument for its abandonment. Practical pearls for patient positioning, preoxygenating strategies, and postoperative pain control appear very useful. Use of an intubating LMA early for difficult airway management may be the best take-home message in this chapter.
The inclusion of a chapter on advanced maternal age and pregnancy was surprising because it is not in the set of what would be considered common medical problems. The chapter essentially reviews the anesthetic management of high risk pregnancy, labor and delivery, and provides a good overview of these topics. The chapter "Diseases of Aging that Emerge from the Metabolic Syndrome" is a unique take on the prototypical middle-aged patient with incipient or mild-to-moderate hypertension (eureka¡), hyperlipidemia, and diabetes. The syndrome is of course common and relevant to the scope of the volume and a whole "Clinic" needs to be dedicated to this vast, but important, topic, to do it full justice.
The chapter on toxins is generally well written and wisely focuses only on three drugs of abuse (cocaine, alcohol and opiates) and three chemical asphyxiants (carbon monoxide, methemoglobinemia, and cyanides). The discussion includes both pathophysiology and treatment rationale that is very relevant to the anesthesiologist and makes the chapter very useful. There is however no mention of the anesthetic management of patients undergoing early withdrawal from common substances of abuse. Frequently, the care of such patients does not end following their acute intoxication, and withdrawal (e.g., from ethanol) is quick to appear and potentially more dangerous than acute intoxication.
Given the horizon-to-horizon scope of the title, the reader might easily suggest at least one topic that "ought to have been included," but we feel this is an unfair criticism given the guest editor's stated aims. Overall, he succeeded by judicious selection of topics and authors. We feel that this volume addresses sufficiently relevant topics and is a very good addition to the practitioner's library.
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