Anesthesia & Analgesia:
Book And Multimedia Reviews: Media Review
Showan, Ann M. MD
Assistant Professor of Anesthesia
University of Pennsylvania
Day Care Anaesthesia Ian Smith, Editor. London: BMJ Books, 2000. ISBN: 0-7279-1422-7. 263 pp. $42.00.
Day Care Anesthesia testifies to the fact that the ambulatory anesthesia revolution, which began in the United States, has now become a global practice. A volume in the series Fundamentals of Anesthesia and Acute Medicine, this compact yet comprehensive book utilizes the expertise of clinicians from the United Kingdom, Scandinavia, and Australia to provide a thorough review of and discuss challenges in ambulatory anesthesia. This field was initially shaped by economic and political factors encouraging the development of ambulatory techniques. Now our specialty is beginning to benefit from the subtle effects of culture, specific population needs, and exchange of international perspectives in ambulatory anesthesia.
This volume will assist those practitioners interested in organizing a day surgery center and offer fresh perspectives on techniques and pharmacology for seasoned anesthesiologists. The volume is well organized and interesting to read. For example, the cogent discussions of the nuances of the VIMA (volatile induction and maintenance of anesthesia) technique and TCI (target-controlled infusions) serve to review the physiology and pharmacology while introducing practical tips for success from the authors. By comparing advantages and pointing out drawbacks, they encourage refinement of clinical practice and offer well-selected references to the literature to support their clinical conclusions.
Recent advances in this field are highlighted and include presentations on the use of newer drugs including remifentanil and broad topics such as the renewed interest in regional anesthesia for outpatients. The book’s scope is realistic; in-depth pharmacological discussions are limited and the anatomic details in the sketches for regional blocks are quite basic, for example. In another situation, simple drawings effectively describe common systems for monitoring end-tidal CO2 in the chapter on sedation. Appropriate references for supplemental information are provided at the end of each chapter. Though occasionally duplicative, discussions about alternatives and elements that contribute to the success of procedures build credibility for the authors throughout the book. It is clear that their writing comes from both strong scientific foundations and years of management and clinical experience. Among the strengths of the book is respect for the value of time. Multimodal approaches to pain and nausea control and suggestions such as designing an induction room for establishing solid anesthetic blocks reflect the author’s experience with direct patient care. The clinician will find that other strengths of this volume include the excellent chapter on patient assessment and preparation, patient education strategy throughout, and the numerous checklists that can serve as a guidelines to modify his or her own style.
There is a reminder of our responsibility to patients in the title of this book—“Day Care”—care before, during, and after the anesthesia. Our calling is to care for patients, not just to perform the anesthesia. In the midst of the explosion of ambulatory and now office anesthesia, this book wisely reminds us that to improve quality we must observe our outcomes and be prepared to adapt our thinking and practice.