BOOK AND MULTIMEDIA REVIEWS: Media Review
Thoracic Anesthesia; Volume 19, Number 3 of Anesthesiology Clinics of North America Slinger PD, ed. Philadelphia: WB Saunders, 2001. ISSN: 0889-8537. 222 pages; $145 annual subscription (four issues).
The Clinics of North America series, whether the bimonthly Medical or Surgical Clinics or the quarterly Anesthesia version, feature monographs which represent compact compendia of information and references on a unified topic. This issue on “Thoracic Anesthesia” certainly fulfills that purpose. Although much of the material presented is evidence-based, it is intertwined with the authors’ clinical experience and opinion. The signature presentation is without a doubt that of the guest editor, Dr. Slinger, and his colleague Dr. Johnston. This treatment of preoperative assessment is a superb blend of science and practical clinical “pearls.” It is also interesting to note that its content, including title, is virtually identical to their review article published last April in Journal of Cardiothoracic and Vascular Anesthesia (2000;14:202–11).
In contrast, the final presentation in the issue provides the enticing title of “Post-Thoracotomy Analgesia.” Unfortunately, the author, Dr. Conacher, presents a somewhat arcane philosophical discussion that provides little in the way of a “take-home message” and suffers in comparison with a decade-old review by the same author (Br J Anaesth 1990;65:806–12).
Invited reviews, such as in the Clinics format, do not generally receive the same degree of editorial scrutiny and peer review characteristic of scientific journals. This often allows erroneous statements to slip by, as exemplified by two in the otherwise excellent presentation by Dr. Szededi on “One Lung Ventilation.” The author, for example, states that in the atelectatic lung the increased pulmonary vascular resistance is almost entirely a result of hypoxic pulmonary vasoconstriction. This ignores the role of passive collapse of extra-alveolar vessels associated with the reduced lung volume. He also refers to the “intrinsic PEEP-induced increases in lung volume.” Physiologists and clinicians have determined that the PEEP is the result rather than the cause of the increased lung volume, i.e., the “dynamic hyperinflation.” The intrinsic PEEP (i.e., the airway pressure above zero) reflects the elastic recoil of the respiratory system at the elevated lung volume and not a pressure acting to distend the lung.
When cost is considered, the overall clinical value of the information presented in this issue tends to justify the $145 annual price tag. This, of course, assumes that the other three issues measure up to the same quality.
Thomas J. Gal, MD
Department of Anesthesiology
University of Virginia Health System