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Anesthesiology:
Review of Educational Material

Clinical Anaesthesiology: Obstetric Anaesthesia. Volume 9, Number 4

Cerda, Sergio E. MD

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James C. Eisenach, M.D., Editor
Clinical Anaesthesiology: Obstetric Anaesthesia. Volume 9, Number 4. Guest edited by D.G. Bogod, M.B.B.S., F.R.C.A. Bailliere Tindall, W.B. Saunders, London, 1995. Pages: 169. Price: $30.00.
In this volume of Clinical Anaesthesiology, 14 authors from Europe, Australia, and the United States contributed reviews of common topics related to the practice of obstetric anesthesia.
The book is divided into ten chapters. The first describes the principles of modern management of labor. Emphasis is placed on a thorough review of recent changes in active management of labor. An interesting analysis of the long-term effects of epidural anesthesia is performed by Drs. Robin Russel and Felicity Reynolds. The recent association between long-term backache and epidurals and its wide dissemination in the lay press leading to patient reluctance to accept epidural anesthesia are excellently covered. Their discussion emphasizes the multifactorial origin of this problem.
General and regional anesthesia for cesarean section delivery are discussed in two chapters. In the first, Dr. Schneider addresses practical considerations for the management of the difficult airway and failed intubation, and his suggested protocol is clearly presented. The chapters on effects on neonate of highly lipid soluble opioids and new techniques and drugs for labor pain relief are current. In his chapter, Dr. Helbo Hanssen makes a comprehensive summary of the effects on the neonate and placental transfer of neuraxial maternally administered fentanyl analogues.
High-risk pregnancy, whether due to obesity or cardiovascular or neurologic disease, are well presented by Dr. Brighouse. She provides an excellent overview of the impact of pregnancy on preexisting disease and the anesthetic considerations for these patients. The final two chapters focus on practice organization and negligence in obstetric anesthesia. Drs. Crowhurst and Simmons provide the reader with information and approaches to the organizational aspects of an obstetric anesthesia service. They stress the challenge of providing continuous quality improvement in their Australian institutions. The issue of negligence is discussed in the context of English law, but many of the determinants of liability in anesthetic errors in the performance of obstetric anesthesia are universal.
The writing style throughout the chapters is concise and easily comprehended. Although 70% of the authors are from the United Kingdom or Australia, there is a balance and breadth of coverage of most topics that should make this reference useful to an American audience.
There are two major drawbacks to this text. One is the absence of a more detailed review of combined spinal epidural techniques and "walking labor analgesia." This is somewhat surprising, because both techniques were developed and popularized in England. The other is the lack of mention of the effect of epidural analgesia on progress of labor and the incidence of operative delivery. This is one of the key controversies in modern obstetric anesthesia, and it clearly deserved coverage in this periodical.
The book is intended to serve as a review, and does not replace more comprehensive obstetric anesthesia texts. This reviewer believes this is a good alternative for the anesthesiologist involved in the practice of this specialty, and, given the modest price, I am sure it will find its place in many personal libraries.
Sergio E. Cerda, M.D.; Assistant Professor of Anesthesia, University of Chile, Santiago, Chile.

© 1996 American Society of Anesthesiologists, Inc.

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