Clinical Anesthesia Practice, Robert R. Kirby and Nikolaus Gravenstein, eds. Philadelphia: WB Saunders, 1994, ISBN 0-7216-33285-5, 1458 pp, $85.00.
The tables of contents of most anesthesiology textbooks are frequently interchangeable, and the information provided within each chapter is similar. The differences tend to be primarily in the clarity of presentation by the authors of individual chapters. But Clinical Anesthesia Practice dares to be different and succeeds. The emphasis is purely clinical. Each chapter is written from the point of view of an attending anesthesiologist who expects that a resident in anesthesia, having been assigned a particular case or task tomorrow, will read tonight in very focused preparation. Within each of the 80 chapters, headings pose commonly asked questions. Detailed explanations of the particular topics then follow.
The first section addresses general concerns with interesting discussions of quality assurance, medicolegal issues, risk stratification, and the anesthetic record. The chapter addressing preanesthetic evaluation provides an excellent overview of issues regarding coexisting diseases, nonanesthetic and anesthetic preoperative medications, and preoperative laboratory and diagnostic tests. The often short-changed area of postanesthesia recovery is not slighted. A multitude of postoperative problems are discussed. The next eight chapters discuss disease states and pain management. Thorough discussions of preoperative work-up, intraoperative management, and postoperative care are provided in the areas of cardiology, pulmonary medicine, endocrinology, nephrology, and neurology. An excellent chapter on radiology presents normal and abnormal radiographic anatomy pertinent to anesthesiology. The chapters on pain management are brief but concise with excellent charts and tables.
Ten chapters are devoted to anesthesia equipment and monitoring. The authors stress the importance of these monitors not as substitutes for but as supplements and aids to vigilance and physical diagnosis. Sections on transesophageal echocardiography and laryngeal mask airway provide more recent and practical information than do many standard textbooks.
The three chapters on anatomy discuss the airway, autonomic nervous system, and spine and are well illustrated with diagrams, graphs, and radiographs. The section on procedures focuses on positioning, regional anesthesia, and vascular access. Techniques to improve the success rate for regional anesthesia are emphasized.
The pharmacology section focuses on comparisons and choices of drugs rather than basic pharmacology. Practice, not theory, is emphasized here as throughout the text. The chapters on inhaled drugs and local anesthetics are particularly good, with discussions of everyday issues not usually addressed in standard texts. A separate chapter on neuromuscular blocking drugs is not included, although these drugs and the monitoring of neuromuscular blockade are discussed in context with other topics.
A large part of the book is devoted to management of physiologic aberrations and disease states. Again, the focus is on approaches to common problems and scenarios. These sections are very readable and well illustrated. The chapter entitled "The Neonate" is especially complete, with excellent discussions of development, normal physiology, and disease states common to the neonate. Chapters covering cardiac and liver transplantation, laser surgery, and extracorporeal shock wave lithotripsy are also discussed.
The strengths of Clinical Anesthesia Practice may also be its weaknesses. The philosophy of the expert authors and editors is accepted in preference to extensive referencing. Application over theory is emphasized, and the book does not always have enough discussions of basic concepts. Repetition and length (1400 pages) are accepted as a means of avoiding frequent interruptions with excursions to the index to look up information in different chapters. However, these tradeoffs are worthwhile. The readable and pragmatic approach make Clinical Anesthesia Practice a "must have" for bedside tables of residents, new practitioners, and those preparing for oral board examinations.
Patricia Roland, MD
Department of Anesthesiology, Medical University of South Carolina, Charleston, SC 29425-2207