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Anesthesia for the Cardiac Patient

Fleisher, Lee A., MD

doi: 10.1097/00000539-200211000-00090

Professor and Chairman

The Johns Hopkins University School of Medicine

Department of Anesthesiology

The Johns Hopkins University

Baltimore, MD

Anesthesia for the Cardiac Patient C.A. Troianos. New York, New York: Mosby, 2002. ISBN 0-3230-0874-7. 657 pp., $99.00

Christopher Troianos and his contributors have created a well-illustrated and referenced book on anesthesia for the heart patient. As he outlines in the preface, the purpose of this new book is “to advance the care and anesthetic management of patients with cardiac disease regardless of whether they are undergoing cardiac or noncardiac surgery.” To facilitate that, they have divided the book into four sections. The first addresses perioperative care of the cardiac patient, including preoperative evaluation, cardiovascular medications, intraoperative monitoring, postoperative care, and pain management. The second section of the book provides information on the anesthetic management of the cardiac disease processes, including coronary artery disease, valvular heart disease, electrophysiologic problems, congenital heart lesions, and less common cardiac problems. The third section addresses topics specifically applicable to cardiac surgery. The fourth section addresses the issues in anesthetic management of a patient with cardiac disease specifically undergoing noncardiac surgery.

The tone of the book is educational with an emphasis on practical management rather than exhaustive details regarding basic science. Despite this, it includes a wealth of references. For example, much of the text can have immediate practical applications. The section on transesophageal echocardiography has an extensive discussion of the basic principles and physics of echocardiography, which most novices in this area would find extremely helpful. In part, this relates to the fact that numerous tables and boxes, which highlight the material, accompany the text itself and emphasize key points. All of these are in similar, readable format, making it easy to quickly identify important information. This is further enhanced by a section on key points and key references in addition to the exhaustive reference list at the end of most chapters. Altogether, this book provides excellent reading for the resident or practitioner who wants to expand his or her knowledge base. The sections on monitoring are further enhanced by illustrations demonstrating various techniques. These illustrations could aid even the most experienced practitioner by including anatomic details and relationships that are critical in the anesthesiologists’ daily practice. The section on echocardiography has both basic physics illustrations as well as excellent figures demonstrating different lesions and abnormalities. There is even a color insert highlighting color Doppler findings. The one minor issue is that the black and white illustrations reside within the text while the color illustrations of the same figures are grouped later, which may initially cause some confusion before the reader recognizes the formatting.

Despite the wide range of authors, the editor has done a nice job in trying to mesh styles and materials. There is some degree of overlap between the Preoperative Evaluation chapter and later chapters on coronary disease, but this is kept to a minimum. One weakness is that despite the attempt to include more unusual topics in the text such as Pain Management, Neurosurgery, and Ambulatory Surgery, these chapters do not have the same depth and focus on the cardiovascular issues as the other chapters in this book.

The question remains who can best utilize this book. Clearly, it is a wonderful resource for residents and fellows training in patients with cardiovascular disease because of its strong educational bent and structure. The experienced practitioner may also find it useful. For those practitioners who specialize in cardiovascular surgery, this book may not provide sufficient details for the more complex patient. Despite a relatively recent publication date, there is still a paucity of information on OPCABs. In summary, this book is an excellent addition to the libraries of individuals who have sufficient funding to buy a textbook devoted solely to anesthesia for the cardiac patient and who wish to learn some of the techniques in a highly readable format.

© 2002 International Anesthesia Research Society