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Fundamental Principles and Clinical Practice of Anaesthesia

Shangraw, Robert E., MD, PhD; Adams, John P., MB, CHB, MRCP, FRCA

doi: 10.1097/00000539-200212000-00090

Professor of Anesthesiology

Visiting Assistant Professor of Anesthesiology

Oregon Health & Science University

Department of Anesthesiology, UHS-2

Portland, OR

Fundamental Principles and Clinical Practice of Anaesthesia P. Hutton, G.M. Cooper, F.M. James III, J.F. Butterworth IV, eds.

London, United Kingdom: Martin Dunitz, 2002. ISBN 1-899066- 57-8. 1072 pp., $135.00.

This new anesthesia textbook is edited by four prominent academic anesthesiologists, two each from the United Kingdom and the United States, and is targeted at individuals in the first 2 years of anesthesia training. The book is bigger and more comprehensive than the typical introductory textbooks used in medical school, yet more concise than the definitive textbooks used in the United States as either reference material or preparation for the board examinations for the American Board of Anesthesiology. Including the four editors, each of whom contributed extensively to the book, there are 53 contributing authors. Many, but not all, chapter authors hail from the home institutions of the editors, the University of Birmingham in the United Kingdom and Wake Forest University in the United States.

The book is divided into 87 chapters, each of which is subdivided in the table of contents into succinct topics occupying a page or less, which facilitates quickly finding an area of interest. Chapters are copiously illustrated with tables, graphs, and/or photographs to supplement the text. Appended at the end of each chapter there is a deliberately brief list of further reading material for more in-depth review. The chapters, in turn, are organized into four sections: Basic Anesthesia Practice, which covers principles of general anesthesia, airway management, and regional anesthesia; Integrated Basic Science, which presents the fundamental biological principles underlying the specialty; The Presenting Patient, which highlights anesthetic implications of comorbidity; and Special Subjects, which discusses essential procedures performed by the practicing anesthesiologist, considerations outside of the operating room, and assorted other topics. The complete index at the end of the book complements the excellent table of contents to allow fast referral to a subject matter of interest.

The first section seamlessly overviews fundamental aspects of anesthesia care from the preoperative visit, anesthesia equipment and monitoring, considerations in airway management, patient positioning, and basic issues associated with the induction, maintenance, and emergence from general anesthesia. The chapters on anesthesia equipment, which include color photographs, are especially good. Regional anesthesia, while by no means handled exhaustively, is reasonably complete in the common techniques of neuraxial anesthesia, brachial plexus blockade, and Bier block. A limitation is that local anesthetics widely used in the United States (e.g. mepivicaine and chorprocaine) are not mentioned, probably because their use in the United Kingdom is limited or nonexistent. Another limitation is that tables listing local anes-thetic alternativesand doses for spinal and epidural anesthesia, which would be important for the junior trainee, are missing. The chapter on surgical requirements for anesthesia was adequate for simple procedures but did not address issues associated with craniotomy, thoracotomy with or without one-lung ventilation, or cardiopulmonary bypass.

The section on basic science, in particular, is new and attractive because of its strong and relatively in-depth presentation. It is by far the largest section, accounting for 482 pages divided among 23 chapters. In this way it differs most from the approach of U.S. elementary textbooks that integrate the basic science into the practice of anesthesiology. It is not clear why the chapters on “Properties of the Endothelium,” “G Proteins,” “Cellular Aging,” and “Nitric Oxide” are separated from the rest of the basic science topics and placed in the last section. However, it is easy to track down these subjects using either the table of contents or the index at the end of the book. The material is clearly presented and will be understandable for all anesthesia trainees.

Organization of the third section centers on the pathology that a patient brings to the operating room. A chapter each is dedicated to considerations for pediatric patients, elderly patients, and patients with pregnancy, obesity, abnormal EKG, coronary artery disease, valvular heart disease, anemia, pulmonary disease, diabetes mellitus, other endocrine dysfunctions, jaundice, arthritis, renal dysfunction, infection, neurological disease, and acute abdomen. This type of mental organization is especially helpful in assessing patients and the type of risks associated with their comorbidities, regardless of the planned surgery.

Difficulties encountered with the book are the transatlantic vocabulary and the lack of chapters dealing with more complex surgical operations. Examples of the former are words such as “suxamethonium” versus “succinylcholine,” “lignocaine” versus “lidocaine,” “trolley” versus “gurney,” and “fridge” versus “refrigerator.” U.S. trainees without an interface with a British-experienced anesthesiologist may have trouble deciphering these terms. While it is understandable that comprehensive anesthesia considerations for a given surgical procedure are not among the topics presented, it is common for U.S. trainees to encounter more complex cases such as a craniotomy, thoracotomy, or cardiopulmonary bypass by the time of their second year of training. Therefore, it would be necessary for U.S. anesthesia residents to consult another textbook to attain adequate insight for the conduct of anesthesia during these procedures. There was no mention of the special concerns of providing anesthesia care in the MRI suite, which is an environment to which trainees will be exposed and would have been valuable in the last section.

On the other hand, the emphasis and organization of the book is ideal for anesthesia trainees in the United Kingdom, for whom a 2-year training period culminates in a basic science-laden Primary FRCA examination. This hurdle must be overcome before one can graduate to more complex anesthesia training. Clearly the Primary FRCA syllabus was in mind when the book was planned, as it comprehensively covers the syllabus and would need only minor supplementation from other texts. There is no doubt that this book will prove to be immensely useful and popular with new U.K. anesthesia trainees.

In summary, this is an excellent new book that we wholeheartedly recommend for U.K. trainees working toward the Primary FRCA examination. It would serve as an enjoyable and useful addition for their U.S. counterparts, but will not supplant more established texts. It should certainly have a place in every departmental library.

© 2002 International Anesthesia Research Society