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The Vasopressinergic System: Physiology and Implications for the Treatment of Shock. Vol. 22, No. 2 in Best Practice and Research Clinical Anesthesiology

Nunnally, Mark E. MD

doi: 10.1213/ANE.0b013e318197f592
Book and Multimedia Reviews: Media Reviews

Assistant Professor; Department of Anesthesia and Critical Care; University of Chicago; Chicago, IL;

The Vasopressinergic System: Physiology and Implications for the Treatment of Shock. Vol. 22, No. 2 in Best Practice and Research Clinical Anesthesiology Westphal M, Ertmer C, eds. Philadelphia, PA: Elsevier Ltd., 2008. ISSN 1521–6896. 164 pages, $198.00 subscription for four issues or $71.00 for a single issue.

Vasopressin is a valuable adjunct to the field of anesthesiology. This drug and its analogues are appealing because of low cost and utility in a variety of hypotensive situations. Although vasopressin and its analogs effectively raise blood pressure, they also have the ability to exacerbate ischemia. The risk to benefit ratio for vasopressin remains poorly defined in anesthesiology and critical care. This is in part because of a lack of clinical outcomes data to assess vasopressin’s clinical usefulness and also because consensus development is in an early phase. The Vasopressinergic System: Physiology and Implications for the Treatment of Shock is a well organized and encyclopedic synthesis of research and source of expert insight. It will be valuable to those seeking a deeper understanding of how and when vasopressin might work, under what circumstances it is most useful, and what is known about its risks and benefits.

The publication is volume 22, number 2 of the series Best Practice and Research: Clinical Anesthesiology, a series dedicated to compiling and synthesizing data supporting topics of clinical interest. The editors of this edition focus comprehensively on vasopressin and its analogues. Chapters are devoted to cardiovascular and endocrine physiology, pharmacology, and the potential to improve clinical outcomes in a variety of shock settings, including sepsis, hemorrhage, epidural neuraxial blockade, and cardiopulmonary resuscitation. Other chapters suggest the growing roles of vasopressinergic drugs in decreasing renal failure and improving survival. Pitfalls and therapeutic hazards are also considered. Each chapter addresses a specific topic, summarizing scientific data and presenting questions for future research.

Every chapter is a complete review article, including an abstract that can be read individually. The individual reviews contribute to a complementary whole. One can immediately access the bulk of available data (in some cases surprisingly sparse) and theory regarding the use of vasopressinergic analogues in various clinical circumstances. The entire book is a fairly comprehensive synopsis. The chapter bibliographies cover the relevant data well. Chapters are well researched and the authors demonstrate good insight and understanding of the field. Rather than just list or summarize available information, most authors explain what the information means to both an expert researcher and a clinician. The insightful reviews also help orient nonexpert readers and provide the appropriate context for the research questions found at the end of each chapter.

The book itself is thin and light. Its 164 pages are printed on a light paper, making it weigh a mere 6.4 ounces. For a text this rigorous, portability makes it ideal professional reading for travel or work downtime and a ready clinical consult.

There are some shortcomings. Grammatical and spelling errors detract from the professional quality of most of the writing. Chapters succeed variably in balancing data synthesis and speculation. Some items are repeated too much (do the introduction and the first two chapters have to start with the original description of vasopressin by Oliver and Schäfer in 1895?). Tables and figures are used with uneven effectiveness. These are minor criticisms when considering the breadth and depth of information assembled in such a concise source.

As a clinician who uses vasopressin frequently and one with an interest in the subject, I found this work valuable. Although it is concise, it is targeted at a reader looking for an in-depth discussion of vasopressin pharmacology. The text is worthwhile reading for anyone wanting to understand the expanding role of vasopressinergic drugs. Synthesizing the insights presented in the various chapters, one could argue that the future for these drugs looks bright.

Mark E. Nunnally, MD

Assistant Professor

Department of Anesthesia and Critical Care

University of Chicago

Chicago, IL

© 2009 International Anesthesia Research Society