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Anesthesiologist's Manual of Surgical Procedures, 4th ed.

Vlassich, Francesca, MD; Janjanin, Sanja, MD; White, Paul F., PhD, MD, FANZCA

doi: 10.1213/ANE.0b013e3182273c1e
Book, Multimedia, and Meeting Reviews: Media Reviews
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Department of Anesthesia Cedars Sinai Medical Center in Los Angeles, CA White Mountain Institute in Los Altos, CA Pail.white@cshs.org

The fourth edition of the Anesthesiologist's Manual of Surgical Procedures is a comprehensive textbook written jointly by anesthesiologists, surgeons, and anesthetists with considerable expertise in their field. The new edition of this unique textbook has been extensively updated and is now in full color. This book serves as a comprehensive guide to the anesthetic and perioperative management of patients undergoing a wide spectrum of operative procedures representing all surgical specialties. The book explains each procedure from both the surgeon's and the anesthesiologist's perspectives, skillfully guiding the practitioner through the decision-making processes involved in the perioperative care of surgical patients.

The basic format for the book is a brief description of each surgical procedure written by a surgeon followed by a detailed discussion of the anesthetic considerations from the anesthesiologist's perspective, including descriptions of the pre-, intra-, and postoperative aspects of the patient's anesthetic management. In addition to suggested monitoring procedures, positioning of the patient for surgery, common perioperative complications, and recommended modalities for postoperative pain management are described in detail. As pointed out by Richard Jaffe in the Preface, the 4th edition of this multidisciplinary textbook is intended to provide an easily accessible source of clinically relevant information about a wide variety of common and uncommon surgical procedures. The latest edition includes several new surgical procedures, with an increased focus on laparoscopic and endovascular procedures. The book lacks an international flavor because the majority of the contributors (including the editors and associate editors) are from Stanford University or were formerly associated with the institution. Another criticism relates to the recommendation of some outdated clinical practices (e.g., the use of meperidine [Demerol] for perioperative analgesia). In fact, meperidine is no longer used for postoperative analgesia in most parts of the world.

The textbook is organized into 15 chapters representing the surgical specialties of neurosurgery, ophthalmic surgery, otolaryngology, dental surgery, thoracic surgery, cardiovascular surgery, general surgery, obstetric/gynecologic surgery, urology, orthopedic surgery, plastic and reconstructive surgery, pediatric surgery, out-of-operating-room (OR) procedures, office-based anesthesia, and emergency procedures. Several of the chapters have subsections within which are listed the specific surgical procedures. For each of the listed procedures, a detailed description of the operation is provided, including variations on the approach depending on the preoperative diagnosis. A summary of the various procedures is provided in a tabular format, including patient positioning, type of surgical incision, expected surgical time and blood loss, typical postoperative care (e.g., postanesthesia care unit, surgical ward [or day surgery unit], intensive care unit), and the etiologies of major morbidities and mortality. Associated medical conditions are also presented in tabular format, with demographic and population characteristics (e.g., age, sex [gender] distribution), etiology of the typical preoperative diagnosis, and anesthetic considerations discussed under pre-, intra-, and postoperative concerns. Preoperative preparation of the patient, monitoring equipment, and the anesthesia care team activities are addressed as preoperative considerations. This section also discusses indications for preoperative testing based on the surgical procedure and individual patient characteristics. The intraoperative section provides a step-by-step guide to the anesthetic management during the procedure, including specific drug and dosage recommendations. Common complications are noted in the intra- and postoperative sections, including monitoring pain management strategies.

The chapter on neurosurgical procedures is subdivided into 4 sections: intracranial neurosurgery, functional surgery, spinal surgery, and carotid endarterectomy. In describing the management of the patient undergoing the clipping of a giant intracranial aneurysm under deep hypothermic circulatory arrest, the authors emphasize the importance of the anesthesiologist examining the cerebral angiogram and MRI scan preoperatively to visualize the size, site, and nature of the aneurysm/tumor. There is also an excellent, concise review of the evaluation of the head-injured patient. Of note, there was no mention of the role of bilateral maxillary nerve block in controlling the acute hemodynamic responses during transphenoidal resection of a pituitary tumor. Similarly, in the section on posterior lumbar/lumbosacral spine surgery, there is no mention of the role of locoregional anesthetic techniques.

In the chapter on ophthalmologic surgery procedures, the images and descriptions are very clearly described. However, there was no mention of local resection of a choroidal melanoma, which has major anesthetic implications (e.g., controlled hypotension). The chapter on otolaryngology (head and neck surgery) includes a very interesting section on facial plastic surgery (e.g., rhinoplasty, facelift, and blepharoplasty) and reconstructive surgery for sleep- disordered breathing conditions (including uvulopalatopharyngoplasty, uvulopalatal flap, lingualplasty, and mandibular osteotomy procedures). The chapter on dental surgery is succinct and provides the anesthesiologist with all the essential information for managing these cases.

The chapter on thoracic surgery is well written with each surgical procedure clearly described, making it easy for the reader to understand and anticipate the various difficulties that may be encountered during these procedures. The anesthetic techniques are fairly standard, but surprisingly, the use of paravertebral blocks as an alternative to epidural analgesia was not mentioned. The 4-part chapter on cardiovascular surgery for both adult and pediatric patients includes subsections on cardiac surgery, minimally invasive cardiac surgery, vascular surgery, and heart/lung transplantation. Coronary revascularization (including off-pump coronary revascularization), valve replacement surgery, thoracic aortic surgery, correction of various congenital heart defects, percutaneous endovascular procedures, carotid endarterectomy [also covered earlier in the neurosurgery chapter], and heart/lung transplantation are discussed in great detail. However, the section on vascular surgery does not review cardiac risk factors and the indications for preoperative stress testing. The section on pediatric heart surgery would benefit from a summary of the special considerations for pediatric cardiac anesthesia.

The chapter on general surgery is divided into 13 sections, namely esophageal surgery, stomach surgery, intestinal surgery, colorectal surgery, hepatic surgery, biliary tract surgery, laparoscopic general surgery, pancreatic surgery, peritoneal surgery, breast surgery, endocrine surgery, liver/kidney/pancreas transplantation, and trauma surgery. Although laparoscopic cholecystectomy is covered in detail, laparoscopic hernia repair and Nissen fundoplication were discussed very briefly. In the description of the anesthetic techniques, there is no mention of the use of transverses abdominis plane (TAP) block as an alternative to epidural analgesia, nor the use of ultrasound as an aid for performing invasive anesthetic procedures (e.g., complex regional blocks, central line placement).

The chapter covering gynecologic surgery is subdivided into 4 parts: specifically, gynecologic oncology, infertility, and obstetric surgery (with a special emphasis on laparoscopic procedures and robotic-assisted surgery). The anatomical descriptions of each surgical procedure (with line drawings both in color and black and white) is very instructive. The summary table describing the various toxicities associated with different chemotherapeutic agents, as well as the “in-depth” discussion of the physiologic changes associated with pregnancy, are extremely useful additions to the latest edition of this book.

The chapter describing urologic surgery procedures includes an in-depth discussion of the common endoscopic and open urology procedures, with particular attention to the preoperative anesthetic consideration. This is valuable information because many of the patients presenting for urologic surgery (in particular, prostate and bladder procedures) are elderly and have many preexisting medical illnesses. The section on special anesthetic consideration for robotic-assisted laparoscopic procedures was also extremely helpful because this generally elderly surgical population can present many challenges for the anesthesiologist.

The chapter on orthopedic surgery is subdivided into 6 sections describing hand, shoulder/arm, and spine surgery; hip, pelvis, and upper leg surgery; knee surgery; lower leg, ankle, foot and other lower-extremity surgery. Although these chapters are well written and very detailed, certain regional block techniques (e.g., sciatic 3-in-1 block) were not mentioned for lower-extremity amputation in diabetic patients with severe vascular insufficiency. These patients may be taking thrombolytic therapy before surgery, which can increase their risk of bleeding complications with epidural or spinal anesthesia. The commonly performed bunionectomy and ankle fusion procedures are not even mentioned.

The chapter dedicated to plastic and reconstructive surgery is subdivided into 6 sections: facial cosmetic surgery, nonfacial esthetic surgery (including anesthetic consideration for abdominoplasty in the morbidly obese), craniofacial surgery (for which each surgical procedure is described using narratives, tables, and excellent line drawings of the relevant anatomical considerations), and burn surgery. In the latter chapter, the description of the intraoperative management is very useful, as well as are the 2 diagrams showing the probability of survival for patients with and without inhalation injury and within different aged patient populations.

The chapter on pediatric surgery encompasses a wide variety of surgical procedures from neurosurgery, ophthalmic surgery, otolaryngology, cardiovascular surgery, general surgery, urology, orthopedic, and craniofacial malformation, as well as surgery for liver and renal transplantation. After the summary of each surgical procedure, a very detailed pathophysiologic-based description of the anesthetic consideration is provided (including a description of the choice of anesthetic technique and advice about maintenance of anesthesia, blood and fluid requirements, possible complication, and postoperative pain management).

There is also a chapter dedicated to “out-of-OR” procedures in adult and pediatric populations that frequently require the presence of an anesthesiologist for sedation and to maintain cardiovascular and respiratory stability (e.g., imaging and image-guided procedures, implantable cardioverter defibrillator and pacemaker placement, and cardioversion). Office-based plastic and dental surgery procedures are also discussed in this chapter (with some redundancy in earlier chapters on these topics [e.g., facial laser resurfacing]). Curiously, this chapter does not discuss laser ablation of congenital hemangiomata.

The potential usefulness of rocuronium and cisatracurium as alternatives to succinylcholine and vecuronium on rapid-sequence tracheal intubation is not mentioned anywhere in the book. Similarly, the potential role of sugammadex in the latter situation—as well as when a patient administered a steroid-based muscle relaxant cannot be adequately reversed with conventional anticholinesterase drugs—is not discussed. Information on the different doses and onset times of muscle relaxants for standard tracheal intubation are presented in Appendix B, Sections 2 and 3.

The final chapter in the book describes several emergency procedures of importance to anesthesiologists (e.g., how to perform an emergency cricothyrotomy, pericardiocentesis, arterial cutdown, and emergent needle/catheter thoracostomy procedures). At the end of the book there are several very useful appendices specifically dealing with the value and utility of laboratory testing and diagnostic studies, standard anesthetic and pain management regimens for both adult and pediatric surgical populations, drug interactions (including a table with the list of herbal agents that can alter hemostasis), and finally, important considerations for the patient with a latex allergy.

For trainees in anesthesia and surgery, the Anesthesiologist's Manual of Surgical Procedures is a “must-have” book to rapidly familiarize themselves with the commonly performed operations, procedure-specific guidelines for anesthesia care in the OR, and those for postanesthesia care unit, as well as postoperative pain management. Even the experienced practitioner will find this textbook to be an excellent resource for reviewing aspects of a surgical procedure for which he or she is not familiar or has not recently provided anesthesia services. Caution is advised regarding drug doses because there were a number of typographical errors, and some doses are given as absolute dosage amounts of a given drug rather than the more standard μg/kg or mg/kg dosages.

We feel that the editors (and their numerous contributors) have clearly succeeded in achieving their stated purpose in writing this textbook by providing the anesthesia practitioner with clinically relevant information about a wide variety of surgical procedures. It is particularly important for clinicians to have access to the information contained in this textbook when they are asked to care for a patient who is undergoing a procedure that they do not routinely perform. This unique textbook is also an outstanding reference source for new trainees in anesthesiology (and surgery) because it provides an excellent foundation regarding both the anesthetic and surgical considerations involved in all of the commonly (and less commonly) performed surgical procedures. As expected with any major multiauthored textbook largely written by practitioners from a single institution, there are some limitations as noted above. However, overall this textbook is extremely well written and comprehensively illustrated with excellent anatomical diagrams. This 4th edition continues the book's strong tradition and is easier to read than the earlier editions because of the increased use of color graphics. Finally, each copy of the book comes with access to the complete contents online.

Francesca Vlassich, MD

Sanja Janjanin, MD

Paul F. White, PhD, MD, FANZCA

Department of Anesthesia

Cedars Sinai Medical Center in Los Angeles, CA

White Mountain Institute in Los Altos, CA

Pail.white@cshs.org

© 2011 International Anesthesia Research Society