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Clinical Anesthesia Fundamentals

Kilkelly, Shannon DO; McEvoy, Matthew D. MD

doi: 10.1213/ANE.0000000000001148
Media Review: Book Review

Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee,

Clinical Anesthesia Fundamentals, recently released by Wolters Kluwer, is a concise fundamental version of the iconic Clinical Anesthesia textbook by Barash et al. Although the large majority of the chapter authors is different from the comprehensive text, the book is edited by the same group that produces the compendium text. This is not an exhaustive anesthesia textbook but is a solid introduction to the specialty for early trainees, as stated in the preface.

Clinical Anesthesia Fundamentals is loosely structured with the same format as Clinical Anesthesia. After providing a brief, well-written introduction concerning the history and future of the specialty, the book transitions to Section II: Scientific and Technical Foundations of Anesthesia. This begins with a number of chapters of major organ systems followed by several chapters in the pharmacology unit, which starts with a basic treatment of pharmacokinetics and pharmacodynamics and then moves on to address the classes of medications most commonly encountered in anesthetic practice. This section concludes with a brief review of technology used in routine anesthesia practice. Section III: Clinical Practice of Anesthesia covers a broad array of topics addressed from various perspectives—by specific knowledge or skill (Chapter 20—Airway Management; Chapter 24—Blood Therapy), by type of surgical procedure (Chapter 30—Anesthesia for Neurosurgery), or by patient population (Chapter 33—Neonatal and Pediatric Anesthesia). Section IV: Appendices contains a collection of clinically useful protocols and guidelines, including the American Society of Anesthesiologists Difficult Airway Algorithm, American Heart Association resuscitation protocols for cardiac emergencies, and the Malignant Hyperthermia protocol. In addition, and probably most useful for early learners, is a remarkably well-done section on basic electrocardiography. This section merits special comment because basic electrocardiography is a subject with which many early trainees struggle. The elements of electrocardiography most relevant to the perioperative care of patients are covered in a clear, concise manner. Included are topics such as the relationship between a lead and its correlating area of coronary perfusion, chamber enlargement, ischemia, electrolyte disorders and medications, commonly seen arrhythmias, and pacemaker findings. It is a great introduction for beginners and a great review for more experienced readers.

In terms of learning aids, each chapter includes a generous number of multicolored diagrams, charts, and graphs to illustrate the points being made in the text. In addition, key points are emphasized in 3 different ways: (1) highlighted Did You Know text boxes in the margins, (2) video clips, and (3) multiple-choice question sets with annotated answers at the end of each chapter. The Did You Know text boxes often provide pertinent, high-yield summaries of concepts more fully described in the body of the chapter. For example, Chapter 32, Trauma and Burn Anesthesia, includes a text box summarizing the principal issues in the intraoperative care of the burned patient. Overall, the chapters are written in clear, concise language and the concepts follow a logical, progressive order of presentation. The information is reasonably up to date with most chapters including a few references from 2012 and later.

Access to the electronic version of the text is obtained on the Inkling website by redeeming the access code provided with the book. The online content contains all the text, diagrams, figures, and appendices of the paper text as well as some additional question sets and lectures. The advantage to the reader of this format over the paper version is that the online content is continually reviewed and updated, providing the reader with the most up-to-date material available. It represents a working version of a living textbook. One drawback of this text compared with the digital version of Clinical Anesthesia is that the references in the compendium text contain direct PubMed links to source articles, whereas the digital version of this text does not.

Also included in the online content are a generous number of videos to assist readers in their understanding of key concepts. The videos include live action descriptions of procedures, ultrasound imaging, and discussions of graphic representations. Although the narration provided with the graphs and diagrams is not substantively different from the written descriptions in the body of the text, having that narration comes during the step-by-step recreation of the diagrams is what makes these videos so helpful. Video 3–4 The Cardiac Cycle is a particularly good example of the utility of this technique. The procedural videos are a bit more variable in their utility. The videos demonstrating femoral, transversus abdominis plane, and interscalene blocks are complete and very well done. However, video 20-11 in the Airway Management chapter shows just the final step of an emergent tracheostomy. Fortunately, emergency surgical airway is an exceedingly rare event in most anesthetic practices, and when it is required, a cricothyrotomy (either percutaneous or open) is the intervention of choice, not a tracheostomy, which has a significantly higher risk of vascular and/or pulmonary injury. The authors do state that a complete discussion of a surgical airway is beyond the scope of the text, which makes inclusion of this video curious. Similarly, video 32–3, which demonstrates tube thoracostomy, omits entry of the operators finger into the thorax—a vital step to confirm that the operator indeed feels the lung, not the liver or spleen, and that the lung is not adhered to the chest wall, thereby increasing the risk of pulmonary parenchymal injury during tube placement. Although these procedural videos probably should not be used as how-to material, they are relatively useful in giving the beginner a general overview of the processes.

The print version of the book includes multiple-choice questions at the end of each chapter. The 5 to 10 questions are designed to reinforce key concepts presented in the body of each chapter, and like any question set, they range in their difficulty and clarity. The explanation to each question is provided at the back of the book. Explanations are succinct and to the point, because most of the questions relate directly to information contained in the chapter.

Overall, this book represents a solid addition to the collection of introductory books available concerning the practice of anesthesia. The book reads well and is presented in a manner that makes the information easy to consume for learners or to use as a discussion aid by teachers. The electronic content is well done, illustrative, and, best of all, continually updated. In terms of utility, the electronic content is much more interactive and easily accessed than the PDF presentations of other references. In the preface to the book, the editors describe the creation of a text for beginners. They are clear in their position that the text is not meant to be a substitute for the reference textbooks required for mastery of the specialty. In that regard, they hit their mark with an excellent product.

Shannon Kilkelly, DO

Matthew D. McEvoy, MD

Department of Anesthesiology

Vanderbilt University Medical Center

Nashville, Tennessee

© 2016 International Anesthesia Research Society