Anesthesia for the Cardiac Patient
Christopher A. Troianos
Mosby: St Louis, USA, 2002, 512 pp; 308 illus.; indexed
ISBN: 0–3230–0874–7; Price £75.00
Christopher Troianos, who is at the Mercy Hospital, Pittsburgh, PA, USA, has recruited 31 authors from 14 leading institutions across the USA collectively to produce a comprehensive book aimed at advancing the anaesthetic care of patients with cardiac disease requiring cardiac or non-cardiac surgery. Given that cardiac-related events are the most common cause of significant morbidity and mortality in patients undergoing elective surgery, the niche for such a book is self-evident.
The text is divided into four main sections, the first, entitled ‘Peri-operative Care of the Cardiac Patient’, contains chapters on preoperative evaluation, cardiovascular medications, intraoperative monitoring, perioperative transoesophageal monitoring, and postoperative care and pain management. Regional wall motion abnormalities detected by transoesophageal echocardiography are one of the earliest signs of myocardial ischaemia and Troianos has written an excellent chapter about the development and advances in its use, much of it based on his own extensive expertise in this area.
The second section reviews the anaesthetic management of specific cardiac disease processes and deals with each pathology in turn, suggesting haemodynamic goals for anaesthesia in cardiac and non-cardiac settings. The pathophysiology of myocardial ischaemia is carefully reviewed and the reasons for the lack of correlation among the various methods for detecting myocardial ischaemia are explained, along with newer concepts such as myocardial perfusion/contraction coupling.
The third section is dedicated to a discussion of topics specifically related to cardiothoracic surgical procedures such as cardiopulmonary bypass, minimally invasive cardiac surgery and cardiac transplantation.
The final section is devoted to non-cardiac surgical settings and contains useful chapters on vascular surgery, trauma, neurosurgery, obstetrics, day care and thoracic surgery.
With the exception of perioperative β-adrenoceptor blockade, there is little evidence to suggest that specific anaesthetic agents or techniques significantly alter cardiac morbidity/mortality. Therefore, the ultimate aim of reducing myocardial ischaemia must be achieved by maintaining stable intraoperative haemodynamics with the avoidance of hypertension and tachycardia postoperatively. To this end, the book achieves its aims well, offering a wealth of knowledge that will enable the reader to select appropriate strategies to achieve these goals for a wide variety of operating conditions. A minor criticism of the text is that the format can appear dull in places, with many tables. However, against this, each chapter concludes with a useful summary of key points and is well referenced.
At over 500 pages Anesthesia for the Cardiac Patient is an authoritative text, but its cost would probably not have a wide appeal to trainees within Europe. It is also clearly aimed at the North American market with a different emphasis in certain areas, for example the inclusion of billing procedures for transoesophageal echocardiography and the evidently more widespread use of pulmonary artery catheters in cardiac surgery in the USA. I would therefore recommend the book as a useful and worthwhile reference book for the departmental library and for the anaesthetist with a special interest in cardiothoracic anaesthesia.
M. W. Frost