Fundamentals of Perioperative Management. D. W. Green, M. Ervine, S. White. Greenwich Medical Media: London, UK, 2003, 320 pp; indexed, illustrated ISBN: 1-84110-135-4; Price £32.50
This book fills a useful place in the education of junior hospital doctors or senior medical students. It will be especially valuable for senior house officers in anaesthesia and surgery, because the treatment and management of conditions are closely linked with the scientific principles on which the management is based, thus helping the trainee to understand and to remember the facts covered. Each chapter is laid out in the same clear fashion with aims, objectives and introduction; the index of chapters lists the topics covered within each chapter, which in turn is easily identifiable by the coloured bands at the edge of the page. I particularly liked the clarity of layout and the way diagrams, tables, flowcharts and algorithms are used to explain and clarify the text, thus helping the learning and retention.
For example, the physiology of the correlation of blood volume and perioperative fluid-replacement therapy (which in my experience is very badly managed by junior medical staff), blood gas physiology, cardiac and respiratory function, central nervous, renal and hepatic function, as well as pregnancy, are clearly described. In some chapters, however, I felt that in a book aimed at this group of doctors, the detail was a little bit more than may be necessary; these parts can always be initially skimmed through and be used as a reference in the future.
Practical procedures are admirably dealt with in the chapters. These include insertion of central venous pressure lines, urinary catheterization, insertion of chest drains, arterial puncture, passing a naso-gastric tube, as well as some local anaesthetic regional blocks.
I liked the chapters on the patient's view-point and legal aspects of the perioperative period. Although much of this is now available in some hospitals in introductory booklets, it is an essential part of obtaining consent and explaining an often frightening situation to patients. The principles and problems of blood transfusion are described, and the reasons for this, as well as the difficulties encountered with Jehovah's Witnesses and consent to transfusion. I felt that perhaps the chapter on surgical infections and their management was a little bit involved for this stage of a junior doctor's career, but it will certainly be a valuable reference and an aid to appropriate management.
A subject frequently omitted in the education of junior doctors, i.e. the principles of nutrition in perioperative medicine, is clearly explained. Hopefully, this will ensure that the trainee does not allow perioperative patients to starve for days without appropriate oral or parenteral nutrition. The theory and practice of acute pain management, also often badly taught at Medical School, is likewise well covered.
Finally, the chapter on statistics, a vital part of every modern doctor's education that is often poorly understood, is covered at the end of the book. However, for a non-mathematician, some of it may be difficult to understand - but that, perhaps, is always the case with statistics!
There is a helpful section with tables of useful values and formulae with a few multiple choice questions towards the end of the book which can enable the reader to assess his understanding of any particular subject.
Overall, I think the authors are to be commended on an admirable book which is clearly laid out with good diagrams and tables and which has a useful combination of theory and practice. It will become an essential part of the library of every newly qualified doctor.