The Year in Anaesthesia and Critical Care. J. M. Hunter, T. M. Cook, H.-J. Priebe, M. M. R. F. StruysClinical Publishing: Oxford, UK, 2005, 384 pp; indexed, illustrated ISBN: 1-904392-47-4; Price £59.99
In the foreword to this book Peter Simpson lays heavy emphasis on the difficulties practising clinicians have in maintaining Continuing Medical Education and Professional Development (CEPD). Therefore the first question I asked myself as a practising clinician addressed this point. Would reading this book be of more benefit as a CEPD activity than other sources of material? The second question as a reviewer then followed on: to whom should this book be recommended?
The book is in four parts, each part being edited by an authority in the field. Each part contains four chapters in which equally eminent contributors have reviewed the most important papers published in 2004 relating to a chosen topic. An introduction sets the context of the original papers presented and then these are individually set out as a background summary, interpretation of findings and then contributor's comments. The four parts cover perioperative care, clinical pharmacology, monitoring and equipment, and critical care. It is not stated how each of the topics within each part was selected. Inevitably in a volume of its size it could not be a comprehensive summary of all the important papers, which have been published in anaesthesia and critical care in the year 2004.
Some of the topics were concise whilst others were difficult. For instance in the critical care section was a chapter entitled ‘the critical care outreach conundrum’. This presented a comprehensive summary of the evidence behind outreach development, different models in practice around the world and finally a discussion about their efficacy and value for money. Clinicians arguing for scarce resources to develop these services would gain from being familiar with the arguments put forward as well as having references to the counterarguments. Further explanation was not required. By contrast in the clinical pharmacology section there was a chapter entitled ‘clinical applications of pharmacokinetics and pharmacodynamics’. This chapter focused on propofol and opiate interactions in relation to markers of anaesthetic depth and contained reference to 10 papers, which contained much data relating to research concepts that the practising clinician would be unlikely to be familiar with. Furthermore the measurement tools used to measure hypnotic depth, bispectral index and electroencephalographic approximate entropy, are not routine monitoring devices in clinical practice. The reader with a particular interest in the field might persevere but generalists would probably find themselves skipping forward through this chapter.
Some papers appeared in more than one section of the book. A paper entitled ‘A comparison of Cardio Q and thermodilution cardiac output during off-pump coronary artery surgery’, appears in the perioperative care and the monitoring and equipment sections. One reviewer felt it might be valuable for monitoring downward trends in cardiac output in patients undergoing off-pump coronary artery bypass grafting, whilst the alternative view was that it was an unreliable alternative to the pulmonary artery catheter due to its inherent inaccuracies. The former view was put forward by the reviewer who was approaching the paper from a clinicians point of view, where there is a need to recognise and treat the cardiovascular changes which are associated with this type of surgery. The latter view was more of a technical assessment of a device which has still not gained widespread clinical acceptance. The reader would need to judge for himself the two different interpretations of the same paper.
I did think there was an over representation of papers on fluids with chapters on ‘perioperative intravenous fluid therapy’ and ‘choice of resuscitation fluid in the critically ill’, although they were written from a different perspective.
Notwithstanding the above comments I found much of interest in each part. I particularly enjoyed the well-written chapter on pharmacogenetics and anaesthesia, which presented a fascinating summary of the past and present in a rapidly emerging field. Several papers were then presented which highlighted the difficulties clinicians should expect in achieving adequate analgesia in patients due to genetic polymorphism.
The part on critical care contained topics, which the general anaesthetist would find useful and relevant to his/her practice and similarly the ‘anaesthesia’ parts contained topics, which the intensivist would also find relevant to his/her practice, particularly in the field of resuscitation. Presumably the editor had selected the topics with this in mind.
In answer to the questions posed, for the clinician wishing to get up to date, this book is more challenging and time consuming than reading a series of review articles. However the effort involved is worthwhile. It should be an essential purchase for the departmental library. This is also a good location to read it so that the quoted original articles are at hand. The senior trainee who is looking to develop a research interest in a particular field covered in the book will also find it a useful place to start.