This textbook has been edited by a basic scientist and a clinical scientist based in Michigan and the many contributors hail, almost exclusively, from either the USA or Canada. The background of the editorial partnership is reflected in Neuroscientific Foundations of Anesthesiology; the text aims to explore anaesthetics as a branch of neuroscience – combining clinical anaesthesia with the basic science of the nervous system. The philosophical introduction argues that it is anaesthetists, above neurologists or neurosurgeons, who are the clinicians most commonly modulating the nervous system in daily practice and this statement reflects the direction along which the book as been written.
The book is structured into seven parts, with a systems-based approach looking initially at the brain, spinal cord, peripheral nervous system and autonomic nervous system; with the final two sections focusing on the neuromuscular junction and then neural toxicity related to the administration of general anaesthetics.
The first half of the book, which concentrates on the central and peripheral nervous system, is fairly dry with chapters dedicated to the cellular and molecular effects of general anaesthetics, the thalamocortical system and it's role in unconsciousness, memory processing and anaesthetic-induced mobility. These opening chapters contain little of direct clinical relevance and are much more orientated to the basic science. However, the following sections, which concentrate on the autonomic nervous system and neuromuscular junction, are written with more of a clinical emphasis and contain well presented sections detailing the pharmacology of agents affecting the two systems. The final part of the book looks at the neurotoxic potential of general anaesthetics. This contentious, though contemporary, area is covered initially with a look into the current evidence for anaesthesia-mediated neurotoxicity and highlights areas of rapidly emerging research. Following this, there is an excellent chapter on postoperative cognitive disorders. This chapter begins with three case studies and then a detailed report of up to date evidence surrounding the mechanisms of postoperative cognitive dysfunction (POCD) and its distinction from delirium and dementia. It looks at methods to minimise the risks of POCD specific to orthopaedic and cardiac surgery and also has a section on current research in the area. The final chapter is a brief overview of neurodegenerative disorders and anaesthesia, which includes short sections on Alzheimer's disease, Parkinson's disease and Huntington's disease.
The book is extensively referenced and given the amount of basic science contained in the chapters, it is written in such a way that the wealth information is easily assimilated. The illustrations are plentiful, well presented and compliment the text. Some sections, such as the final chapter on anaesthesia and neurodegenerative disorders, are, however, surprising light and almost come across as an afterthought – especially when compared with the detail of some of the earlier chapters.
Overall, this is a thought provoking, interesting text with a refreshing take on anaesthesia's place in the discipline of neuroscience. Although it contains a great deal of useful clinical information, the amount of basic science contained in the earlier chapters give it the feel of a reference text for a department rather than a book to guide clinical practice for the majority of anaesthetists.
Specialist Registrar, Sheffield and South Yorkshire School of Anaesthesia, Sheffield, UK
Consultant Neuroanaesthetist, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK