Book reviews

B. Bissonnette and B. Dalens, eds McGraw-Hill Medical Publishing Price: $195 Pediatric Anaesthesia is a new comprehensive textbook of paediatric anaesthesia comprising 1600 pages, edited by␣Professor Bruno Bissonnette of the Hospital for Sick Children, Toronto and Dr Bernard Dalens of the Hotel Dieu, Clermont Ferrand. The book has 86 chapters separated into six sections with a total of 145 contributors. The␣sections are developmental considerations, pharmacology, anaesthetic management and techniques, special monitoring and resuscitation techniques, surgical and anaesthetic considerations of procedures and, finally, the future of paediatric anaesthesia. The section on development comprehensively covers the changing anatomy and physiology of the paediatric patient and includes many useful tables particularly one for blood pressure. This section also includes a valuable chapter on chronic and recurrent pain by McGrath, Hetherington and Finley. The pharmacology section is well presented and makes great efforts to focus the information on paediatric practice. The anaesthetic management section covers topics varying from pre-operative assessment, induction and maintenance to outpatient anaesthesia, critical care and pain management. This section of the text maintains a very high standard and is particularly useful for both the trainer and trainee. Bernard Dalens' chapter on regional anaesthetic technique is a chapter of the highest quality, combining clarity with completeness and should be compulsory reading for all trainees. The section on special monitoring is a cornucopia, containing such diverse subjects as neonatal resuscitation and latex allergy, finishing up with a chapter on miscellaneous techniques. This section contains many useful chapters, but unfortunately I am unable to understand the place of a chapter on ‘manipulating the lower renal tract’ in an anaesthetic textbook. The section on surgical and anaesthetic considerations is an interesting innovation. A chapter by a surgeon precedes each anaesthetic chapter therefore the basic anaesthetic principal, of discussing with the surgeon what they are going to do, has been transferred to the written page. The chapters on ENT are a good example of this process, although it is interesting that the anaesthetist carefully discusses the use of the re-inforced LMA in tonsillectomy only for it to be dismissed in one sentence in the surgical chapter. Unfortunately in some other cases there does not appear to have been much collaboration on the format of the paired chapters, such that a 17-page surgical chapter on the GU tract is followed by a 4-page anaesthetic chapter! This textbook is a welcome addition to the field; overall, it is well written and extremely well referenced. The tables and illustrations are clearly presented and appropriately placed. It will be a valuable and well-used addition to any paediatric anaesthetic library. A.M. Zbinden and D. Thomson, eds Butterworth-Heinemann Price: £45.00 The prosecution, presentation and publication of research are the cornerstones of progress in anaesthesia and Intensive Care Medicine, both for individual career progression and the specialities as a whole. However, few if any of us have had any formal training in research methodology, and until recently opportunities for such instruction have been limited or ignored. Most researchers have learnt from their colleagues and mentors, or in some aspects from their own experiences. Only the duplicitous would suggest that all their research has been flawless, or that they had never submitted a less-than perfect manuscript. There is therefore a niche for this kind of book, which broadly aims to minimise the flaws in design, literature review, ethical considerations and statistical analysis that limit the likelihood of success in research. The list of contributors is a catalogue of international authors and journal editors from a wide variety of disciplines (biochemistry, linguistics, mathematics) in addition to medicine and anaesthesia. Most are highly eminent within their academic fields, although one chapter appears to be co-authored by a junior family member whose qualifications for authorship are unclear! The editors are to be congratulated on a reasonable uniformity of style: all but one of the chapters are entitled ‘How to …’ (although this approach is mandatory given the nature of some of the subject matter) and have a common structure. The chapters are presented in a logical sequence and are well presented, using a question-and-answer format or checkboxes where applicable. The first chapter on literature searching provides an overview of the available methods and their pitfalls, and useful hints on what to do when your search reveals unexpected results. The chapter on interpretation of publications offers a fascinating insight into the process of publishing and peer review, sources of bias in citation indices, issues of funding, ethics and common problems of quality of measurement, randomisation and data analysis. Chapter 3, ‘How to obtain funding’ amounts to entertaining, considered career advice but it concentrates largely on the USA system and commercial funding. I enjoyed mostly the middle chapters of the book: ‘How to write …, How to present …, How to get published …, How to process text’. These all contain valuable advice, for example, an account of the reasons for rejection of manuscripts, tips regarding verbal and non-verbal aspects of public presentations, and a reminder that many reviewers review for more than one journal! The chapter ‘How to use the English language’ included useful hints on both scientific writing and grammar for this reader, whose first (and only) language is English. My criticisms of this book are partly that it attempts to be both uniform in style and comprehensive when such efforts are impractical. Chapters on ‘How to perform measurements’ and Statistics are too superficial, and do not easily fit within the ‘How to …’ format. Other chapters are detailed in part but limited in scope; consequently the interested researcher will need to refer to other more detailed texts. There is inevitable overlap, with general ethical issues considered in several chapters, in addition to the brief chapter so titled. In addition, there is little specific to the practical problems of research in Intensive Care, such as issues of consent and ethical concerns about research in the critically ill. In essence, the editors have attempted an impossible task and succeeded in parts. The reason that many current researchers have learnt mainly from colleagues and from their own experiences is to some extent pragmatic: you can't learn research methodology entirely from a book. However, this text provides a useful insight into many aspects of research and publications and contains much practical advice. It should be available in your local medical library both for active or potential medical researchers, and those who simply want a better understanding of the literature. J. Thompson University Department of Anaesthesia, Critical Care and Pain Management, Leicester Royal Infirmary Blackwell Science Berlin This is a regional anaesthetic textbook written from a pain management perspective. It is also a didactic and detailed description of the techniques used by the authors. The book both benefits and suffers from the consequences of this provenance. The benefits of its pain origins include the presentation of a number of blocks that often do not appear in ‘comprehensive’ regional anaesthesia texts, such as occipital nerve block, superior cervical ganglion block, subscapular and suprascapular nerve blocks, thoracic and lumbar paravertebral blocks, and trigeminal nerve block. There are also ‘before, during and after’ photographs of the limbs of patients with complex regional pain syndromes undergoing a course of nerve blocks. However, the concentration on pain blocks and neuraxial techniques leaves a mere 28 out of 340 pages to cater for brachial plexus blocks. In case it was thought that this comment is influenced by my own subspecialty interest, it is worth pointing out that proximal lower limb blocks occupy only 24 pages. Arguing that these are the areas that are usually covered by the established regional anaesthesia texts leads one to conclude that this book complements the others by making up for their deficiencies. The breakdown of page allocation is as follows: Head and neck 18%, Upper limb 16%, Trunk 41%, Lower limb 14%, Neuraxis 39%. The overall style of presentation is methodical, thorough and precise. The description of each block is broken down into headings: definition; anatomy; indications; contra-indications; technique; drug choice and dosage; side-effects; complications. The authors do not fear repetition, thereby ensuring, for instance, that both general and individual contra-indications are included in the description of each and every block. This makes the book highly suitable as an occasional reference for individual blocks rather than a treatise that has to be read as a whole. Photographs of the equipment needed for the blocks are included, and procedure-specific paper records and checklists are included to promote appropriate monitoring, record keeping and block assessment. The illustrations and anatomical drawings are lavish and of good quality, although they can on occasion be a little adventurous - the two still photographs illustrating a ‘blackout’ and a ‘tonic-clonic seizure’ are good cases in point. Jankovic's preface makes it clear that the techniques described are based on his ‘many years’ experience' in clinical practice. Certainly, the didactic approach he adopts as a result of this is useful in its clarity and unambiguity. However, some minor aspects of his techniques are far from universally accepted. For instance, we are told that after the insertion of an axillary brachial plexus block, 3–5 min of ‘compression massage’ of the axilla is obligatory. Similarly, we are told in the section on single-shot lumbar epidural injection that, after the administration of the test dose, the needle should be rotated at 1-min intervals for 5 min However, the benefits of this ‘single-author’ attitude include a coherence and unity of clinical approach. It also␣means that we are treated to a well-illustrated description of the much-maligned and now rarely used hanging-drop technique for identifying the epidural space. The positive aspects of this book far outweigh the negative ones. However, adverse criticism comes to me more easily than praise and I will not resist the temptation to call the potential reader's attention to two of the book's minor irritations. In the important introductory section of the first chapter that details the resuscitation equipment that should be available whenever blocks are performed, we are advised to ensure that the following are always at hand: a range of Wendel tubes, two ampoules of Alupent and an ampoule of dimethindine maleate! Almost all the regional anaesthetic equipment recommended is made by a single (German) manufacturer - to the virtual exclusion of every other manufacturer. However, it must be noted that this was probably a␣book, in its original conception, for local consumption only that it is becoming more widely disseminated as a result of its quality and popularity. I like to place books into one of four categories: a must-have for every anaesthetist; a must-have for every anaesthetist practising in the subspecialty covered by the book; a must-have for every department library; a book that can safely be left to gather dust on the publisher's shelves. I would place this book in the third (department library) category. If I ever needed a detailed description of a regional block, in particular a ‘pain block’, I would know where to go. W. Harrop-Griffiths St Mary's Hospital, Paddington A. Merry and A. McCall Smith Cambridge University Press Yet another book on medicine and the law, you think, expecting dense prose on Bolam and after. This book is not like that. Written by a working anaesthetist (AM) and the only legal academic (AMcCS) I have come across who seems to be at least partly on the doctors' side, this book is as clear as any I have come across on any technical subject. It is well written, in English that Sir Ernest Gowers would not, I think, have been able to criticise, and achieves the double aim of discussing much of the relevant law in the field, then discussing what it ought to be. ‘The central thesis of this book is that many incidents currently defined as negligent.do not, on close analysis, reflect significant blameworthiness.’ This sentence stands at the beginning of a chapter, and is elegantly fulfilled. The analysis is based on consideration of how untoward events occur in medical practice. Culpability is considered, ascending from the slip/lapse, through violations, negligence and recklessness to deliberate acts. It is convincingly demonstrated, with fully referenced discussion of psychology of error, that the lowest levels of culpability, though frequently just the type to result in criticism and damages in the Courts, will inevitably occur in the practice of the most careful practitioner. For example, 89% of one group of anaesthetists had made a drug error, most more than once, and one in eight had caused harm by it: these figures are probably representative, and occur in spite of our best efforts. Can it be suggested that almost all are at fault? The avoidability that is a necessary part of culpability is absent. The book further looks into alternatives to the Courts, showing that the tort based system does not efficiently meet the multiple demands of compensation, accountability and discipline. It looks closely at non-tort compensation systems, and concludes that for all the faults of non-tort systems – expense, difficulties defining accidents, political meddling and the replacement of armies of lawyers by armies of administrators –‘There is certainly no enthusiasm for a return to tort law’. This book is full of new knowledge, new insights, new approaches, even for a reviewer with a thorough familiarity with relevant English law. Its clarity is enviable, and one can only hope that a Law Commission will consider its contents at an early opportunity. Any doctor with an interest in medical law will enjoy this book. C. Heneghan FRCA Barrister, Abergavenny S. J. Mills, S. L. Maguire and J. M. Barker Greenwich Medical Media Three post-Fellowship trainees, fresh from recent success in the Final FRCA examination, have written ‘The Clinical Anaesthesia Viva Book’ specifically to aid anaesthetists-in-training who are preparing for the Clinical Viva. This book comprises 15 long and 60 short clinical viva questions. These are based on common and repeated scenarios from the Final FRCA examination, identified by a survey of examination candidates. The questions are realistic, important, and even topical, but do not attempt to comprehensively cover the examination syllabus. The first chapter provides a brief but worthwhile discussion of the necessary preparation for the clinical viva, with emphasis on frequent practice, orderly presentation and the benefits of group revision. This is followed by suggestions on viva technique. The clinical viva in the Final FRCA examination tests more than factual knowledge. Candidates are required to apply their knowledge to the management of clinical problems. At this level, black and white answers to taxing clinical questions are the exception: presentation of alternative solutions, together with their relative advantages and disadvantages are needed. A sound knowledge of clinical anaesthesia is important but not enough. Candidates must apply this knowledge to answer questions clearly concisely and with a sense of proportion. The sample of short cases is drawn from elective and emergency anaesthesia, intensive care and chronic pain management. These are presented in alphabetical order and supported by up-to-date references. Candidates preparing for the examination may wish to use these examples to devise their own scenarios for areas of perceived weakness and perhaps for topical journal editorials and reviews. Fifteen specimen long cases complete with investigations are varied, plausible and promote thought and discussion. Simple questions accompanied by brief, pertinent answers develop the clinical problem. The preferred decisions of the authors are necessarily presented in a didactic manner. They must not be taken at face value but rather used to stimulate deeper thinking and discussion about issues of evidence, appliance of basic science, and safety. Candidates are encouraged to practice thinking through the options for management before addressing the examiners. The importance of recognizing and managing medical comorbidity and optimal preparation for anaesthesia and surgery is clearly demonstrated. Issues surrounding informed consent with disclosure of risk are given less attention. This book is more than a brief revision guide for cramming key facts. It enables candidates to practice answering realistic clinical viva questions, and encourages them to do this in small groups with constructive and supportive feedback from their peers and senior colleagues. Such realistic practice is daunting to many trainees but is essential preparation for the clinical viva. Viva skills develop quickly with encouragement and experience of realistic viva practice. ‘The Clinical Anaesthesia Viva Book’ is a valuable resource for both candidates and practice examiners. It provides useful insight into the nature of questions and the appropriate content and depth of answers in the structured clinical viva. A. R. A. Rushton Derriford Hospital, Plymouth

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