Problems in Anesthesia: Cardiothoracic Surgery

Problems in Anesthesia: Cardiothoracic Surgery J.E. Arrowsmith and J. Simpson, eds. London, England: Martin Dunitz, 2002. ISBN 1-84184-138-2. 308 pp., $73.00. This book exposes the reader to the current, impressive complexity of the subspecialty of cardiothoracic anesthesia. A total of 39 chapters addresses various areas of cardiothoracic surgery (congenital heart disease, cardiothoracic trauma, lung surgery, including living-related lung transplantation, intrathoracic vascular surgery, esophageal surgery), newer technical developments (ventricular assist device, transmyocardial laser revascularization, port-access cardiac surgery, off-pump coronary artery surgery), cardiac surgery during pregnancy or, in a patient with brain tumor, complications of cardiothoracic surgery (renal, respiratory, and neurological), and issues of general interest (heparin resistance, heparin-associated thrombocytopenia, transesophageal echocardiography, thrombelastography, glucose-insulin-potassium infusion, high-frequency ventilation). The problem-based teaching approach of the book makes reading enjoyable and, at the same time, highly informative. After a brief introduction, each chapter starts with the presentation of an actual case by knowledgeable, experienced, and specialized practitioners. This is followed by a critical review of the literature and by evidence-based reasoning to support the taken course of action. Each chapter ends with conclusions that summarize the most relevant material. It is instructive to read case reports in which complications are frankly discussed, and in which not all patients have survived. No question, this approach provides for a considerable learning effect. Don’t we (unfortunately) all learn more from mistakes and complications than from “straightforward” cases? Of the 63 contributors, some two thirds are from the UK, the remainder from the US, Australia, and Canada, except for one from Belgium. Thus, this book has the advantage of providing us with North American, British, Australian, and European views on the practice of anesthesia. This is likely to confront the reader with unfamiliar practices of anesthesia. For example, use of a Carlens tube with a carinal hook, use of fluoroscopy for correct positioning of such a tube, maintenance of anesthesia with continuous infusions of propofol and ketamine, or primary use of intravenous magnesium to reduce the incidence of intraoperative cardiac arrhythmias (chapter 32) may not necessarily be part of everyone’s standard anesthetic practice. Most chapters are clearly written, to the point, and the content is presented in a concise manner. Duplication of material between chapters is minimal. Some chapters are more like a mini-review than a case report. Chapter length varies between 4 and 12 pages, the number of references per chapter between 11 and 68. Half of the chapters include references with a publication date up to the year 2000. Most of the remaining chapters include references with a publication date up to 1999. However, in a couple of chapters, the most recent references date back as far as 1998 and 1997. Thus, the references are not always all that current. The numerous diagrams, flowcharts, guidelines, and algorithms are very helpful. Reproduction of illustrations is of good quality. There is, however, a strange mix of British and American spelling and medical vocabulary throughout, at times even within a single chapter. Except for listing of a wrong epidural clonidine dosage (0.2 mg rather than 0.2 μg · kg−1 · h−1, p. 244), no other factual errors were noted. This book clearly makes for a very different kind of reading than we are usually used to. The material presented is of great variety and attractively presented. This reviewer frankly enjoyed reading it. The text presents a broad range of information and an attractive combination of case report—“How did and do I do it?”—and critical review of literature. For those readers who are interested not only in the mere description of the practice of cardiothoracic anesthesia, but also like to know about the problems associated with this, at times, complex anesthetic subspecialty, and who are keen to profit from the experience of practicing specialists—experience that is based on success as well as on failure—for those readers this book is highly recommended. This volume cannot and is, of course, not intended to replace a conventional textbook on cardiothoracic anesthesia. However, it provides additional, highly useful information that may well improve one’s own clinical practice.

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