This book details the anesthetic considerations for a variety of common and uncommon surgical procedures. The book is divided into chapters by surgical subspecialty (eg. neurosurgery, general surgery, gynecology and obstetrics) and most chapters are further divided by anatomic region (eg, intracranial, spinal, other neurosurgery), or by general type of surgery (gynecological oncology, infertility, obstetric surgery). Each subdivision is co-authored by one or more surgeons and one or more anesthesiologists.
For each surgical procedure, surgical and anesthetic considerations are discussed. First a description of the surgical procedure is given, including variations on the procedure or approach and usual preoperative diagnoses. A summary of the procedure in table form includes position, type of incision, surgical time, expected blood loss, usual postoperative care (eg, PACU to floor, ICU), morbidity, and causes and incidence of mortality. Each procedure is assigned a pain score based on a scale of zero to ten. Patient population characteristics, such as age, sex ratio, etiology of usual preoperative diagnosis, and associated conditions are also presented in table form. The incidence of this procedure in the surgical population of a university hospital is estimated.
The anesthetic considerations are divided into preoperative, intraoperative, and postoperative concerns. Preparation of the patient, the necessary equipment, and the anesthesia team are addressed as preoperative considerations. This section discusses indications for preoperative testing based on the surgical procedure and the common characteristics of patients presenting for that procedure. The intraoperative section provides a step-by-step guide to anesthetic management during the procedure, including recommendations of specific drugs and doses. In the preface, the editors acknowledge that "there is no such thing as a standard anything, and that each patient should be individualized." In order to provide a practical guide, the authors of each section outline their usual practice for the average patient undergoing a particular procedure. Common complications are noted in the intraoperative and postoperative sections and management strategies outlined. Postoperative monitoring and pain management are also discussed.
Most readers will find the "how-to" nature of this text particularly helpful, although they may not always agree with the author's recommendations for procedures with which they are familiar. For those procedures with which they have little to no experience, this step-by-step approach is invaluable. It gives one a place to start, and from there one can use clinical judgment to tailor the anesthetic to the patient. Caution must be used regarding drug doses, however, since there are a number of typographical errors, and some doses are given as absolute numbers, where mcg/kg or mg/kg would be more appropriate.
In spite of the editor's disclaimer that "this manual is not, and should not, be regarded as an anesthetic textbook in the standard sense", there are clinical pearls scattered throughout the text. The neurosurgical section includes an excellent, concise review of the evaluation of the head-injured patient and the obstetrical section discusses the physiologic changes of pregnancy. The section on vascular surgery does not review cardiac risk factors and indications for preoperative stress testing, and the sections on pediatric surgery do not include a summary of the special considerations of pediatric anesthesia.
As with any textbook that attempts to comprehensively review such a broad field, there are omissions. While laparoscopic cholecystectomy and gynecological laparoscopy are covered, laparoscopic hernia repair and Nissen fundoplication are not. There is a section entitled "Out-of-Operating Room Procedures" that does not include electroconvulsive therapy or laser ablation of congenital hemangiomata (Port wine stains). Rocuronium is not mentioned as an alternative to succinylcholine for rapid-sequence induction, presumably because this book was compiled before rocuronium came into use.
In spite of these limitations, this book will serve as an excellent reference for an anesthesiologist confronted with an unfamiliar surgical procedure. The outline format allows one to scan the section for only the necessary information. The organization of topics makes sense, and the text is well indexed. It will be a welcome addition to any anesthesia clinician's library.