Anesthesiologist’s Manual of Surgical Procedures

Abstract

Anesthesiologist’s Manual of Surgical Procedures R. A. Jaffe & S. I. Samuels . ( eds ) Lippincott Williams & Wilkins , Philadelphia , ISBN 9780781766708 , 1526 pp ., Price £106.00 The definition of a manual is ‘a small reference book, especially one giving instructions.’ The Anesthesiologist’s Manual of Surgical Procedures is a very big A4-sized hardback book that redefines the word ‘manual’ in as much as it is not the type of book to carry around with you, unless you schedule your discectomy in advance or are in training as a competitor for the world’s strongest man/woman. The book is 1526 pages long, excluding appendices and index, and is divided into 15 chapters predominantly according to surgical specialty, e.g. Orthopaedic, Thoracic, Ophthalmic. There are also chapters on Paediatric Surgery and Emergency Procedures for the Anesthesiologist. The editors and most of the contributing authors are from Stanford University Hospital in California. Each chapter, written jointly by an anaesthetist and a surgeon, is further split into several subsections according to which part of the body is being operated on. In these subsections, many operations are dealt with individually. Each operation is described with reference to the surgical considerations followed by the anaesthetic considerations. Although the book is divided into chapters, sections and subsections, the presentation appears a little cluttered and the table of contents is vital to help the reader navigate through it. Each surgical procedure is described using narrative, tables and some excellent diagrams and drawings, both in colour and in black and white. In the opinion of several surgical colleagues commenting on their own surgical specialty, the surgical detail is insufficient compared with surgical texts. However, from the anaesthetist’s point of view, there is plenty of useful surgical information allowing him or her to understand clearly what the surgeon is doing. This is vital to providing safe anaesthetic care and in this aspect the book succeeds. As well as describing the surgical procedure itself, there are interesting details about relevant patient populations, e.g. patients with Crohn’s disease could be on high dose steroids and be anaemic. The relevant anatomy is described, as is the positioning required and associated complications. Other topics include the type of incision, the estimated blood loss, postoperative pain, and the expected mortality and morbidity. Although the surgical aspects are described for each individual operation, the anaesthetic considerations are described for similar groups of surgical procedures. To avoid repetition, reference is often made to an appendix at the end of the book that lists standard anaesthetic techniques, drug doses and infusion regimens. When there are specific anaesthetic concerns relating to a particular group of operations, the authors categorise these into pre-, intra- and postoperative. The pre-operative focus is on the medical conditions associated with the surgery, e.g. obstructive sleep apnoea in patients having surgery for sleep disordered breathing. Any specific investigations that may be required are listed. Intra-operatively, particular anaesthetic techniques, e.g. one lung ventilation for pneumonectomy, are described, as are the patient’s position, specific fluid requirements and monitoring techniques. Anaesthetic and surgical risks and complications associated with the specific operation are also described, e.g. bleeding may occur during dissection of the splenic flexure when performing a proctocolectomy. Highlighting these surgical risks to the anaesthetist is another strength of this book. There are several appendices at the back of the book that, in addition to describing standard anaesthetic techniques (adult and paediatric), include topics on paediatric pain management, drug interactions and specific considerations for patients with latex allergy. In the book’s introduction the authors say ‘this book does not pretend to be either a textbook of anesthesia or a textbook of surgery’. This is true. Surgical detail is insufficient for the surgeon and the same is true of the anaesthetic detail for the anaesthetist. Although there is much mention of many regional anaesthetic techniques, nowhere in the book is there a description of how to perform any of them. However, there are detailed descriptions about other topics such as preventing postoperative nausea and vomiting, and performing a fibreoptic intubation. There are also several omissions. For example, certain regional blocks are not mentioned, such as 3:1 block for total hip replacement. This, along with several of the drug names and terms used, e.g. MAC (Monitored Anesthesia Care), may reflect the difference between US and UK practice. Much of the anaesthetic information in this book is available, sometimes in more detail, in standard anaesthetic textbooks. However, what this book does offer is a unique way of presenting information that is vital to the anaesthetist. It focuses the anaesthetic mind not only on tailoring the anaesthetic to fit the patient, but to fit the surgery as well. I think it would be a useful addition to any anaesthetic department’s library.