Clinical Neuroanesthesia

Abstract

Clinical Neuroanesthesia A. Schubert. Boston: Butterworth-Heinemann, 1997, ISBN 0-7506-9502-1, 406 pp, $60.00. This addition to the Butterworth-Heinemann series of subspecialty anesthesia manuals is intended to assist residents in preparing for neurosurgical cases when reading time may be limited. Part I of this single-authored manual consists of 15 well organized chapters dealing with specific neurosurgical procedures, including supratentorial tumor, posterior fossa mass lesions, chiari and cranial nerve decompression, epilepsy surgery, pituitary surgery, aneurysm clipping, arteriovenous malformation management, carotid endarterectomy, spinal surgery, cerebrospinal fluid shunting procedures, central nervous system trauma, neuroradiologic procedures, and stereotactic surgery. Each chapter begins with a list of anesthetic goals for the specific procedure. The author then reviews relevant aspects of neuropathology/physiology, preoperative evaluation, and intraoperative anesthetic management. Of particular value are diagrams of operating room layout and patient positioning for different procedures, lists of necessary equipment, and figures depicting hazards and pathophysiology unique to neuroanesthesia. Within the text there are many helpful hints to avoid pitfalls and to manage complications. The use of typographical highlighting and more frequent tables might have made such points easier to identify when preparing for a case with little notice. Because Part I is organized on a procedure-specific basis, it is easy to focus reading in anticipation of a case assigned for the following day. However, because each chapter is intended to stand alone, there are numerous places in which overlap occurs in the book. While providing completeness, use of an appendix to cover frequently encountered topics would have improved reading efficiency. Notable omissions from Part I are procedures dealing with chronic pain and movement disorders, e.g., dorsal root entry zone, spinal cord stimulation, pallidotomy/thalamotomy. Part II concisely covers general topics of neuroanesthesia practice, including neuroanatomy, cerebral blood flow and metabolism, intracranial hypertension, brain protection, neurophysiologic monitoring, induced hypotension, venous air embolism, and considerations for the emergence of neurosurgical patients. These topics are treated more superficially than they are in a textbook format. Although not intended to be a textbook substitute, this section of the book provides succinct reviews, which will likely be of greatest benefit to those embarking in this subspecialty or those desiring a review of basic principles of neuroanesthesia. The author gives a balanced perspective to each chapter, acknowledging those statements that reflect his personal or institutional bias. In summary, the practical advice within this manual and its compact size make it a useful departmental resource for residents rotating through neuroanesthesia. Jennifer M. Fabling, MB ChB, FANZCA Department of Anesthesia; Duke University Medical Center; Durham, NC 27710