SECTIONEDITOR
NORIGELLISON
Book and Multimedia Reviews
Regional Anesthesia. The Requisites in Anesthesiology series.
Rathmell JP, Neal JM, Viscomi CM. Philadelphia: Elsevier Mosby, 2004. ISBN 0-323-02042-9. 218 pp, $79.95.
Regional Anesthesia by Drs. Rathmell, Neal, and Viscomi is one of several books in the series The Requisites in Anesthesiology edited by Roberta Hines, MD offering concise reviews of specific topics for trainees preparing for board-certification examination. In that as- pect, it succeeds admirably. At about 200 pages, it can easily be carried to the work area. Organized into straightforward topics, this book is enhanced by highlighted lists of key points and numerous figures. All three authors are well recognized in this field, collec- tively covering a broad range of expertise.
The text is organized into five logical sections: Anatomy and Physiology, Pharmacology, Techniques, Complications/Outcomes, and Specialty Considerations. Wisely, given the brevity of the book, the authors do not venture far from the regional anesthesia focus.
The chapter on sympathetic blocks might fit better in a book dealing with pain techniques, however the succinct final chapter on man- agement of acute pain includes important information on adjuncts to block techniques. The numerous gray scale figures throughout the text include excellent original drawings and redrawn classic figures with very complete legends. A reader can easily glean much of the salient information on each topic by scanning the figures and highlighted key concept boxes in each chapter. The occasional clin- ical cases presented in the boxes were distracting to this reviewer.
Either they should be offered consistently in each chapter, or delet- ed—preferably the latter. The text is generally pithy and well writ- ten, providing appropriate depth of information. The short ‘sug- gested reading‘ lists provided at the end of each chapter were less useful, often simply providing titles of classic texts or review arti- cles. Space limitations prohibit an exhaustive list; perhaps the reader should be trusted to do a computer literature search if further information is desired.
Not surprisingly the text format works better for some topics than others. The first three chapters cover the basic science of neuroanat- omy and pharmacology. These are important but unexciting topics, and the authors do a good job of providing the information in an easily accessible format. The illustrations in the chapter on neuro- anatomy are excellent, and the chapter on local anesthetic additives is highly readable. There are some puzzling elements in the chapter on local anesthetics, such as a highlighted case study involving bupivacaine in an obstetrical patient and a key point box regarding transient neurologic syndrome, both of which are covered more appropriately in the final chapters on specialty considerations.
Overall the eight chapters in the Techniques section are very well done. The first chapter in this section gives a brief, but helpful overview of equipment and monitoring. The subsequent chapters cover anatomically grouped techniques. There are obvious space and format limitations. Techniques requiring more visual descrip- tion, such as ultrasound needle guidance, receive minimal attention.
The authors tend to emphasize more common techniques. It is difficult to balance brevity and comprehensiveness, and though I might quibble with the choice of supraclavicular block technique or the equal emphasis on interpleural and paravertebral blocks, overall the authors do a superlative job. The three chapters covering com- plications and outcomes are superb. The authors do not hesitate to clarify controversial areas and provide evidence-based suggestions.
Several color plates are provided at the beginning of the book.
This has become an obligatory addition to block technique texts, and the figures are borrowed from well-known texts. The prints include a variety of techniques, including brachial plexus, celiac
plexus, and centroneuraxial anatomy. While the prints themselves are visually captivating, I would have preferred classic approaches to commonly used blocks. Most trainees will not be performing the plumb bob approach to the supraclavicular block or celiac plexus blocks for surgical procedures. Color anatomy plates of the lower extremity to complement the upper extremity plates would have been more cohesive.
However, this is a minor quibble. This well-edited text admirably fulfills its promise to provide succinct and useful information to the anesthesiologist or trainee preparing for the examination process.
Denise J. Wedel,MD Professor of Anesthesiology Mayo Clinic
Rochester, MN
Hematologic Issues in Anesthesia, Vol. 42, No. 3 of International Anesthesia Clinics.
Park KW, ed. Philadelphia: LWW, 2004. ISSN 00-20-5907. 165 pp.
$263.00 annual subscription for 4 issues.
Ten chapters comprise this potpourri of issues. The grouping is loosely all hematologically related, but certainly a different editor might have chosen other topics. All are good, relevant, and timely, although one might not include antiphospholipid syndrome (Chap- ter 4) as a consistent topic of interest for the average anesthesiologist or even the cardiac anesthesiologist. It therefore does make one wonder how the editor selected the 10 topics to be included. Dr.
Park has authored four of the chapters himself and the selection clearly stems from topics of interest to him personally. That is not bad, as they are all well written and contain up to the date and useful information. If the reader therefore takes this volume for what it is, a potpourri, he will not be disappointed and, in some cases, very glad to have it on his or her shelf.
The first chapter, Basics of Coagulation Pathways, is a prime example of why this reviewer, for one, is happy to have this volume.
The chapter is extensive and complex. It focuses mostly on protein pathways but takes the correct and contemporary view that most of these protein reactions occur on the surface of activated platelets and white cells. In only 9 pages, the author covers the primary coagulation cascade, platelets, fibrinolysis, and mechanisms of an- ticoagulation. Unbelievably, there are none of the usual charts with arrows describing reactions. Perhaps that is a plus, as most often these charts are outdated by the time they are published. Dr. Breen does mention a number of proteins that have truly been underap- preciated in standard teaching. His mention of PAI-1, TFPI, acti- vated protein C, and others is good, in that it takes up as much or more discussion than the initial cascade. Turning to the initial cascade, he correctly points out how different today our under- standing of coagulation is from the days of separate intrinsic and extrinsic cascades. The focus on tissue factor as produced by ex- travascular sources or endothelial cells themselves is important and correct. Unfortunately, coagulation cannot be learned from a book.
This seems to be one topic that perhaps three-dimensional comput- erized learning could really be of use. But this chapter is up to date and condenses a lot of information into a very small number of pages.
The second chapter, on Transfusion Associated Complications, is again capable of packing a great deal of information into a limited space. Entire books and conferences and considerable debate whirl around this timely topic today. The chapter is structured in the standard way that most discussions of transfusion are set up. They
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focus on the viruses, HIV-1, HCV, and HCB. Variant Jacob- Creutzfeldt disease has now gained almost as prominent a place in these discussions as the two viruses. Unfortunately, and this book is no different than most, this perpetuates the impression that these pathogens are the major or important problems with blood trans- fusion. By reading the chapter, one quickly learns that the risk from these potential contaminants of our blood supply is exceedingly small and is shrinking. It is clear these are what are on the lay public’s mind, but it is up to us as learned physicians to focus on the real threats. The major threats from allogeneic blood transfusion today, at least as noted by the United States Food and Drug Ad- ministration (FDA), are ABO-rh incompatibility, transfusion-related acute lung injury, and immunomodulation. In this reviewer’s opin- ion, it is certainly immunomodulation that causes the most harm to our recipient’s blood transfusion. Thus, although this is wonderful and relatively up to date (everything in blood transfusion is out- dated by the time it is published), it could have been structured differently if only to deliver a more subliminal message.
The third chapter, on Heparin Induced Thrombocytopenia (HITT), is again jam packed with great information. Anyone in- volved in heart and vascular surgery today will find the epidemic of HITT real and problematic. The authors could well have gone further to speculate on the effect of heparin antibodies, present and circulating, but not leading to either thrombotic complications or massive drops in platelet counts. It seems as though there is truly a gradation of physiologic effects and simply not manifesting the worse case scenario may not mean that these antibodies are not really doing considerable harm. Unfortunately, the management section is not up to date. Physicians purchasing this edition may well try to use the chapter as a guide for how they could approach a patient in the operating room. There is a great deal written about danaparoid and hirudin, but the contemporary shift is towards shorter acting direct thrombin inhibitors, argatroban and bivaliru- din. With argatroban having achieved FDA approval for HITT anticoagulation (but not approved as a primary anticoagulant for bypass) and bivalirudin having a large number of case reports in the literature, it would seem that the timing target was missed by just a bit. Perhaps during the time of writing, editing, and publishing, this area is evolving so quickly that it simply could not have been timelier unless it was rewritten last week.
Antiplatelet therapy is as timely or more so even than HITT. The chapter is short and perhaps misses the mark a bit because of that.
The most important point in the operating room with these agents is how much are the patients going to bleed after having received one and what period of time is necessary to be sure that their effect is gone. The chapter on antiphospholipid syndrome is interesting, but again one wonders how often this is a problem for most anes- thesiologists. It is really quite rare. The chapter on coagulopathies of cardiopulmonary bypass is quite complete with almost 200 refer- ences. It is by far the best work in the book and is quite up to date.
In summary, if one accepts that this emphasis on hematologic issues is a selective appetizer from a menu of perhaps a hundred or more topics pertinent to the anesthesiologist, there are some gems within its covers. It is well worth examining for its strengths, par- ticularly in relation to coagulopathies.
Bruce D. Spiess,MD Associate Professor Department of Anesthesiology University of Washington Seattle, WA
Books and Multimedia Received
Receipt of the books and multimedia listed below is acknowledged. Selected books and multimedia from this list will be reviewed in future issues of the Journal.
The Journal solicits reviews of new books and multimedia from its readers. If you wish to submit a review, before proceeding please send a letter of intent, identifying the book or multimedia in question, to Norig Ellison, MD, Department of Anesthesia, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283. The Journal reserves the right of final decision on publication.
Barash PG, Perrino JAC, Reeves ST, Garwood S, Sivarajan M: A Practical Approach Trans- esophageal Echocardiography, PDA, Lippincott Williams & Wilkins, Phila., 2005. ISBN 0-7817- 4349-4. $79.95.
Fink MP, Abraham E, Vincent J-L, Kochanek PM (eds): Textbook of Critical Care, 5thEd., Elsevier Saunders, Phila., 2005. ISBN 0-7216-0335-1. 2358 pages, $199.00.
Montgomery H & Goldsack N: Puzzling Out Anaesthesia, Remedica Publishing Ltd., Lon- don, 2006. ISBN 1-901346-75-7. 96 pages, $14.00.
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