Anaesthesia in Cosmetic Surgery

Abstract

B. L. Friedberg ( ed .) Cambridge University Press , ISBN 978-0-521-87090-0 , 263 pp ., Price £55 This publication from the Cambridge University Press focuses on an area of medical practice that is almost entirely consumer-driven. The phenomenon of ‘Office-based Anesthesia’ (i.e. not in the hospital setting) is widespread in the USA, and it is from this standpoint that this book is compiled. The editor, and all but one of the chapter authors, are based in the USA, and thus bring a different experience of the issue when compared to readers on this side of the Atlantic. The book comprises 18 chapters, divided into three parts; Minimally Invasive Anesthesia (MIA)®, alternative anaesthesia approaches, and other considerations. The first chapter is entitled ‘Propofol Ketamine with Bispectral Index (BIS) Monitoring’, which is written by the editor. In it, he describes his technique for the administration of anaesthesia for all cosmetic surgery patients, which is explored further in the next few chapters. The remainder of the first, and the second, part contain chapters on local and regional anaesthetic techniques, as well as more conventional forms of general anaesthesia for cosmetic surgery. The photographs and illustrations, although not in colour, complement the text well and the description of local anaesthetic blocks in head and neck surgery is excellent. The third part deals with more diverse topics. There is a very extensively referenced chapter on psychological aspects of cosmetic surgery, and a series of chapters on the economic, political and medicolegal aspects of office-based practice. Although these are written from an American perspective, it is interesting to see these topics addressed in a medical text. In the changing world of healthcare provision, an appreciation of these issues will be vital. Anesthesia in Cosmetic Surgery is written in a relatively personal style. This brings the advantage of readability, and allows the chapter authors to demonstrate the principles behind their own practice clearly and persuasively. Nowhere is this more apparent than in the chapters contributed by the editor. This personalised style allows Dr Friedberg to offer a detailed ‘recipe’ for his own trademarked technique, with information boxes offering checklists, tips for success, and pitfalls to avoid. This style of writing has drawbacks, however. The personalised, almost didactic, style has a tendency to read as a treatise to justify the author’s point of view, rather than a balanced summary of the evidence. A passage in the preface reads, ‘The reader who demands level 1 study to accept new solutions to clinical problems is reminded that neither aspirin nor penicillin ever had a level 1 study to validate their efficacy.’ Perhaps not, but if introduced today, a study of this kind would be necessary. This reviewer does not doubt the efficacy of the MIA® technique, but I found that the style of the argument detracted from the usefulness of the message. Does this book deserve a place on your bookshelf or in your departmental library? If you practice in this area, or have an interest in anaesthesia outwith the traditional hospital setting, then this book will provide much food for thought. You may even adopt the editor’s own anaesthesia technique. If, however, you are looking for a balanced overview of the subject, then you may wish to look elsewhere.