Anesthesia and Transplantation.

Abstract

Professor of AnesthesiologyDepartment of AnesthesiologyUniversité Catholique de LouvainBrussels, BelgiumDeKock@anes.ucl.ac.beAnesthesia and Transplantation.Edited by Michael D. Sharpe, Adrian W. Gelb. London, Ontario, Butterworth-Heinemann, 1999. Pages: 560. Cost: $125.00.As an anesthesiologist who is involved in liver transplantation during my on-call time, it is with pleasure that I review this interesting and particularly well-written textbook. The publication is multiauthored and contains 22 chapters that are 15 to 30 pages in length. Contributors are respected experts in the field of transplantation. These authors are not solely anesthesiologists, but are also surgeons, intensive care physicians, immunologists, nephrologists, infectious disease physicians, endocrinologists, ophthalmologists, psychiatrists, pharmacologists, pathologists, and transplant coordinators. This multidisciplinary approach largely contributes to the strength of this book. Moreover, all of these experts point out what is really relevant to the clinical practice of transplantation within their particular field of interest. Each chapter begins with an outline, which provides the reader with an opportunity to scan the content for a desired topic. All of these elements make this book a particularly useful and pleasant tool for physicians who are interested in transplantation medicine.The early chapters discuss the history of organ transplantation, organ resources, the determination of brain death, and the management of organ donors. The first chapter is very interesting and deserves particular comment. This chapter considers both the North American and European perspective regarding organ resources. The two following chapters are well structured and essential information is summarized in tables. The next chapter is dedicated to mechanical devices—a bridge to transplantation. Although very well illustrated, this chapter considers only heart transplantation. A note considering the artificial liver could have been an interesting addition.In the core of the book, some seven chapters review the specific organs used in transplantation: the heart, lung, lung, liver, small bowel, pancreas, kidney, and cornea. These chapters are well organized, clear, informative, and easy to read. They follow approximately the same architecture: history, reason to perform organ transplantation, pathophysiology of the recipient, surgical technique, and anesthetic management. I have only a few regrets. First, there is no chapter that discusses bone marrow transplantation, a procedure that frequently involves anesthesiologists. In the anesthetic-technique section, there is no mention of the recent developments (e.g., the use of new volatile agents or opioids), but this omission is not a major problem. In the chapter regarding liver transplantation, there is no section dedicated to the particular problem of fulminant hepatitis and cerebral protection.The final chapters span important topics related to transplantation, including intensive care unit management, anesthesia in the patient undergoing transplantation, nutritional support, hematologic and psychosocial considerations, immunosuppression, infectious diseases, pharmacokinetic, and ethical issues. These topics are well presented and are full of useful information. The degree of overlap in this book is surprisingly low.In conclusion, despite a price that is relatively high, this book is worth the investment. Anesthesia and Transplantation contains a lot of information that is directly related to clinical practice and, therefore, should be available in the library of any department of anesthesiology in which transplantation procedures are performed.