Anesthesia for Cardiac Surgery

Abstract

Anesthesia for Cardiac Surgery, J. A. DiNardo, ed. Stamford, CT: Appleton & Lange, 1998, 0-8385-0253-9. 417 pp, $105.00. This second edition of Anesthesia for Cardiac Surgery is designed to provide the background information and approach necessary for the sophisticated and informed evaluation and management of patients undergoing cardiac surgery. Thirteen well organized chapters cover the topics of preoperative assessment; interpreting cardiac catheterization data; monitoring; anesthesia for myocardial revascularization; anesthesia for valve replacement in patients with acquired valvular heart disease; anesthesia for congenital heart disease; anesthesia for heart, heart-lung, and lung transplantation; anesthesia for pericardial disease; anesthesia for surgery of the thoracic aorta; management of cardiopulmonary bypass; mechanical circulatory assist devices; myocardial preservation; cardiac surgery; and the central nervous system. All of the chapters except for two were written by J. A. DiNardo. The chapter on anesthesia for surgery of the thoracic aorta was written by B. J. Cammarata, and the chapter on cardiac surgery and the central nervous system was written by B. J. Hindman. The most impressive feature of this book is that it is not only practical, but also theoretical and analytical, referring to the relevant cardiovascular physiology and pathophysiology of each disease and to the mechanism and detailed characteristics of the drugs used (e.g., to improve bradycardia in myocardial revascularization, for equal increases in heart rate, atropine will cause a greater reduction in the duration of diastole and will compromise subendocardial perfusion to a greater degree than a beta1-adrenergic agent). In that sense, this book is useful and informative for experienced anesthesiologists, residents, and fellows. Each chapter contains an ample number of simple and beautiful figures, which are especially helpful to residents trying to understand the complicated anatomy and surgical therapy of congenital heart disease. In the chapter on monitoring, transesophageal echocardiography (TEE) is especially well discussed, in a concise, easy to understand format. Plain but precise TEE examinations and the up-to-date automated border detection (ABD) method are covered. Practical, detailed schematic views of the multiplane probe at the different levels of the esophagus and stomach are included. Chapters 4-9 are enlightening and provide useful instruction of how to perform various anaesthetic procedures. Again, the chapters are organized to review the relevant physiology and pathophysiology of each disease, to outline the concrete and specific goals, and to describe a specific anesthetic plan from preoperative preparation through induction and maintenance of anesthesia to postcardiopulmonary bypass management. This book is both interesting to read as a textbook and helpful to refer to as a manual. However, because the authors describe a specific anesthetic plan for each disease, there is a lot of overlap, and the same references are cited many times, which one might find tedious. The authors introduce both old and current controversy (e.g., the coronary steal of isoflurane, glucose management in the perioperative period, acid-base management during cardiopulmonary bypass, hypothermic versus normothermic heart surgery). They provide opposing references in a neutral perspective and offer their own suggestions. In the last two chapters, "Myocardial Preservation" and "Cardiac Surgery and the Central Nervous System," different authors introduce new topics and controversy. The issue of hypothermic versus normothermic heart surgery is especially novel and interesting, introducing a somewhat different perspective to the neurologic safety of normothemia itself. Although Hindman introduces up-to-date theories of hypothermic brain protection, such as the prevention of glutamate release and attenuation of free radical formation, in addition to the reduction of the cerebral metabolic rate, the review of brain protection by barbiturates seems inadequate. Compared with the discussion of inhalational anesthetics and narcotics, that of propofol anesthesia is rather poorly written. Because propofol is increasingly being used in cardiac anesthesia and in perioperative sedation, more information about propofol anesthesia in cardiac surgery, especially when discussing the anesthesia for myocardial revascularization, would have been desirable. It is regrettable that our knowledge of anesthetic-induced ischemic preconditioning is too recent a topic to be reviewed adequately in this book. In summary, this is a well written and practical text of cardiac anesthesia with adequate information. Not only residents and fellows, but also more experienced anesthesiologists, will find it useful and informative. The price does not seem expensive in light of the content and beautiful print. Shin-ichi Nakao, MD Koh Shingu, MD Department of Anesthesiology; Kansai Medical University Hospital; Moriguchi-shi, Osaka 570-8507, Japan