Applied Anatomy for Anaesthesia and Intensive Care

Abstract

It was a pleasure to review the first edition of ‘Applied Anatomy for Anaesthesia and Intensive Care’ published by Cambridge University Press. A good knowledge of anatomy is essential for practising anaesthetists and critical care physicians; it is fundamental for the safe conduct of procedures such as endotracheal intubation, central venous cannulation, bronchoscopy, tracheostomy, and peripheral and central neuraxial regional anaesthesia. An understanding of anatomy is also essential for the interpretion of imaging investigations. Anatomy as an abstract discipline is almost boundless and not the most stimulating of subjects for most anaesthetists. It does, however, become much more interesting when correlated clinically, and learning is really enhanced by good-quality illustrations. This book provides focused clinical context combined with superb illustrations and images. This has been made possible by the complementary expertise in anatomy, regional anaesthesia, and artwork of the three authors, all of whom are consultant anaesthetists. The book is easy to follow and read. It is published in paperback with 195 pages; approximately one-third of the content is made up of colour pictures, line diagrams, and ultrasound images. There are nine chapters covering the nervous system, spine, head, neck, thorax, upper limb, abdomen, lower limb, and the fetus. We thought that the quality of the illustrations, print, and paper were excellent throughout, although the hand-drawn diagrams, the point-wise description of the anatomy, and the font size may not appeal to all readers. The blocks and procedures are easy to find because they are presented in light purple-coloured boxes. This all makes the book eye catching and stimulates the reader’s interest. The ‘Organisation of the nervous system’ chapter concisely describes the central, peripheral, sympathetic, and parasympathetic nervous system; coeliac plexus block is then described in detail. The chapter on the ‘Spine’ describes the anatomy of vertebrae, caudal epidural block (includes ultrasound images), spinal cord and meninges, pain pathways, the anatomy of the meningeal spaces (epidural and subdural spaces), the vascular supply of the spinal cord, and the anatomy of central neuraxial blocks. The ‘Head’ chapter describes the anatomy of the skull and discusses magnetic resonance images of the brain, the vascular supply of the brain, and the cranial nerves (including trigeminal nerve block) in detail. The anatomical basis of brainstem testing is discussed. The anatomy of the eye, nose, and mouth is followed by a description of eye blocks (subtenon, peribulbar, and retrobulbar) and fibre-optic tracheal intubation. We can recommend the section on fibre-optic tracheal intubation for those about to undergo supervised training of this procedure or, indeed, consultants who use it infrequently. The chapter on the ‘Neck’ describes the fascia, vessels, and nerves. This chapter includes a detailed description of cervical plexus blocks, brachial plexus blocks, and stellate ganglion block. We particularly liked the description of the interscalene approach to the brachial plexus, where the authors describe four landmark-based approaches (Winnie, Meier, Borgeat, and Low), nerve stimulator and ultrasound techniques. The description of the anatomy and the conduct of block was succinct but provided sufficient detail for even experienced consultant anaesthetists to benefit from reading. However, for the supraclavicular block the description was sufficient for the purpose of examination candidates but it lacked finer details. This chapter also covered the anatomy of the airway, cricothyroidectomy, and percutaneous tracheostomy. The chapters on the thorax, upper limb, abdomen, and lower limb follow the same pattern, describing the anatomy, clinical implications, and procedures in detail. The book ends with a two-page chapter on the ‘Fetus’ which describes the fetal circulation. The authors mention that the book is intended as a reference and core knowledge text for the FRCA examinations and for revision and development of procedural skills. The book does indeed comprehensively cover all anatomy topics of the Primary and Final FRCA curricula. It was difficult to find any gaps in potential coverage, but some intensive-care techniques, such as intra-osseous needle insertion, were missed. Likewise, advanced regional anaesthetic blocks, such as interfascial pectoral and serratus anterior plane block, are not described. Another good feature of the book is avoidance of unnecessary repetition; the common indications, contraindications, pre- and postprocedural checks, complications, and anticoagulant advice for regional anaesthesia are described at the beginning rather than being repeated again and again with each block. In summary, the distinguishing features of the book are comprehensive coverage of the FRCA curriculum, beautiful coloured images, and description of ultrasound images with probe position and cross-sectional anatomy. This book is therefore ideal for trainees who are preparing to sit the FRCA examinations. It is also an excellent reference or quick revision textbook for consultants for procedures that they perform on an infrequent basis. It should therefore be in every departmental library.