Book review

Abstract

Moyle, John T. B. This is more than a book on pulse oximetry. It covers a significant amount of cardiovascular and respiratory physiology as well as providing a historical background to the development of the oximeter. The book begins with a rather dry historical account of prototype oximeters and then progresses to optical principles, spectrophotometry and an in-depth explanation of the workings of a pulse oximeter. The content is detailed and often technical, but simple diagrams and graphs are used to good effect and facilitate the understanding of quite complex text (for those of us less technically inclined!). At times an assumption of prior knowledge is made, but in general the text is easy to follow and the physics is well explained. A detailed section on in vivo and in vitro calibrations of pulse oximeters and accuracy will appeal to those physics-lovers amongst us. The physiology of oxygen transport is core knowledge for anaesthetists and is a commonly asked question in both the Primary and Final FRCA, the intricacies of which are not always well explained in larger textbooks. This section in Pulse Oximetry, however, is well set out and is dealt with in a clear and thorough fashion. I enjoyed the section on pulse oximetry at high altitude as this combined the application of knowledge of the oximeter with interesting physiology in a clinical setting, albeit it a different scenario to the one where we usually encounter oximeters. The book also provides a fairly exhaustive list of clinical applications of the pulse oximeter which includes the expected medical conditions such as asthma and COAD, but also discusses its use in surgical conditions such as the assessment of a threatened limb and in obstetrics to assess fetal wellbeing during labour. I thought this clinical section in the book was particularly well thought out and thorough. A significant amount of background physiology and pathology is included as well as a brief discussion of the correct management of each of the different conditions. Topics of particular relevance to anaesthetists include postoperative hypoxaemia in recovery, the effect of pre-oxygenation and the different methods by which it may be achieved and specific conditions such as obstructive sleep apnoea. Importantly, the book contains a chapter on the limitations of pulse oximetry. In order to ensure safe practice and limit morbidity, it is vital to have a thorough understanding of a device that is used by anaesthetists and nurses on a daily basis and which is considered to be an essential monitor during anaesthesia. The book is well set out with clear and appropriate headings. Boxes are used to highlight points and summarise lists of causes which was useful as they stand out visually. Good use was made of diagrams and graphs to explain some of the complex physics. Each chapter contains up-to-date evidence-based material to substantiate the text and this is well referenced at the end of each chapter. The index is thorough and a specific topic may be looked up with ease. In summary, I think Pulse Oximetry is an excellent book. It is a good read for any anaesthetist, but I would particularly recommend it to anaesthetic department libraries, anaesthetic SHO's attempting the Primary and any anaesthetist with an interest in physics.