Cardiac Anaesthesia; Thoracic Anaesthesia

Abstract

Cardiac Anaesthesia Barnard, M. & Martin, B. OUP, Oxford , July 2010 , ISBN 978-0199209101 , 624 pp., Price £42.99 Thoracic Anaesthesia Wilkinson, J., Pennefather, S. H. & McCahon, R. A. OUP, Oxford , July 2011 , ISBN 978-0199563098 , 786 pp., Price £44.99 Cardiac Anaesthesia and Thoracic Anaesthesia are new books in the Oxford Specialist Handbook series. They are pocket-sized, making them easy to carry around (and lose). Cardiac Anaesthesia has a protective plastic cover, perhaps reflecting the greater blood loss anticipated in such cases. Readers familiar with the Oxford Handbooks will not be surprised by the layouts: succinct prose with plenty of bullet-points. The inclusion of ‘Key Points’ boxes is useful where they appear, as are the ‘Further Reading’ references. There are also sufficient blank pages and spaces to allow personal annotation. This is divided into three parts. ‘The Cardiovascular System’ covers anatomy, pharmacology and physiology; ‘Organ System Implications of Cardiac Surgery’ includes chapters on the inflammatory response and infection; and ‘Clinical Practice of Cardiac Anaesthesia’ reviews investigations, monitoring and postoperative management before looking in detail at key cardiac operations. The chapter on transoesophageal echocardiography is useful with clear pictures. There is also an extensive chapter on paediatric congenital heart disease, with wonderful illustrations, but no chapter on grown-up congenital heart disease. There is a short final chapter on cardiac disease in pregnancy, but it lacks sufficient practical anaesthetic advice. The authors have aimed to cover a vast amount of material. As with all multi-author productions there are strengths and weaknesses, but overall this is a very good book that fulfils the aims set out in the editors’ preface. It covers a lot of key subjects for the Final FRCA and explains concepts that are poorly explained in other exam texts (pacemakers, alpha stat versus pH stat), but is perhaps too detailed and expensive to buy purely for revision purposes. Its availability would benefit every trainee during their cardiac module and some will want their own copy for their future career. We believe it would be of value to anyone caring for ‘high-risk’ adult patients undergoing major surgery. This is divided into 12 chapters. The first three cover physiology, anatomy and pharmacology. Whilst their inclusion is perhaps inevitable, and they focus on aspects relevant to practising clinicians, they exist perhaps more as an aide memoire than a primary source. The pharmacology chapter is particularly impressive at nearly 100 pages, outdone only by the following one on pre-operative assessment, which accounts for 20% of the book. Then come the chapters on the procedures, including emergencies, followed by ‘Management of intra-operative problems’ and ‘Critical care and the post-operative patient’. The final chapter, ‘Techniques in thoracic anaesthesia’, provides a focused review of the practical aspects of care. That this book is 749 pages long, compared with the 570 pages of its companion volume, should give some indication of the amount of repetition. Repetition is of course inevitable, and also useful (when we call it ‘consolidation’), but we couldn’t help feeling, when ploughing through the book for the purpose of this review, that the editors hadn’t quite struck the right balance. Having said that, ‘in real life’ this book would be dipped into by readers who may well be glad that each section has it all, without the need for constant cross-referencing. To some extent the editors have tried to ameliorate the problem through highlighting blocks of text to focus the reader. Interestingly, the section on the ECG was longer than its counterpart in Cardiac Anaesthesia– did they get mixed up in the OUP offices? This book is certainly comprehensive and contains everything necessary for the thoracic anaesthetist and trainee. It would benefit, perhaps, from more brutal editing. Certainly it would benefit from more illustrations, and also from standardised use of the commonly used units for partial pressures, creatinine, etc, rather than have one author use mmHg and the other kPa, for example. One can’t help wondering if a combined Cardiothoracic Anaesthesia may have been possible. Surely the decision to produce two books wasn’t just a cynical marketing ploy?