Cardiology for Anesthesiologists (International Anesthesiology Clinics 50, Number 2, Spring 2012).

Abstract

Advances in pharmacologic and invasive techniques have vastly transformed the general practice of cardiology into one with very focused subspecialties. Anesthesiologists must adapt to these advances, as our patients present to us with treatment modalities that are ever changing. Cardiology for Anesthesiologists explores several advances and describes their corresponding anesthetic considerations.In the tradition of International Anesthesiology Clinics, Cardiology for Anesthesiologists is not a comprehensive conglomerate of all things cardiology. Rather, it is an assortment of independent topics, each written by its own group of authors. The reader should not expect to learn how to interpret an electrocardiogram or how to treat new onset atrial fibrillation. The preface explains this by describing this text as one that stays off the “beaten path” and attempts to introduce fresher topics.The book succeeds in this goal by presenting several topics that are not commonly covered in current anesthesiology texts, such as “When Cardiac Patients Need ECT” and “Inflammatory Diseases and the Heart.” “Perioperative Hypertensive Crisis: Newer Concepts” describes current literature and pharmacologic treatments and emphasizes the importance of evaluating pulse pressure rather than just suggesting a threshold for treating systolic or diastolic hypertension. In “Robotic-Assisted Cardiac Surgery,” the text leaves its strict cardiology theme. It presents a history of robotic surgery and current cardiothoracic techniques. The chapter “Congenital Heart Disease in the Adult” includes an eight-page table that briefly describes the anatomy and perioperative considerations for caring for these patients. It is a solid review, but it is not likely to be enough of a resource to help practitioners who seldom anesthetize this population formulate an anesthetic plan.A thorough discussion of modern monitoring techniques is presented in the chapter entitled “Monitoring Hemodynamic Risk in Remote Locations.” This chapter is disguised as an overview of treating ill patients outside the operating room, but is actually a review of modern invasive and noninvasive monitors, including the physics behind them. The chapter provides good descriptions of the technologies, but the devices would be better introduced in the operating room until a comfort level is achieved to allow their employment in remote locations. “Severe Heart Failure and Mechanical Circulatory Support” presents current data on the efficacy of commonly used monitors, such as pulmonary artery catheters, and describes newer treatments, including percutaneously placed ventricular assist devices.“Cardiac Electrophysiology Procedures in Clinical Practice” should not be considered to be a review of how to care for a patient with a pacemaker or automatic implantable cardiac defibrillator. The reader will not find an answer to the question, “To magnet or not to magnet?” Instead, the chapter presents an excellent review of the anatomy and physiology of arrhythmias, the electrophysiology procedures used to treat them, and suggestions for corresponding anesthetic plans.While the topic of anticoagulation therapy in the patient with a recent history of primary coronary intervention is widely available for review, there is no discussion in the text contrasting the algorithm for withholding anticoagulants perioperatively in patients with bare metal versus drug-eluding stents. When selecting a text entitled Cardiology for Anesthesiologists, the audience would likely expect a discussion of this topic. However, because these algorithms change regularly, as they have recently, they quickly become outdated and are not included here.In summary, Cardiology for Anesthesiologists is a text that will be of greatest interest to the anesthesiologist who wishes to learn about several focused topics in cardiology without having to read through well-covered themes, such as treatments for coronary artery disease and chronic hypertension. It is not written as a reference book for all cardiology topics. Instead, it introduces new topics and covers some less-discussed pathologies that are still of importance, including a great discussion of the treatment of patients with cardiac tamponade. I would highly recommend this book as an adjunct to traditional anesthesiology texts.