Case Studies in Neuroanesthesia and Neurocritical Care

Abstract

University of Illinois Medical Center at Chicago, Chicago, Illinois. mmuell6@uic.eduEdited by George A. Mashour, M.D., Ph.D., and Ehab Farag, M.D. New York, Cambridge University Press, 2011. Pages: 360. Price: $90.00.Few texts endeavor to specify the perioperative concerns for various procedures and disease states on a case-by-case basis across the breadth of a subspecialty. Fewer still manage to do so while systematically addressing the fundamentals one must understand to appreciate that subspecialty. The unique success of Case Studies in Neuroanesthesia and Neurocritical Care lies in its thoughtful, logical progression through the basics of neuroanesthetic care by way of an interesting and very readable series of clinical vignettes.Well-suited for trainees, Case Studies provides both an overview of subspecialty neuroanesthetic practice and a handy reference for whichever specific cases one might encounter on a given day. From intracranial vascular procedures and major spine cases to functional neurosurgery and carotid endarterectomy, the learner in neuroanesthesia will find both a preview of what a prototypical case entails and a description of common critical events and concerns in the first half of this text. Special attention is given to preoperative assessment and postoperative complications for each class of procedure. Pediatric neuroanesthesia receives its own separate section, as does the discussion of an assortment of neurologic sequelae in other patient populations (including pregnancy, liver failure, and nonneurosurgical procedures).The second half of the text is given over to discussion of the intensive care of the neurosurgical patient. Topics covered include basics of the intensive care unit, such as management of hypotension, mechanical ventilation, and end-of-life issues, as well as common neurosurgical problems, such as vasospasm, hyponatremia, and status epilepticus.Good case selection and the close interrelationship of the neurosurgical intensive care unit and neurosurgical operating suite keep many of the vignettes directly translatable to intraoperative anesthesia care. This section should also be considered essential reading for residents who are primarily concerned with the operating room environment.As with any overview or survey of a subspecialty, caveats regarding the level of detail and depth on any specific topic apply. With two to four pages of text allotted for each vignette, one cannot expect a thorough discourse on the subtleties of either surgical procedures or physiologic principles. In this regard, the editors undertake a significant challenge by including such intricate problems as postarrest cooling and decooling and noncardiac surgery in a patient with a ventricular assist device. Although such topics might be soundly discussed over the course of several vignettes, as the editors do with aneurysm clipping and other major neurosurgical procedures, the brief treatment these topics receive in a single case description do well by mentioning the highlights and recommending other relevant resources. Practitioners who encounter these entities in practice hopefully have a robust appreciation of the complexity involved with their management, and can draw upon the experiences of their colleagues for more guidance.Case Studies in Neuroanesthesia and Neurocritical Care delivers a solid and succinct overview of the subspecialty in a useful and enjoyable format. The book provides ready reference for teaching in the operating room, and will be especially useful for correlation to the day's clinical experiences. It is suitable as a primary text for residents rotating in neuroanesthesia, and deserves a place on the bookshelf of fellows and other learners in neuroanesthesia as well. This is a very successful first iteration of a sound and much-needed approach to teaching the subspecialty of neuroanesthesia.