Clinical Ambulatory Anesthesia

Abstract

Northwestern University Feinberg School of Medicine, Chicago, Illinois. r-boyer@northwestern.eduEdited by Johan Raeder, M.D., Ph.D. New York, Cambridge University Press, 2010. Pages: 194. Price: $ 55.00.There have been a myriad of textbooks and manuscripts written about the practice of ambulatory anesthesia, both as a subspecialty and as a subset of a general anesthesia practice. Unfortunately some authors writing on the subject have had little actual practice experience in the subspecialty. Because currently most surgeries globally are performed on an outpatient basis, for both clinical and financial reasons, it is refreshing to review a text by an author whose clinical and academic focus is the subject of the matter.Johan Raeder serves as Professor in Anaesthesiology at the University of Oslo, and in addition clinically practices ambulatory and office-based anesthesia and trauma care at Ullevaal University Hospital in Oslo. His stated purpose in writing Clinical Ambulatory Anesthesia is to help equip anesthesia providers with valuable tools and practical insight, based on his 30 yr of clinical practice focused on ambulatory and office-based anesthesia in Norway. His intended audience is the postgraduate anesthesiologist as well as, in the United States, certified registered nurse anesthetists. Dr. Raeder's focus is sensible and pragmatic and the short (194 pages) text is basically meant to assist those clinically involved with the daily perioperative care of the ambulatory surgical patient.This is a not an exhaustive review of current controversies and differing opinions, but a well-researched, realistic review of the background and history of ambulatory anesthesia, its basic organization, practical pharmacology, preoperative patient preparation, anesthetic techniques, and postoperative care as well as his anesthesia “recipes” and vision of the future of the subspecialty.The procedure, patient selection, and preoperative patient preparation chapter is exceptionally thorough and the author's methodology regarding presurgical/postsurgical patient information gathering/distribution is excellent. His well-researched, reasonable approach to preanesthesia evaluation could also be applied to most inpatient surgical venues.The well-annotated pharmacology section clearly reflects the author's additional academic and research interest in anesthetic pharmacology and anesthetic depth monitoring. It is complete with excellent tables and graphs, which assist the reader's understanding of this sometimes complex subject.Most chapters of the book, with the exception of that dealing with clinical pharmacology, are written in an almost informal, conversational tone and represent the author's reasonable approach to preoperative, intraoperative, and postoperative anesthesia care.Notwithstanding, there are several current periprocedural anesthesia management conundrums, where the author's beliefs may differ from current suggested practice guidelines in United States. A case in point is the recommended routine “safe” use of droperidol for postoperative nausea and vomiting. Another example of this is his approach to perioperative management of patients with obstructive sleep apnea. In 2006, the American Society of Anesthesiologists published suggested practice guidelines for the perioperative management of patients with obstructive sleep apnea that are fairly more robust than his suggested management paradigm.Nonetheless, this is a very readable reference for the practitioner not particularly desiring extensive data, charts, statistics, or tables, but who is more interested in a practical review of current preoperative, intraoperative, and postoperative ambulatory anesthesia issues and the author's experienced opinion and treatment strategies garnered from his 30 yr of clinical experience practicing anesthesia in Norway.