Perioperative Care in Cardiac Anesthesia and Surgery.

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Associate Professor Department of AnesthesiologyWake Forest University School of MedicineWinston-Salem, North Carolina 27157dzvara@wfubmc.eduPerioperative Care in Cardiac Anesthesia and Surgery. By Davy C. H. Cheng, Tirone E. David.Austin, Lanes Bioscience, 1998. Pages: 247. Cost: $45.00.Perioperative Care in Cardiac Anesthesia and Surgery is a pocket-size spiral-bound manual. This book is the combined effort of 40 contributors, all of whom are from either the University of Toronto or the Toronto General Hospital, Toronto, Canada. The manual includes 40 chapters that are grouped into four major sections:“General Introduction into the Toronto General Hospital Cardiac Surgical Program and Fast Track Cardiac Surgical Procedures,”“Anesthesia for Cardiopulmonary Bypass Management,”“Surgical Technique and Postoperative Considerations,” and “Postoperative Cardiac Surgical Unit Management.” There is an extensive appendix and an adequate index.The authors summarize their subject in the introduction:“This handbook describes the perioperative management of adult patients who undergo cardiac surgery at our center.” The text is largely a compendium of practice management paradigms that involve patients who present for cardiac anesthesia and surgery at the contributors’ two institutions. The book thus represents “the Toronto way.” The introductory chapter outlines the authors’ institutions’ combined cardiac morbidity and mortality rates for 11,112 patients undergoing cardiovascular operations with use of cardiopulmonary bypass from 1993 to 1997. The overall operative mortality rate for the period was 3.4%. Data regarding mortality by surgical procedure and significant morbidities are outlined clearly in the first table. These data provide the foundation for the authors’ recommendations throughout the book. From their experience in a successful, busy cardiothoracic surgery practice, they describe techniques and make recommendations that practitioners everywhere can apply.The individual chapters are well-written and follow a basic outline format. Each chapter is approximately 2–10 pages, with an average length of 3 or 4 pages. There is heavy use of tables and lists, but surprisingly few diagrams. The tables and lists serve as quick references for specific problems clinicians may encounter. These are especially helpful in certain infrequent events. For example, Chapter 12 is a handy reference for clinicians who rarely, if ever, have an occasion to use nitric oxide. The majority of chapters discuss the material adequately; however, on occasion, the text is basic and general and is best suited for a resident or a fellow at the first stages of training in cardiothoracic anesthesia and surgery. Several of the chapters, however, provide excellent in-depth information. In particular, Chapter 17, “Intra-aortic Balloon Pumps,” and Chapter 20, “Valvular Heart Disease,” are particularly well-written.The book’s strength is its ability to present a large amount of information in a concise format. The appendices are particularly helpful, especially for managers in a cardiovascular intensive care unit and section heads of cardiothoracic surgery or cardiothoracic anesthesia programs who design and implement accelerated recovery programs. Each chapter ends with a short list of suggested readings. Although these supplement the reader’s research pool, the text itself does not have references. I consider this a troubling omission. On many occasions, a particular fact or figure is given for a disease condition, but these statements are not referenced, and, therefore, readers must further investigate or verify statements on their own. A second edition would be strengthened by an abbreviated reference list.Drs. Cheng and David have provided a well-written reference manual. Perioperative Care in Cardiac Anesthesia and Surgery is a comprehensive work, including the preoperative, intraoperative, and postoperative course of patients presenting for cardiothoracic surgery.