Perioperative Care in Cardiac Anesthesia and Surgery.

Abstract

Baylor College of Medicine, Division of Cardiovascular Anesthesiology at Texas Heart Institute, Houston, Texas. ccollard@heart.thi.tmc.eduPerioperative Care in Cardiac Anesthesia and Surgery. Edited by Davy C. H. Cheng, M.D., M.Sc., F.R.C.P.C., and Tirone E. David, M.D., F.R.C.S.C. Philadelphia, Lippincott Williams & Wilkins, 2006. Pages: 526. Price: $74.95.Although labeled as a first-edition text, this book is in reality an outgrowth of a small, portable “handbook” first published by Landes Bioscience in 1999 under the same title and editors. In contrast to the original handbook, which was primarily based on the contributors' clinical experience at the Peter Munk Cardiac Centre in Toronto, the current book has grown to include both contributors from outside institutions and a wider breadth of surgical and anesthetic topics relevant to the care of adult cardiac surgical patients (noticeably still absent, however, is the pediatric cardiac surgical patient). Contributors include anesthesiologists, surgeons, intensivists, and perfusionists, reflecting the book's multidisciplinary team approach to the management of the adult cardiac surgical patient.Primarily targeted for the practicing resident or physician, the book assumes a basic level of medical knowledge. For example, there are no traditional chapters on cardiovascular pharmacology and physiology. Instead, the book is composed of 50 chapters divided into six sections, progressing from preoperative assessment and prognostic risk factors to postoperative intensive care unit and ward management. Sections include Introduction, Anesthesia and Cardiopulmonary Bypass Management, Surgical Technique and Postoperative Consideration, Cardiac Surgical Recovery Unit, Surgical Ward Management, and Appendices. Coverage includes up-to-date information on cardiac and neurologic monitoring, off-pump surgery, new devices for anastomosis, robotic surgery, heparin alternatives, blood conservation, management of pulmonary hypertension, and neurologic complications and outcomes. Fifteen appendices summarize key facts, protocols, and clinical decisions. Indeed, the final section contains some of the most useful, hands-on information for the practicing clinician, because this section contains not only the clinical protocols of the Toronto General Hospital and London Health Science Centre, but also cardiovascular drug tables that list the dose, mechanism, physiologic effects, and contraindications of each drug.In general, information within each chapter is presented in bulleted fashion, making the text easily readable. However, like all bulleted texts, the information at times is presented with little or no explanation. Compounding this problem is the fact that there are no references within the chapter text. Instead, there is only a short, unnumbered bibliography at the end of each chapter (usually less than 10 references). Therefore, readers who wish to pursue a particular topic in more depth are basically left to fend for themselves.In addition, there are topics that suffer not only from brevity, but because the information is scattered throughout the book. For example, chapter 8, “Anesthesia for Patients with Ventricular Assist Devices (VAD),” is only 4 pages long and contains no figures. Moreover, it is not until chapter 36 that VAD surgical considerations are presented (which is again only 4 pages long and contains no figures). Therefore, it may be challenging for the true beginner using this book to assimilate the multitude of intraoperative VAD anesthetic and surgical considerations, because there are no figures and because of the nearly 300 pages of intervening text between chapters (as opposed to texts that have a unified chapter on VAD intraoperative considerations, including figures).The first edition of this book also contains errors. For example, in the chapter on “fast-track” cardiac anesthesia (chapter 3), there is a statement that suggests that fast-tracking increases perioperative morbidity and mortality. Similarly, the running title of chapter 14 is mislabeled as the “Essence of CBC and IABP.” Another example is figure 13-3, which is referred to in the text as being the American Society of Echocardiography and the Society of Cardiovascular Anesthesiology recommended 16-segment transesophageal echocardiographic examination of the left ventricle. In fact, it illustrates the myocardial coronary blood flow distribution. However, all of these oversights can be easily corrected in subsequent editions.With the recent decision by the Accreditation Council for Graduate Medical Education to accredit fellowships in adult cardiothoracic anesthesiology, there will likely be a growing need for up-to-date, definitive cardiothoracic anesthesiology texts (especially should the Accreditation Council for Graduate Medical Education also decide to institute a written board examination in the future). Although this book provides an excellent overview of the perioperative anesthetic and surgical management of the cardiac surgical patient, it may not be definitive enough for the full-time practitioner of cardiac anesthesia and surgery. Nonetheless, this book will be a valuable resource for individuals seeking a basic introduction and overview of the anesthetic and surgical management of the cardiac surgical patient.Baylor College of Medicine, Division of Cardiovascular Anesthesiology at Texas Heart Institute, Houston, Texas. ccollard@heart.thi.tmc.edu