Positioning in Anesthesia and Surgery. 3rd ed

Abstract

Positioning in Anesthesia and Surgery. 3rd ed., John T. Martin and Mark A. Warner, eds. Saunders, Philadelphia: WB 1997, ISBN 0-7216-6674-4, 345 pp, $75.00. Positioning in Anesthesia and Surgery, is a multi-authored, hardcover book with minimum overlapping of information among chapters. It is divided into seven different sections, with each section having between one and five chapters. It is easy to read and well referenced, and the chapters are well illustrated with clear drawings by Roy E. Schneider. Section I discusses the general principles of surgical positioning of an anesthetized patient, followed by an overview of the basic operating Table withits various modifications. Subsequent chapters in Sections II-V describe the process of positioning an anesthetized patient in the desired surgical posture, i.e., supine, prone, lateral decubitus, sitting, and lithotomy, in a stepwise fashion. The physiological changes brought about by these positions in an anesthetized patient are well discussed. This book makes it quite clear that the process of getting an anesthetized patient to a desired position is a team-work approach requiring communication, coordination, meticulousness, and vigilance among operating room workers. Section VI describes positioning in special conditions because of unique surgical requirements, e.g., extracorporeal shockwave lithotripsy in waterbath or in nonwaterbath. Similarly, positioning in various patient populations, e.g., morbidly obese, pediatric, pregnant and geriatric, is well described. Their special needs, i.e., technical difficulty in handling the morbidly obese, guarding against hypothermia while positioning a pediatric patient, supine hypotensive syndrome in the obstetric patient, degenerative diseases of the geriatric population, and altered physiological state with its attendant implication in positioning are well discussed. In Section VII, possible predisposing factors and mechanism of nerve injury during the perioperative period and quick and reliable ways of diagnosing major peripheral nerve injury are described. Finally, Chapter 21 in Section VII discusses the medico-legal consideration and reminds the clinician to keep adequate documentation regarding surgical positioning for future reference. In summary, as Dr. Martin states in the introduction, "Outlining specific techniques for establishing a surgical postures can be 'cook-bookish.' Potentially, the practice implies that the reader will accept the presentation as the definitive standard for that maneuver, condemn all other alternatives, and attempt to enforce compliance thereto. Such an interpretation we neither intend nor support." To that end, this book provides the reader with ample information in achieving a particular surgical posture, its physiological implications on the anesthetized patient, and ways and means of avoiding potential complications arising from the position. This book is highly recommended for anesthesiology department libraries so that clinicians can use it as a quick reference guide to bring about desired patient outcome. Gaury S. Adhikary, MD Theodore J. Sanford, Jr. MD Department of Anesthesiology; University of Michigan; Ann Arbor, MI 48109-0048