Postoperative Care of the Critically Ill Patient

Abstract

Department of Anesthesiology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263.James C. Eisenach, M.D., EditorPostoperative Care of the Critically Ill Patient, edited by T. James Gallagher, M.D. Baltimore, Williams & Wilkins, 1995. Pages: 502. Price: $99.00.This book addresses the most common problems encountered by high-risk surgical patients when treated in the intensive care unit. The book contains 18 chapters, written by 22 contributors. The chapter on immediate needs of the postoperative patient serves as an introduction to the most relevant chapters. Monitoring techniques are presented as a broad overview of methods used in intensive care. The chapters on pain management and sedation and the use of neuromuscular blockade detail the physiologic and pharmacologic basics and offer useful guidelines for their use in critical care. The information in these two chapters will be welcome by intensivists without anesthesiology training. Other chapters include the perioperative stress response, fluid therapy, acute electrolyte imbalance, and acute renal failure. Sections on myocardial ischemia and infarction, acute airway problems and postoperative ventilatory support, oxygen delivery and utilization, postoperative sepsis, posttraumatic head injury, management of the obtunded patient, postoperative bleeding, deep venous thrombosis, and pulmonary embolism complete the book.Each chapter is introduced with a case report followed by a brief description on pathophysiology, assessment, and management. Most chapters do not provide an in-depth discussion on pathophysiology, which makes for a very useful tool for clinicians who need a quick reference for practical information. Margin notes highlight the most relevant information of the paragraphs. The overall quality of the chapters is good, although the areas on decision-making and goal-oriented management are discussed superficially. In general, the chapters have an adequate number of references with current literature citations.The book is presented in a well-organized format. However, chapters on postoperative pulmonary and cardiac dysfunction in the high-risk patient, as well as the management of hemodynamic information, multiple organ failure, postoperative acid-base imbalance, and nutritional support would have been welcome. In addition, a discussion on the discrepancies of recent clinical trials on "supranormal hemodynamics" and recommendations based on these recent studies would have complemented nicely the chapter on oxygen transport.The chapter on postoperative myocardial ischemia, although well written, does not cover the topic. This chapter has an extensive discussion on preoperative cardiac risk assessment, but does not address the incidence of postoperative myocardial ischemia and infarction in different high risk surgical populations and the different clinical approaches that have been attempted to decrease the incidence of the problem.The strength of the book lies in its easy readability, the relevant facts provided in the margin notes, and the valuable information offered for a clinician searching for a rapid source of practical information.In summary, this book will fulfill the needs of medical students and residents who are introduced to the management of critically ill surgical patients. In addition, it can be a useful tool for physicians preparing for a board examination.Pedro A. Mendez, M.D., Oscar A. de Leon-Casasola, M.D., Department of Anesthesiology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263.