Principles and Practice of Obstetric Anaesthesia and Analgesia

Abstract

A. Holdcroft and T. Thomas Blackwell Science, 466 pp. £75 The principles and practice of obstetric anaesthesia all come down to learning and understanding how normal physiological changes, which occur in pregnancy, alter anaesthetic techniques. This book starts with a review of organisational issues surrounding provision of obstetric anaesthetic services and then looks at when things go wrong. This is a good place to start because it puts the rest of the book into perspective. Section two, which occupies almost half of the book, is an immaculate and detailed account of all aspects of maternal physiology. It describes in detail those changes which impact on all anaesthetic techniques in obstetric practice. Without doubt, careful reading of this section puts all anaesthetic procedures that are routinely carried out on the delivery suite into perspective. There is an unusual mixture of normal and abnormal physiology within this section. Mixing the two, for example normal cardiovascular changes in pregnancy, with problems encountered when the mother has cardiac disease, is a good way to teach the subject, but the indexing system lets the book down. Although each chapter has plenty of headings and subheadings within the text, there are no chapter contents at the beginning. This makes browsing through the book difficult, especially as the format is unusual. Section three considers the practice of regional obstetric analgesia and anaesthesia. It is a relatively short section, and although the anatomy and exact techniques of epidural insertion are described, I felt that an up-to-date approach to labour ward analgesia was lacking. The regional techniques for labour analgesia and Caesarean delivery were rather mixed together, and although there are obvious overlaps, I don't think that this book adequately describes how they differ. Section four looks at the practice of general anaesthesia. There is generally a comprehensive approach, but this section typifies the problem of this book. Because there has been such a heavy emphasis on maternal physiology in the first half of the book, and this impacts so heavily on the conduct of general anaesthesia, some very important points have apparently been left out. The most obvious to me is the use of antacid prophylaxis. This subject has been comprehensively covered in the chapter on ‘Gastrointestinal System’ but unless the book has been read in its entirety, then the importance of this subject may be overlooked. The final 100 pages cover in detail the obstetric and fetal issues. The process of normal and abnormal labour must be understood to be an effective obstetric anaesthetist and the book strives to put them into context. This book is an excellent place for the obstetric anaesthetic trainee to start. The first 200 pages cover the principles of obstetric anaesthesia so comprehensively that safe practice must surely follow. As an expensive hardback, the aim of the book must be to find its way onto the Departmental shelf. I can certainly commend its purchase.