Spinal and Epidural Anesthesia

Abstract

Spinal and Epidural Anesthesia Wong CA, ed. New York: McGraw-Hill Medical Companies. ISBN:0071434322X. 363 pp. $99.00. To date, a monograph solely devoted to neuraxial anesthesia that links the practical aspects of management to their scientific foundations has not existed. Individual chapters from general, regional, and obstetric anesthesia textbooks discussed aspects of spinal and epidural anesthesia, but a single comprehensive work has been lacking. Cynthia Wong’s Spinal and Epidural Anesthesia is a highly referenced, well-organized examination of the breadth of neuraxial anesthesia and its role in modern clinical practice. The first half of the book covers basic spinal anatomy, physiology, and neuraxial techniques, as well as the pharmacology, contraindications, and complications of spinal and epidural anesthesia. While these six chapters provide an excellent foundation and discussion of basic principles, much of this material can be found in other sources. Nevertheless, these chapters progress logically, read evenly, and make excellent use of summary tables and figures. The book’s first half successfully synthesizes much of what is known and has been published on spinal and epidural techniques. Of novel interest is the second half of the book, wherein the use of spinal and epidural techniques in major surgical subspecialties is examined. Each of these chapters reads like a review article exploring available evidence, patient selection, local anesthetic and adjuvant choices, and advantages and disadvantages of neuraxial techniques in specific subspecialty areas. Most of these chapters are exceedingly well supported, several containing more than 100 primary references. The books’ later chapters cover the use of spinal and epidural anesthesia for ambulatory, pediatric, orthopedic, gynecologic, obstetric, general, cardiothoracic, and major vascular surgery. Neuraxial analgesia for labor, postoperative pain, and chronic pain states are similarly covered. The real utility of these chapters is that they present context-specific considerations of spinal and epidural anesthetics within subspecialty surgical areas. While some repetition of material is to be expected, and is acknowledged in the book’s preface, this allows each chapter to serve as stand-alone reference sections, which may eliminate searching the rest of the book for pertinent information. One of the most well-referenced chapters, Postoperative Neuraxial Analgesia, reviews both randomized controlled trials and meta-analyses comparing morbidity and mortality for epidural versus general anesthesia. This discussion objectively presents the outcomes-based evidence for perioperative neuraxial anesthesia and analgesia. Another chapter, Neuraxial Blockade for Obstetric Surgery, is similarly notable for its thorough synthesis of the literature. For example, the long-standing debate between selection of ephedrine or phenylephrine for maternal hypotension is clearly addressed by presenting relevant meta-analyses of available randomized controlled trials. These chapters leave the reader with the belief that thorough review of available evidence has been conducted. Detracting slightly from its content is the book’s visual appearance and material quality. Its small print and colorless tables and figures give the work a dated, drab appearance compared to many modern publications that flaunt vivid photography and computer-generated illustrations. Paper quality is low, which creates an inexpensive impression. Despite its valuable content, given the $99.00 cover price, readers might wish to receive more for their money. The book may be recommended and is of use to all in the field of anesthesia, including providers in private and academic practice, attendings and trainees, and student and certified nurse anesthetists. In summary, Spinal and Epidural Anesthesia is a novel and important contribution to the clinical literature. It succeeds in providing comprehensive discussion of neuraxial fundamentals while at the same time linking spinal and epidural techniques to clinical domains beyond regional and obstetric anesthesia. Hugh M. Smith, MD, PhD Denise J. Wedel, MD Department of Anesthesiology Mayo Clinic Rochester, MN [email protected]