Trauma Anesthesia, 1st ed.

Abstract

Trauma Anesthesia, 1st ed. Smith CE. New York: Cambridge University Press, 2008. ISBN: 978-0-521-87058-0, 606 pages (hardback), $99.00. Major trauma still represents a leading cause of death and disability despite the fact that remarkable advances have been made in the understanding and treatment of the severely injured patient. State-of-the-art medical care for this group of patients always requires a multidisciplinary “team” approach involving many different medical specialties. The modern anesthesiologist plays a key role on the trauma team because of their responsibility for airway management, obtaining vascular access, blood and fluid resuscitation, treatment of coagulopathies, prevention of hypothermia, insuring adequate anesthesia and analgesia, as well as optimizing mechanical ventilation. Anesthesiologists caring for the acutely traumatized patient face difficult challenges that need to be rapidly assessed and managed on an urgent basis. The first edition of Trauma Anesthesia edited by Charles E. Smith, MD, FRCPC provides a broad overview of all relevant topics related to the modern trauma care. The book consists of 37 chapters written by an international collection of clinicians all of whom are involved in the management of patients experiencing traumatic injuries. Although most authors are from the United States, Canada, and the United Kingdom, some contributors are from South America, Australia, and Europe. The chapters are comprehensive, readable, and address numerous issues and specific topics related to trauma care. Numerous black and white figures and tables effectively illustrate the text. Every chapter closes with a collection of multiple-choice questions for self-examination. After an introduction of the mechanisms and demographics of trauma care, the subsequent chapters deal with anesthetic considerations in the management of the traumatized patient. A detailed approach with illustrative figures is provided for one of the most challenging and troublesome responsibilities of the anesthesiologist, namely acute airway management of traumatized patients. The third chapter is dedicated to the pathophysiology of shock as a major cause of morbidity and mortality after major trauma. The underlying physiologic mechanisms that influence fluid resuscitation are also discussed. Subsequently, challenges in establishing vascular access, monitoring, fluid and blood therapy, optimizing pharmacologic therapies, treating brain injuries in adults and pediatric patients, as well as spinal cord, musculoskeletal and cardiac trauma, and burn injuries, are discussed in a series of well-balanced chapters that are a mixture of up-to-date scientific information and the clinical experience of the specific authors. Special attention is focused on the pediatric and the elderly patient populations, as well as trauma occurring during pregnancy. A timely chapter dealing with field (war) anesthesia and military-related injuries is also presented. Trauma care always implies critical care and includes important topics such as mechanical ventilation of critically ill patients (according to the International Trauma Anesthesia and Critical Care Society recommendations), which are discussed in a practical and concise manner. An underdiagnosed problem is chronic pain after traumatic injuries. A chapter in the book gives an excellent overview of regional anesthetic techniques, as well as conservative and invasive pain therapies for managing posttraumatic pain, which can lead to permanent disability (i.e., chronic pain) if it is inadequately treated. In a separate chapter, the use of ultrasound for peripheral nerve blocks is discussed as a useful adjunct to conventional neural blockade techniques. However, in some instances, the quality of the provided ultrasound images does not represent the current level of ultrasound imaging. A brief introduction to other applications of diagnostic ultrasound, namely echocardiography for assessing cardiothoracic injuries and abdominal sonography, is also provided. The last two chapters of the book discuss important issues, such as trauma systems, triage procedures, trauma team training, and the role of trauma simulation. In summary, Trauma Anesthesia is a comprehensive textbook that provides extensive knowledge regarding the field of modern trauma care. The lack of color images is easily overcome by the tremendous amount of provided information. In our opinion, the book is a “must have” for every anesthesiologist who is involved in the care of acutely traumatized patients. Lukas Kirchmair, MD Volker Wenzel, MD, PhD Department of Anesthesiology and Critical Care Medicine Innsbruck Medical University Innsbruck, Austria. [email protected]