Trauma. Vol. 25, No. 1 of Anesthesia Clinics.

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Trauma. Vol. 25, No. 1 of Anesthesia Clinics. Shamir MY, Weiss YG, eds. Philadelphia: Elsevier/Saunders, 2007. ISBN 1-4160-4278-4. 206 pages, $184.00 annual subscription for four issues, $84.00 for a single issue. Anesthesiologists not practicing at a Level I trauma center typically spend limited time considering or treating trauma patients. However, the events of September 11 and the current escalation in urban warfare that impacts many modern cities require all anesthesiologists to take heed of this typically under-appreciated area of study. A consistent theme throughout much of this text is the issue of preparedness. The authors draw from the experiences of September 11, the bombing of the U.S. Marine barracks in Beirut, Lebanon, sarin gas poisoning in Japan, and multiple other incidents that may be smaller in scope but nonetheless have devastating impact. The authors draw attention to the need for appropriate triage and the real possibility of a patient “surge” that can overrun even the best-prepared hospitals. Of particular concern is the treatment of patients who have been exposed to toxic substances, as these individuals can be both critically ill and pose a danger to health care workers. These patients require appropriate decontamination while their caregivers require proper protective equipment. This monograph features focused overviews of airway management and hemorrhagic shock, dealing with multiple areas such as the impact of laryngotracheal trauma, facial fractures, fluid resuscitation, and blood administration strategies. General consideration for the critically injured patient includes a good overview of the mechanisms associated with the development of acute lung injury and its management as well as the role of vasopressors for treatment of patients with hemodynamic instability. The book features a particularly interesting discussion of ‘Nonsurgical Treatment of Major Bleeding.” The use of the terms “nonsurgical treatment” and “major bleeding” in the same sentence initially appeared to be an oxymoron. The authors, however, addressed the utilization of angiography/embolization and various blood component factors, including a detailed discussion of the use of recombinant activated factor VIIa. Most anesthesiologists would probably still choose to allow our surgical colleagues to intervene. However, as innovative technologies advance and specialized blood component therapies become more ubiquitous, these refinements may become a more central part of clinical care. More focused areas of discussion include a review of trauma in the geriatric, obese, and pregnant patients. These chapters provided an excellent summary of the demographics of these patient populations as well as the specific types of injury patterns most likely to be seen in them. A summary of the importance of glucose control was also emphasized in an attempt to improve patient outcomes, particularly in the neurological trauma and critical care setting. The chapter on regional anesthesia acts as a reminder that these techniques can be employed in certain instances in well-chosen patients. The authors might have included more discussion about specific types of traumatic injuries such as head and blunt force trauma. However, they may have intentionally not provided such discussion, since these are commonly covered topics in textbooks on trauma management. Additionally, the arrangement of the chapters seems disjointed. One typically expects the topics that add most to the overall discussion to be placed in a more prominent position toward the beginning of the text. Even though human simulation plays an important role in preparedness, placement of the chapter on simulation in anesthesia within the middle of the text seems out of place, since little new information is provided within this discussion. The editors have successfully addressed a broad scope of topics within the area of anesthesia and trauma. Discussion ranges from innovations in trauma practice to disaster planning and implementation. Emphasis is appropriately centered on the importance that preparedness takes in the successful implementation of any trauma protocol, ranging from an individual motor vehicle accident to trauma due to battlefield engagements, to massive disasters secondary to acts of terrorism. This monograph does an overall good job of providing insight into the areas that were covered, but due to the limitations of scope, should not be considered to be a replacement for standard textbooks on trauma anesthesia and resuscitation. David A. Nakata, MD, MBA Associate Professor of Clinical Anesthesia [email protected] Indira Danturti, MD CA-3 resident [email protected] Department of Anesthesiology University of Indiana School of Medicine Indianapolis, IN