Case Studies in Neuroanesthesia and Neurocritical Care, edited by Drs. George A. Mashour and Ehab Farag, offers a unique, clinically relevant perspective to the myriad of textbooks dedicated to the perioperative care of patients with neurologic disease by adapting the popular problem-based learning format. The book is very thorough in its scope with neuroanesthesia sections on supratentorial and posterior fossa craniotomies, intracranial and carotid vascular procedures, functional neurosurgery, spinal and neuroendocrine procedures, pediatric neuroanesthesia, and neurologic sequelae in other patient populations, as well as extensive neurocritical care sections (including general critical care issues, subarachnoid hemorrhage, stroke, intraparenchymal hemorrhage, traumatic brain injury, seizures, neuromuscular disorders, and end-of-life issues). The information presented on each of these topics is both clinically relevant and up to date. For example, the aneurysm clipping section includes not only chapters on the frequently covered areas of preoperative evaluation, neuroprotection, and intraoperative rupture management, but also has specialized chapters on awake fiberoptic intubation for the patient with an unruptured intracranial aneurysm and intraoperative fluorescence angiography. Some interventional neuroradiologic procedures also are included, such as intracranial aneurysm coiling and intraarterial thrombolysis for acute stroke. A formal section on interventional neuroradiology could be added to the next edition of this textbook to provide for a more comprehensive discussion of the perioperative care of patients with neurologic disease. The readability of the text is facilitated because the topics are covered in a very complete manner, but not excessively detailed. Readers wanting more in-depth handling of a particular area can easily refer to the concise, cited references listed at the end of each chapter (typically 5–10 peer-reviewed articles). Many of the authors are from the University of Michigan or the Cleveland Clinic and this offers a fresh perspective while still maintaining accuracy. Many of the more traditional neuroanesthesiologist and intensivist authors are cited in the up-to-date references. Occasionally, more detail (or a specific reference) would be useful to the reader. For example, instead of noting the use of one small intravenous dose of adenosine for transient circulatory arrest during intraoperative intracranial aneurysm rupture, updating the next edition with a dose range from the literature could allow for more surgical flexibility. Finally, the rare occurrence of potentially confusing wording (e.g., criteria for extubation with a negative inspiratory force less than 25 cm H2O) can be easily corrected in subsequent editions of this textbook. As noted in the book's preface, residents and fellows are the primary targeted readers, and with its well-planned and organized discussion of various topics, it is ideally suited for this audience. We plan to incorporate this new book into our neuroanesthesia fellows' early reading at Northwestern University. The book's coverage of rarely encountered diseases and situations, such as myasthenic crisis, Guillain-Barré syndrome, and neurosurgery during pregnancy, is very helpful in ensuring familiarity with these unusual situations if the trainees have not encountered these challenging cases during their clinical training. This textbook is also well suited to the more experienced anesthesiologist and other anesthesia providers whose routine practice does not include patients with neurologic disease but who need to maintain and expand their knowledge in this area for when they are confronted with these cases during emergency situations. Our staff of experienced neurosurgical anesthesiologists and intensivists at Northwestern will incorporate some of the clinical scenarios into our weekly problem-based learning–formatted neuroanesthesia rounds involving both the residents and fellows. The text is more widely applicable than the title would suggest. With a compilation of challenging clinical scenarios and surgical patients, the principles for anesthetic management also apply equally well when these patients present for nonneurologic procedures. Principles from the chapter “Complex Spine Surgery for a Jehovah's Witness,” for example, can be adapted for the Jehovah's Witness patient presenting for other major surgical procedures. Similarly, complications such as venous air embolism and trigemino-cardiac reflex, although frequently associated with neuroanesthesia, also occur during nonneurologic procedures. The broad applicability of the material in this text, combined with the easy readability and case-based format, also make this textbook a valuable addition to the armamentarium of anesthesiologists preparing for their oral board examinations. With its case-based format, Case Studies in Neuroanesthesia and Neurocritical Care is a perfect companion to the standard neuroanesthesia reference textbooks that delve more deeply into the scientific basis of neuroanesthesia. The comprehensive coverage of the perioperative management of patients with neurologic disorders presented as case studies is rooted in scientific principles and current practice techniques. This book is clinically relevant to a broad range of both general anesthesiologists and neuroanesthesiologists, as well as anesthesia trainees. Laura B. Hemmer, MD Antoun Koht, MD Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago, Illinois [email protected]
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Apr 22, 2012
W Powers 
Open Access