In trauma, time matters; so much so that traumatologists often refer to the “Golden Hour”: the most valuable time in which one can save a life. If you had just 1 book to read in the Golden Hour to prepare for a trauma, then Essentials of Trauma Anesthesia by Varon and Smith is an excellent book to consider. The second edition, edited by Albert J. Varon from Ryder Trauma Centre in Miami, FL, and Charles E. Smith from MetroHealth Medical Centre in Cleveland, OH, is a concise overview of both basic and advanced trauma topics. It contains contributions from a broad list of trauma anesthesiologists practicing in both the United States and Canada. The softcover book is light; while not as small as a pocket book, it is easily smaller than a traditional textbook, making it ideal for on-the-go reading. A digital version of the textbook is also available. The organization of the chapters is well structured, starting with the basics, and moving through various organ systems, and finishing with specific patient populations. Furthermore, the summary at the end of each chapter highlights key points well without being overly inclusive. Discussion surrounding the pathophysiology of tissue injury, coagulopathy, injury patterns, and sequelae early in the book is in depth and clinically relevant without being overwhelming. The latter half of the book is dedicated to organ system–specific trauma: reviewing goals, anesthetic considerations, and surgical concerns for each injury pattern. The authors give a good review of management strategies for different types of injury, breaking it into approaches to the preoperative, intraoperative, and postoperative phases. They review specifics surrounding airway management, oxygenation, and ventilation goals, specifics with regard to anesthetic technique, as well as hemodynamic and fluid management. Discussions about prehospital care, initial evaluation, and a decision-tree style well-written general trauma approach are excellent guides to how to care for the severely injured patient. The information presented in these chapters is up-to-date and includes current guidelines in traumatic brain and spinal cord injury, resuscitative endovascular balloon occlusion of the aorta, and pelvic fractures. The end of the book contains chapters dedicated to changes in management for 3 specific populations: obstetrics, pediatrics, and geriatrics. The text does a thorough job of describing changes in management in each of these populations, highlighting specific concerns and what to be wary of during initial management. Chapter introductions are very useful, containing brief reviews of the physiological and pharmacological changes that occur in these vulnerable patient populations. Unfortunately, the chapters about vascular access, regional anesthesia, and echocardiography fall short of their stated goals of teaching specific applications of these anesthesia skills in the trauma patient, and the descriptions were often lacking in certain details that flesh out the procedures. The paucity of diagrams and figures makes these chapters unable to stand on their own. Clinicians will require supplemental materials and online resources to better understand how to perform these skills. In fairness, these 3-dimensional skills that require haptic and visual feedback are very difficult to learn from a 2-dimensional resource. Specific blocks tailored to the trauma patient (eg, intercostal block, hematoma block, rectus sheath block, erector spinae block) may be a more achievable goal in a handbook format. Similarly, which specific echocardiographic views are best to assess various patterns of trauma would have been useful. However, we did appreciate some of the novel techniques discussed including ultrasound-guided subclavian access, intraosseous devices, and thromboelastography. Mass casualty incidents such as the management of chemical, biological, nuclear, or terrorist threats were unfortunately not included with this current iteration, but which in our modern age, will need to be addressed moving forward. Despite trauma being a ubiquitous part of anesthetic practice, it is often overlooked or taught in a patchwork during residency. Much has changed in trauma practice over the last 10 years, and the new generation of anesthesiologists should be taught the key fundamentals necessary to provide optimum care. Essentials of Trauma Anesthesia sets out to give a concise, systematic overview about all aspects of trauma anesthesiology, and it does this well. The second edition is an essential read for any junior resident preparing for busy nights on call, senior resident preparing for board certification, or clinicians looking for a good review of current concepts in trauma management. The experienced traumatologist may be surprised what they can learn from this text; it is a valuable learning tool for trainee and veteran anesthetists alike. Navraj S. Chima, MD, FRCPCLaura V. Duggan, MD, FRCPCDepartment of Anesthesiology and Perioperative CareUniversity of British ColumbiaVancouver General HospitalVancouver, British Columbia, Canada[email protected]
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Jul 16, 2024
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