Fundamentals of Neuroanesthesia (2016)

T he authors of the textbook, Fundamentals of Neuroanesthesia: A Physiologic Approach to Clinical Practice, identify their goals in the preface. First, the book provides information related to physiology and pharmacology that is the underpinning of the practice of neuroanesthesiology. Second, the authors offer practical suggestions and recommendations for the clinical management of patients undergoing neurosurgical procedures. As defined by the authors, the target audience is anesthesiologists with a general anesthesiology practice that includes the care of neurosurgical patients. This textbook clearly meets those goals. The first section of the book, chapters 1 through 11, address the anatomy, physiology, and pharmacology that provide the foundation for the practice of neuroanesthesiology. Each of the chapters addressing a specific area—anatomy, physiology, monitoring of the nervous system, intracranial volume, cerebral ischemia, cerebral protection, and fluid management—follows a similar structure. The initial section of the chapter contains a review of the relevant scientific knowledge. The depth of information presented is appropriate to provide an effective refresher for the anesthesiologist familiar with the subject matter. It does not provide the depth or breadth of information to fully inform a physician with no prior knowledge of the subject. Because all anesthesiologists are familiar with each topic, this approach is on target. The later portion of the chapter goes on to provide clinical implications and applications of the information reviewed in the earlier section of the chapter. The material is very readable, well illustrated, and informative in a manner that a busy clinician would find very helpful. The second two-thirds of the book includes chapters addressing specific clinical scenarios. The chapters cover neurosurgical procedures: tumor resection, pituitary surgery, neurovascular procedures, radiosurgery, central nervous system imaging, epilepsy surgery, spine surgery, posterior fossa surgery, and awake craniotomy. In addition, other chapters in this section cover specific clinical situations: traumatic brain injury, neurocritical care, airway management in patients with cervical spine disease, and ethical considerations. These chapters also follow a similar format. Each author first provides a review of the clinical condition including the impact of the neurologic pathology on the perioperative plan or the unique aspects of a specific procedure as it impacts the anesthetic management. Following this section, the authors provide recommendations regarding perioperative management of these patients. The evidence supporting the recommendations is presented but not in an exhaustive fashion. At times, a reader may find themselves wondering why a specific technique is recommended or why some other technique is not described. However, this format allows each chapter to be brief, ranging from 7 to 16 pages, succinct, and something a practicing clinician can read relatively easily in preparation to manage a specific patient. Considering that the goal of this text is to provide readable user-friendly practical recommendations rather than to be a reference text for neuroanesthesiology, this tradeoff is effective. There is some redundancy in this section of the textbook with topics covered in multiple chapters. For example, awake craniotomy management is described in 3 chapters by different authors, the chapter on stereotactic procedures, chapter on epilepsy surgery, and the chapter devoted to awake craniotomy. Similar duplication occurs in describing positioning for neurosurgical procedures, which is covered in the chapter on posterior fossa surgery as well as the chapter focusing solely on positioning. This redundancy does allow an anesthesiologist to choose one chapter to review and receive all the desired information without being referred to additional chapters. Chapters in this clinical application section are variable in the depth and breadth of information presented as well as the focus of the author with some authors addressing the underlying pathology or implications of the procedure extensively with briefer comments on specific anesthetic issues and others focusing most on perioperative management. The differing approaches are not problematic. A reader simply needs to be aware that when they read one section, it may not provide exactly what they expect based on what they read and learned from a prior chapter. This textbook is an excellent resource for anesthesiologists both in practice and those trainees on neurosurgical anesthesiology rotations. It is well written, well illustrated, and very readable. It provides an excellent review on topics important in managing patients with neurologic disease and an excellent starting point for someone with interest in digging in greater depth into these topics. Susan Black, MDDepartment of AnesthesiologyUniversity of Alabama in BirminghamSchool of MedicineBirmingham, Alabama[email protected]