Atlas of Anesthesia Volume V: Subspecialty Care.

Field: Medicine (Health Sciences)

Assistant Professor, Department of AnesthesiologyWake Forest University School of MedicineMedical Center BoulevardWinston-Salem, North Carolina 27157ldean@wfubmc.eduAtlas of Anesthesia Volume V: Subspecialty Care., Series Editor: Ronald D. Miller. Volume Editor: Stanley Muravchick. Philadelphia, Current Medicine, 1998. Pages: 214. Cost:$135.00.In the production of this series of atlases, the editors intend to provide visual assistance in the learning and retention of a vast body of information. Information is beautifully depicted in graphs, tables, charts, radiographs, microslides, photographs, illustrations, and algorithms. The authors and editor of this volume have done a wonderful job of achieving their goal to “convey critical concepts through carefully selected visual images.” I do not think this series of volumes should be used as an initial teaching tool for students or residents, but is an excellent adjunct to a complete textbook.The Subspecialty Care volume is number five of seven in Miller's atlas series. The other volumes are Critical Care, Scientific Principles, Preoperative Preparation and Intraoperative Monitoring, Principles of Anesthetic Techniques and Anesthetic Emergencies, Pain Management, Pediatric Anesthesia, and Cardiothoracic Anesthesia . The present 11-chapter volume is well catalogued by a table of contents that organizes the figures and legends clearly. Each chapter begins with a brief introduction to the historic development and salient aspects of the subspecialty.Chapter 1 is devoted to anesthesia for cardiac surgery. Major aspects of cardiac disease are subdivided to focus on aortic and mitral valve surgery, ischemic heart disease, arrhythmias, cardiomyopathies, and cardiopulmonary bypass. This subspecialty could not possibly be completely covered in a mere 19 pages, but the pertinent issues are well illustrated. The chapter is not intended to be all-inclusive; an entire additional atlas volume is dedicated to cardiothoracic anesthesia.Chapter 2 discusses anesthesia for vascular surgery patients. Dr. Youngberg has divided the chapter into carotid, abdominal aortic, thoracic aortic, and peripheral vascular surgeries. Concise methods of preoperative assessment of vascular patients are presented, including the American Heart Association/American College of Cardiology task force guidelines for noncardiac surgery. The carotid surgery section has useful anatomic depictions of cervical plexus blocks for teaching or reviewing these techniques. The aortic subsection succinctly summarizes the hemodynamic response to aortic cross-clamping and shunting.The authors Firestone begin chapter 3 on organ transplantation by first describing immunology of transplantation and immunosuppressant pharmacotherapy. Summaries pertinent to donor collection and individual organ transplant surgeries provide an easy, quick reference for the anesthesiologist involved with these cases.Drs. Gaiser and Gutsche give an excellent review of the broad field of obstetric anesthesia in chapter 4. Maternal physiology, labor analgesia, fetal distress, complications of pregnancy, postpartum problems, and neonatal resuscitation are discussed. The legends throughout the chapter are descriptive and encompassing.Chapter 5 addresses the subspecialty of orthopedic surgery. Anesthetic issues are clearly and concisely reviewed with an excellent discussion of the pathophysiology of bone cement implantation syndromes and fat embolism. The diagrams of various patient positioning for spine surgery are also very useful.Chapter 6 discusses trauma and massive hemorrhage and consolidates a huge body of information into a small space. The controversial subject of fluid resuscitation in the trauma patient is neatly summarized. Physiologic alterations and care of patients with both head injury and massive hemorrhage are addressed to clearly present the relevant and current controversies in management.Neurosurgery and interventional neuroradiology are addressed in chapter 7, which includes interesting examples of pathophysiologic states in a series of magnetic resonance imaging scans. Graphs nicely depict the effects of anesthetic agents on cerebral blood flow and intracranial pressure. Intraoperative complications involving ischemic and embolic events during intracranial surgery and autonomic hyperreflexia in patients with spinal cord injury are described clearly. There is also a concise summary of postoperative management of electrolyte abnormalities.Chapter 8 discusses urologic and male reproductive surgery and uroradiology and also includes a section on adrenal pathology. The chapter begins with the anatomy and physiology of the kidney, as well as its neurohumeral function. The effect of various anesthetics on renal function is summarized nicely. Presentation and treatment of transurethral resection of the prostate (TURP) syndrome are outlined clearly for good board review. Advantages and disadvantages of anesthetic techniques for lithotripsy are listed clearly.Chapter 9 is dedicated to head and neck surgery and includes a brief section on ophthalmology. This chapter is very detailed and provides wonderful illustrations, radiographs, and photographs of the airway. The physiology of breathing and the airway is depicted with flow volume loops. Graphs show the effects of anesthetic agents on airway neural and muscular activity. Regional techniques for securing the airway and performing peribulbar and retrobulbar blocks are nicely illustrated and make for good references.Pediatric anesthesia and pain management are discussed in chapter 10, providing a review of common pediatric diagnoses and anesthetic issues. The chapter begins with a detailed summary of commonly used anesthetics in pediatrics. Normal vital signs and laboratory values are also listed for varying age groups. All of the charts in this chapter are great references for quick review.Finally, chapter 11 addresses the issue of anesthesia for the elderly patient, including an inclusive outline of physiologic and anatomic differences in this population, as well as alterations in response to anesthetic agents. Interesting epidemiologic data regarding elderly patients and disease patterns are presented. Useful algorithms are included to guide preoperative laboratory assessment and intraoperative monitoring in these patients.I agree with the editors that visual images assist the learning process and allow for greater retention of knowledge. As clearly stated in the preface, this atlas is not meant to be all-inclusive or detailed, but rather a general depiction of the nuances of subspecialty practices in anesthesiology. This goal has been achieved, and this atlas volume is well worth its cost.