Practical Trends in Anesthesia and Intensive Care 2019

Field: Medicine (Health Sciences)

The 14-chapter book Practical Trends in Anesthesia and Intensive Care 2019, edited by Davide Chiumello, is a multiauthored collection of texts on intensive care and anesthesia. Because the book lacks a presentation or preface, the rationale behind the choice of themes and its intended audience is unknown. Chapter 1 addresses the role of the heart in preventing the weaning of patients from mechanical ventilation. The comparison between the cardiovascular changes of weaning and strenuous exercise provides the basis for managing heart failure. The role of echocardiography in stratifying, predicting success, and diagnosing failures of spontaneous breathing trials is conveniently illustrated. Next, the handling of infections caused by microorganisms resistant to multiple drugs is reviewed in Chapter 2. There the reader will become familiar with the vast universe of multiresistant pathogens and their confrontation in critically ill patients. The role of antimicrobial stewardship programs in the intensive care unit (ICU) is emphasized. In sequence, the anatomical and pathophysiological bases of diaphragmatic dysfunction and its impact on the weaning from mechanical ventilation are outlined in Chapter 3, which also brings a well-illustrated, didactic presentation of ultrasonography for noninvasive diagnosis of diaphragmatic dysfunction. The book further includes a review of the pharmacology of neuromuscular blockers and their antagonists, in Chapter 4, which, although bringing little new information, may serve as an introduction for novices. In sequence, extracorporeal circulation and its dilemmas in acute respiratory failure management are detailed in Chapter 5. For readers unfamiliar with the theme, this chapter may be epiphanic. The subsequent Chapter 6 traces the management of acute asthma exacerbations in children from the initial examination and treatment in the emergency room until intensive care unit admittance. The chapter also includes detailed dosing regimens for bronchodilators and a critical appraisal of mechanical ventilation modalities. The seventh chapter, about anesthesia outside the operating room, reiterates the importance of management, routines, high-quality equipment, preanesthesia evaluation, and proper monitoring for safe practice. Then Chapter 8 describes the anatomy, assessment, devices, and techniques used to deal with the pediatric airway. The absence of illustrations makes this chapter more appropriate for readers already acquainted with the anatomy, devices, and techniques described in the text. The well-illustrated, scholarly written Chapter 9 addresses the rationale, monitoring, techniques, and complications of goal-directed fluid therapy. The authors have been very successful in addressing the controversies surrounding the theme. Chapter 10 outlines acute ischemic stroke management and summarizes the decision-making process steps in an attractive flowchart. Guidance is also provided for dilemmas frequently faced in treating acute ischemic stroke patients, for example, managing blood pressure, timing endovascular treatment, and transporting the patient to reference centers. The pathophysiology, risk factors, clinical presentations, and prophylaxis of delirium in the immediate postoperative period or the ICU are reviewed in Chapter 11, with remarks on the role of dexmedetomidine in the pharmacological management of delirium. Chapter 12 describes the preoperative evaluation of cardiovascular, respiratory, renal, and hemorrhagic risks of major abdominal surgery patients. Unfortunately, the lack of a standardized layout for tables and illustrations results in an unpleasant reading experience. In contrast, Chapter 13 consists of a scholarly written, engaging text on monitoring the depth of anesthesia in surgical and ICU patients. The authors describe the various electroencephalographic (EEG) patterns, the available monitors, and the methods of assessing analgesia in anesthetized patients. Chapter 14—How Do I Prepare Myself and My Staff for a Difficult Airway?—promises an emphasis on team preparation and crisis management. However, readers may feel disappointed by the marginal contribution of those topics to the chapter’s content. The book would also have benefited from in-depth proofreading to avoid the cognitive overload impinged on readers by typos like “single burst (DBS)” in Chapter 4 or by weird grammatical constructions like the endless single-sentence paragraph in Chapter 8, For these considerations, it is clear that one of the priorities for the operator is to identify children with potential difficult airways in order to program, if possible, the procedure with lower risks and the most appropriate pharmacological approach preparing the most suitable material for the management of the child, and considering the possibility of a secondary transport to a pediatric center for children with known malformative disorders or previous difficulties who need an endoscopic surgical approach for the management of the airway or a postoperative management in a pediatric intensive care unit. Despite its limitations, the book may interest students and residents in their first steps into intensive care matters or even more experienced physicians engaged in continuing education efforts. Getúlio R. de Oliveira Filho, MD, PhDDepartment of SurgeryFederal University of Santa CatarinaFlorianópolis, Santa Catarina, Brazil[email protected]; [email protected]