With the neurosurgical workload in NHS trusts increasing, and with neuroscience patients taking up a significant proportion of critical care capacity, a handbook that covers both anaesthesia and critical care, containing concise contributions from leading North American and European clinicians, is a welcome arrival.
Although billed as a handbook, it provides a comprehensive series of diagnostic analyses and structured algorithmic approaches in all key areas. A major strength of the book is its breadth and excellent organisation into 91 short chapters, each subdivided with clear headings and key references to the primary scientific literature. Each chapter is roughly 10 pages long, with the contents nicely summarised in a series of key points, several – e.g. those on ALS protocols and organ donation – relevant to all anaesthetists. Many flow diagrams are provided, illustrating diagnostic protocols for an extensive set of scenarios, and complemented by numerous tables.
I particularly enjoyed the entire middle section labelled ‘Critical Situations’. Each subsection gives reassuring tips on pitfalls and management of crises in brain surgery, spinal surgery and other relevant procedures. Interventional neuroradiology is sometimes too briefly dealt with by other handbooks; however, this publication covers specific concerns regarding anaesthesia in areas remote from theatres and the procedures involved. The section is complemented by excellent neuroradiological images in CT, MRI and most importantly, angiography (3D). There are also a few colour pictures of CT perfusion maps and areas in MRI.
The book touches on topics of current concern, such as the WHO safety surgical checklist and anaesthetic non-technical skills. Indeed, it has a whole chapter on communication challenges and getting the most out of collaborative care in the operating room.
Although EEG monitoring is mentioned, it is surprising that there is no specific mention of BIS throughout the book. Apart from this minor issue, it is difficult to identify any other significant omissions.
Encompassing both adult and paediatric anaesthesia, the book has considerable depth of knowledge and detail that should see it appeal to both consultants and trainees. Inevitably, a North American style is often prevalent and there are frequent details of tests that are conducted more often in the US than Europe. Overall, the book is well written and maintains a nice relaxed layout that makes the material easily accessible at a glance.
In summary, I strongly recommend this handbook and expect that it should find its way onto the book shelves of all neuroanaesthetists, although at £53.99 RRP they should expect to have deep, as well as wide, pockets. The kindle edition comes in at a more modest £35.90.