Clinical Anesthesia Procedures of the Massachusetts General Hospital


Clinical Anesthesia Procedures of the Massachusetts General Hospital
W. C.Levin, A. M.Allain, T.Alston, P. F.Dunn & J.Kwo ( Eds ) Lippincott Williams and Wilkins , Philadelphia , 2010 , ISBN 978-1605474601 , 728 pp . , Price £34.95

Despite the availability of quick and widespread access to electronic resources to most clinicians, a good handbook may often provide relevant and immediately useful information. This eighth edition of Clinical Anesthesia Procedures, written, reviewed and updated by anaesthetists from Massachusetts General Hospital, blends the right combination of peri-operative care and safe administration of anaesthesia in a succinct manner. The book is mainly written for novice anaesthetic trainees. Although this 728 page, soft-cover book is not precisely pocket-sized, its 20.5 × 14.5 cm size makes it easy to carry and handle.

One of the first parts of the book is the Recommendations for Pre-anesthesia Checkout Procedures (US – 2008), which differs significantly from the Association of Anaesthetists’ checklist published in 2004. Then, as for previous editions, the manual is composed of 40 chapters divided into three sections: (i) Evaluating the Patient Before Anesthesia; (ii) Administration of Anesthesia; and (iii) Perioperative Issues. It concludes with an appendix, Supplemental Drugs Information, and a table, Common Intravenous Antibiotics.

The organisation is clear and compact, and the style of writing is uniform throughout. The chapters are notable for their consistency and brevity: most are 16–20 pages long, allowing one to complete a chapter in a brief sitting. Every paragraph starts with key words highlighted in bold font, which helps to identify the topic, stress important concepts and visually break up the pages. The references at the end of each chapter are up-to-date but not numbered, so readers who wish to pursue a particular topic in more depth may find them difficult to explore in relation to the text.

British readers will notice obvious differences in units of measurement and some epidemiological or local practices, reflecting the authors’ US perspective. For instance, Creutzfeldt-Jakob disease is not mentioned in the Transfusion Therapy chapter, and flucloxacillin is not included in Common Intravenous Antibiotics whereas cefazoline is recommended as first choice for peri-operative antibiotic prophylaxis. Nevertheless, these are unlikely to be more than minor distractions.

The first part offers a comprehensive review of a variety of co-existing medical conditions. The chapter on Specific Considerations with Cardiac Disease conveniently includes a small sub-section about pacemakers and heart transplant patients for non-cardiac surgery.

The second part provides a detailed and accurate description of safety in anaesthesia, the anaesthetic machine and monitoring. The majority of chapters contain mostly text, though there are a few pictures and tables, e.g. Mapleson circuits and central venous pressure tracing. The pharmacology of intravenous and inhalational anaesthetic agents is covered in a separate chapter; however, many drugs are covered very superficially, and some relevant practices such as total intravenous anaesthesia and opioid-based anaesthesia are not adequately addressed. The chapters dealing with pharmacology and practical issues relating to neuraxial and regional blocks are very good, although the images and illustrations of the different regional blocks are not a major strength of the book.

The next 16 chapters cover clinical approaches to the most commonly encountered anaesthetic problems, including speciality topics such as thoracic, vascular, cardiac and head and neck surgery. These chapters are also succinct, and thus are not an exhaustive discussion of each topic; however, the essential points are included and useful clinical ‘pearls’ are included throughout. Other chapters discuss the specific management of paediatric and geriatric patients, day case surgery, Trauma and Burns, and Anesthesia Outside the Operating Room. I particularly enjoyed Anesthesia for Abdominal Surgery which includes bariatric surgery, liver transplantation and retrieval of organs after brain death.

The final section covers postoperative care, resuscitation and pain. In addition, information about alternative medicine, medical ethics and end-of-life issues is included.

Overall, this text serves as an excellent overview of peri-operative anaesthesia and the fundamental principles of anaesthetic practice. This well-priced theatre book meets its goal of being easily readable, and contains an incredible amount of knowledge within its pages, making it a useful reference for anaesthetic trainees in particular.