Practical anaesthetic management- The art of anaesthesiology. 1st Edition


Saru Singh, MD, PGDHM1, Pranav Bansal, MD2, Sharma Ruhi, MBBS, DNB3
 

1Associate Professor; 2Professor and HOD; 3Resident

Department of Anesthesiology, BPS GMC, Khanpur Kalan, Sonepat (India)

 

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Correspondence: Dr. Saru Singh

405/12, Krishna colony, Gurgaon. Haryana.

Mob no. 08607312112; E-mail: drsarusingh @gmail.com

 

C Philip Larson Jr, Richard A Jaffe (Springer international, Switzerland) 2017, 152 pages, $ 109.00 (USD)(paperback), $ 99.79  (USD)(Kindle), ISBN-10: 3319428659, ISBN-13: 978-3-319-42865-9, published in Oct 2016

The “Practical anaesthetic management- The art of anesthesiology” as stated by the authors, is not a textbook, rather an interesting collection of selected key topics. This book is based on long standing experiences of clinicians with an aim to make the art of anesthesia more safe, effective and efficient.

Dr C Philip Larson Jr. is Professor emeritus in Anesthesia and Neurosurgery at Stanford University. Since 1962, he has been making an extensive contribution to literature, focused on domains of airway management, inhalation anesthesia, pulmonary dynamics, hematological and oxygenation concepts. This book reflects his philosophy of fortifying clinical practices with recommendations based on scientific evidence and clinical experiences.

His co author, Richard A Jaffe, is also Professor of Anesthesia and Neurosurgery at Stanford University Medical Center and has comprehensive research to his credit, catering his wide area of expertise.

Aptly named “The Art of Anaesthesiology”, the book is motivated by the fact that evidence-based medicine is imperfect in both content and quality. The clinical outlook of the book improvises the approach to the practically encountered issues, making it quite useful for the practicing anesthesiologists. The language of this 20 chaptered book is fairly easy to read and understand even for a novice in the field. Illustrations, pictures, graphs and videos have been provided for better understanding. The first chapter describes interactions with the patient, check points in pre-operative evaluation and consent which may work to strengthen the trust and enhance comfort of the patient. Picturesque description of series events and complications encountered while induction of anesthesia may help in enhancing clinical skills of the reader.

 

The section on laryngeal mask airway provides hands on insight into its use, trouble shoots and discussion among the variants with regards to clinical scenarios. In the chapter entitled “Essentials of airway management”, the authors recommend that anesthesiologists should aim to master a select number of techniques rather than aiming to know all. Steps to airway management have been discussed in great detail that may successfully overcome almost any difficult airway scenario. The key problems in routine practice of anesthesia have been discussed in detail, including methods of anesthesic induction, tracheal intubation, the potential for perioperative pulmonary aspiration, including management of laryngospasm and bronchospasm. The section on cricothyrotomy describes real life scenerios encountered in most adverse circumstances that warrant timely scalpel intervention. Additionally, case scenarios on tension pneumothorax sensitize readers about the time frame when hesitation or human error could cost a life despite aggressive management strategies. The common practices on nitrous oxides have been evaluated scientifically, recommending safer practices using newer agents like sevoflurane. The revival of meperidine, peri-operative strategies for obese patients, preventive measures for ischemic optic neuropathy, diffusion hypoxia and fire accidents have been well-described in different chapters. On the foundation of expertise, evidence and skills, the authors describe best clinical practice for epidural and continuous spinal anesthesia.

In a similar book on case-scenarios entitled “Clinical Anesthesia- Near Misses and Lessons Learned,” authors John G. Brock-Utne et al discuss clinical experience in 62 cases with solutions and recommendations. Yet, in another book “Complications in Anesthesiology”, Lobato, E. B et al have layed section formats focused on different systems. Here, the anesthetic complications have been described as case scenerios followed by addressal of all these issues in clinical question-answer format, giving it an upper hand due to its wider and methodical coverage of topics.  Though, more clinical issues have been touched in the latter two books, the work of Larson & Jaffe is an appreciable effort in compiling the potentially valuable practices that are at risk of being lost to future generations.

As disclosed, several chapters of the book are a revised compilation of articles that first appeared in the publication “Current reviews in clinical anesthesia”. Although there are no discernible inadequacies in the book, the topics have been chosen according to authors’ experience, and placed in a sequence without any clear organ system format. In the next edition, it would be more meaningful if additional chapters on different clinical scenerios are included in a systematic format and practice questions be added to reinforce abstract thinking. The paperback format at $109.00 may appear little overpriced, however upon reading the content, knowledge, effort and experience put in by the authors, it seems appropriate.

To summarize, this book is a compilation of Anaesthesia practices which are clinically indispensible but lack peer reviewed published evidence. Therefore, this book should be read by all interested in improving their practice of anesthesia. This book may prove helpful to resident as well as practicing anesthesiologists in streamlining and reinforcing their clinical practice.

 

References:
  • Philip, L. J., & Jaffe, R. A. (2017). Practical Anesthetic Management: The Art of Anesthesiology (1st ed.). Cham: Springer International Publishing. doi:https://doi.org/10.1007/978-3-319-42866-6.
  • Brock Utne, J.G (2018). Clinical Anesthesia: near misses and lessons learned. S.l.: Springer International PU.
  • Lobato, E. B., Gravenstein, N., & Kirby, R. R. (2008). Complications in anesthesiology. Philadelphia: Lippincott Williams & Wilkins.