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Reviews of Educational Material  |   April 1995
Anesthesiologist's Manual of Surgical Procedures
Author Notes
  • Assistant Professor of Anesthesiology, Department of Anesthesiology, Case Western Reserve University School of Medicine, 2078 Abington Road, Cleveland, Ohio 44106.
Article Information
Reviews of Educational Material
Reviews of Educational Material   |   April 1995
Anesthesiologist's Manual of Surgical Procedures
Anesthesiology 4 1995, Vol.82, 1088-1089.. doi:
Anesthesiology 4 1995, Vol.82, 1088-1089.. doi:
Carol A. Hirsbman, M.D., Editor
Anesthesiologist's Manual of Surgical Procedures. Edited by Richard A. Jaffe and Stanley I. Samuels. New York, Raven Press, 1994. Pages: 948. Price: $90.00.
Jaffe and Samuels provide an anesthesiologist's view of an extensive array of surgical procedures and their anesthetic implications. This book probably will become a staple in anesthesia education and practice because of its unique scope and format. However, unevenness in coverage and some editing bugs need to be worked out in the meantime.
Anesthesiologists and residents will find the book useful, because it exceeds many other works in breadth and depth of coverage. The format facilitates either a quick review or more extensive study, with each section containing both the surgical and anesthetic considerations for one procedure (including pertinent references from each discipline). Nonphysicians will find the book approachable, too, because it is so clearly written. Anesthetists, of course, as well as nurses, physician assistants, and technicians will find information here to supplement their prior training and add to their understanding of perioperative patient care.
Each section opens with a surgeon's description of the procedure, followed by the indications for operation, probable diagnoses, etiology, and associated illnesses and anomalies. Patient position, length of the case, and estimated blood loss are listed. Potential postoperative surgical complications and their relative frequencies follow, along with estimates of the expected severity of postoperative pain. Anesthesiologists then continue each discussion, beginning with detection and management of abnormalities likely to need special preoperative attention. Intraoperative anesthetic care follows, including the relative merits of possible anesthetic techniques, anticipated blood and fluid losses, need for nonroutine monitoring, and other specialized anesthetic issues. Potential intraoperative events are detailed, including prevention and/or management strategies. Anesthetic complications (intraoperative and postoperative) are presented, followed by suggestions for postoperative pain management.
The sections on burns, management of the organ donor, and adult and pediatric neuroanesthesia are particularly well done. The pediatric cardiac chapter is quite good, but seemed incomplete without PDA (patent ductus arteriosus) ligation, coarctation, and operations for single ventricle-type lesions (Fontan, Glenn, Norwood). Pediatric radiation therapy is nicely covered. Additional nonoperating room procedures (e.g., interventional and pediatric radiology, cardiac catheterization) would be useful, because the anesthesiologist participates in these procedures more frequently. Intraoperative radiation therapy is alluded to in the text but should have been included as a separate procedure with its own details.
The editors assume basic knowledge of anesthesia practice on the part of the reader; this generally works well, though there are slips into jargon that some readers will not understand. For example, the necessity of "a nurse trained in labor and delivery" to assist with intraoperative monitoring is a shorthand way of saying that the pregnant patient undergoing this procedure should be monitored (by the nurse) for the onset of labor and for evidence of fetal distress. That inference will not be obvious to all. The term "local" (anesthesia) in one place seems to mean "paracervical block" and in another means "regional anesthesia" and can be confusing.
Information about the anesthetics appropriate for a given procedure could be covered more consistently and explicitly. The optimum dermatome level of spinal or epidural block is stated in most but not all sections. Usually, there are clear discussions of the merits of general anesthesia versus alternatives. In a few places there is neither a discussion of the relative indications nor a statement about their equivalency.
Many sections of the book offer splendid detail regarding potential intraoperative events or physiologic perturbations that will (or might) occur during a procedure, but there is still unevenness. In several areas, I found myself wanting more detail regarding blood loss and blood ordering, for instance. The potential for large blood loss was alluded to for several operations, but the specifics regarding which structure might bleed at what part of the case (or in which patient) were not uniformly addressed. For one procedure, the authors state that transfusion is rarely required yet, in their preoperative discussion, list the need for a crossmatch. The rationale for these apparent quirks is probably obvious to the writers, but further detail about these areas would increase the utility of the book as a reference for those practicing outside the authors' institution.
The surgeon-authors include "unique considerations" and "special instrumentation" listings for each procedure. For example, they list the types of bowel staplers needed or the "best" instrument with which to procure an iliac crest bone graft. Some of this information is of no importance to anesthetic management and could have been omitted. Several surgical descriptions could be streamlined without sacrificing the overall intent of the book.
Additions to the text might include the rationale for the stated antibiotics, because formulary and purchasing decisions (or allergies) often mandate a drug switch. Perhaps "scope of desired coverage" is more important than listing the currently favored drug. Noting which procedures require bacterial endocarditis prophylaxsis for susceptible patients would assist anesthesiologists, as would information about which procedures require a bowel preparation. Although covered in detail in coexisting disease texts. I was surprised at the omission of blood glucose management during pancreatectomy for insulinoma. The need for and timing of platelet transfusions during splenectomy for idiopathic thrombocytopenic purpura were not mentioned. Preoperative management of extreme polycythemia in the tetralogy of Fallot patient was not discussed. All are issues I expected to be covered, given the intent of the book.
The outline format and chosen typefaces make this volume easily readable. Most of the illustrations are useful. The organization of information is logical. A more extensive index would be helpful, although the existing one led me to my destinations eventually.
Although the production aspects of the book are adequate, the editing is not. The numerous typographic errors and occasional lapses in grammar are disappointing, as is the appendix of abbreviations and acronyms. MH is defined there as malignant hypothermia. NO as nitrous oxide, and MAC as maintained anesthesia care, among other unique definitions.
The copy-editing errors should be corrected before another printing and a more substantial reworking done before the next edition. All in all, this is a very good book. An operating room suite copy would be well read by the entire staff.
Christine A. Jordan, M.D.; Assistant Professor of Anesthesiology; Department of Anesthesiology; Case Western Reserve University School of Medicine; 2078 Abington Road; Cleveland, Ohio 44106.