Reviews of Educational Material  |   April 2015
Anesthesiologist’s Manual of Surgical Procedures, 5th Edition
Author Affiliations & Notes
  • Michael J. Avram, Ph.D., served as Handling Editor for this book review.
    Michael J. Avram, Ph.D., served as Handling Editor for this book review.×
  • (Accepted for publication November 12, 2014.)
    (Accepted for publication November 12, 2014.)×
Article Information
Reviews of Educational Material / Education / CPD / Gastrointestinal and Hepatic Systems / Infectious Disease / Pharmacology / Technology / Equipment / Monitoring
Reviews of Educational Material   |   April 2015
Anesthesiologist’s Manual of Surgical Procedures, 5th Edition
Anesthesiology 4 2015, Vol.122, 957. doi:10.1097/ALN.0000000000000555
Anesthesiology 4 2015, Vol.122, 957. doi:10.1097/ALN.0000000000000555
To prepare for my first operating room day as a first-year clinical anesthesia resident, I looked up each of the patients on the schedule, and, in keeping with my training from intern year, did a thorough preoperative assessment before calling my attending. With confidence, I systematically described their past medical/surgical histories, home medications and allergies, and indications for surgery. In response, my attending had a simple but daunting question: “So, what’s your plan for anesthetic management?” My response? Crickets.
Why did I feel so lost? On reflection, I realized that despite having done a fair amount of reading from anesthesiology textbooks during my intern year, most of these covered necessary and important topics (i.e., the anesthesia machine, inhalational anesthetics, and considerations for different types of surgery) in a compartmentalized manner, without giving the reader a sense of how to approach a single case, let alone a set of cases throughout the day, with a specific, detail-oriented plan. Luckily I discovered (or, rather, was variously advised and prodded by innumerable senior residents and attendings to discover) Jaffe’s Anesthesiologist’s Manual of Surgical Procedures. Whether you are a brand new resident or an attending of several decades experience, this is an invaluable resource. It achieves the rare didactic feat of enriching what you know while also deeply shaping how you think about what you know.
In keeping with the previous editions, this book has 15 chapters, each of which covers a major surgical specialty (neurosurgery, thoracic, etc.) and is further broken down into related groups of procedures (i.e., the general surgery section is divided into esophageal, stomach, intestinal, and so on). Each procedure, over the bite-sized course of a few pages, is finally split into two parts: surgical considerations and anesthetic considerations. Of these, while the latter is clearly more relevant to my attending’s initial question, the former is highly valuable in its own way.
Although the surgical considerations are often highly technical and go into details not directly relevant to our practice, I have found them to be personally beneficial with respect to interactions with our surgical colleagues. Jaffe empowers the anesthesia provider to speak clearly, directly, and with proper terminology to those over the drapes. Let us face it: some surgical team members have little to no idea what we do from the head of the bed and notice us only when the patient is either bucking or failing to emerge. By staying actively involved in the case and conversation, which Jaffe uniquely empowers one to do, our surgical colleagues can be reminded that we are integral members of what is truly a team effort.
For my own practice, of course, it is the sections on anesthetic considerations that have proved most useful. Each procedure is helpfully and consistently organized into preoperative, intraoperative, and postoperative sections. Thus, among other things, one can appreciate what (if any) preoperative testing a patient might need, whether a case requires invasive monitoring, and what complications might be anticipated in the postanesthesia care unit. With this structure, the reader is empowered to approach novel cases with a clear sense of what questions to ask, facilitating high-yield discussion and targeted literature review. Happily, despite a plethora of authors, there is a strong sense of narrative unity that is rare in a medical text. In sum, this is a book that is not just meant to be read—it can actually be used!
So, what makes this new edition superior to prior iterations? For one, there are now 316 additional pages, which afford room for updated techniques, such as robotic surgery. However, the most drastic and welcome improvement to the 5th edition comes in the form of its digital companion, which is a significant upgrade from the 4th edition. Whereas the previous version was merely an image of the text, this one (provided by Inkling, an online textbook service available for online and offline access on computers, tablets, and smartphones) is a fully searchable database that can even save annotations for future reference. Although older attendings may never look past the roughly eight-pound hardcopy, the digital platform provides exactly the sort of portability and manipulability that the current and upcoming generations of anesthesiology trainees seek.
To paraphrase Donald Rumsfeld, there are three types of procedures: those I know I have done; those I know I have not done; and those I have not done and do not even know exist. However, by having a resource such as Jaffe to mold my mental framework, I feel well prepared to approach new procedures with confidence, clarity, and a systematic way of thinking. I recognize that I do not yet have a plan for every case I will encounter as an anesthesiologist. However, I have a plan to make a plan and that begins by opening (whether with a page turn, a mouse click, or a screen tap) this new edition of Jaffe.
Douglas Hale McMichael, M.D., Northwestern University Feinberg School of Medicine, Chicago, Illinois.