SECTION EDITOR
NORIG ELLISON
Book and Multimedia Reviews
Anesthesia: Biologic Foundations Port-Access™ Cardiac Surgery for the
T. L. Yaksh, 1998. 0-397-5874-2, C. Lynch III, W. M. Zapol, et al., Anesthesiology
eds. Philadelphia: Lippincott-Raven, 1528 pp., $229.00 Rafael Ortega and Harold Arkoff. Redwood City, CA: Heartport,
Inc., 1998.
Downloaded from https://journals.lww.com/anesthesia-analgesia by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD355ncMJ+5i/aV3gE4zx5215ywzqfigiuBR9Kdf6/lmJHVy6BBjl9KOQ== on 03/31/2020
This is a multi-editored, multi-authored textbook with 134 mainly
American contributors describing the biology underlying anes- This superb CD-ROM, as the back cover states, “interactively illus-
thesia. The textbook addresses biochemistry, histology, physiol- trates the role of the anesthesiologist before, during, and after
ogy and pharmacology as they affect anesthesia and anesthetic Port-Access™ minimally invasive cardiac surgery.” Although not
agents and goes far beyond what is found in all standard text- recommended to the small number of anesthesiologists who rou-
books of anesthesia. The book is mainly intended for the basic tinely perform these challenging cases (they will learn nothing
researcher but also for the clinical anesthesiologist interested in new), the program represents the best introduction to the technique
the basics of anesthetic action and function in complex physio- for the uninitiated. Indeed, the front cover proclaims that the CD-
logical systems. ROM was awarded the First Prize Scientific Exhibit Award at the
The book consists of 81 chapters and is divided in two sections. 1997 ASA and the First Prize Best Instructional Exhibit at the 1997
The first section on cell biology of anesthetic action describes the NYSSA Postgraduate Assembly.
control of cell signaling in 20 chapters and the different techniques The main menu is arranged in five sections: Introduction, Port-
of cell biologic study in 4 separate chapters. In the second section, Access™ Overview, Port-Access™ Endo-CPB System, Guidelines
anesthetic effects on physiological integrated systems are described. for the Anesthesiologist, and Video Library. The short Introduction
Behavioral states such as consciousness, sleep, memory, and recall by Richard Shemin, correctly emphasizes the need for constant
are discussed in 4 chapters, the basic physiology and pharmacology communication among surgeons, anesthesiologists, and perfusion-
of pain in 14 chapters, specific pain disorders in 15 chapters, and ists during these cases. The Port-Access™ Overview section is a
different pharmacological approaches of pain relief in another 7 narrative providing an overview of Port-Access™ coronary artery
chapters. The cardiovascular system is covered in eight and the bypass grafting and mitral valve repair/replacement procedures.
respiratory system in nine chapters. Although this section has no audio, it provides excellent photo-
The attempt by the editors to compile the entire biological basis of graphs and short videos of the instruments and how they are used
anesthesia in a single volume is most impressive. However, this is by the surgeon during these procedures.
not an easy task. A textbook should include all relevant data in an The bulk of the program is in the Port-Access™ Endo-CPB System
area to fulfill its objective as a reference book in that field. In the and Guidelines for the Anesthesiologist sections. The Port-Access™
present volume, most chapters in the second section on integrated Endo-CPB System section provides a detailed description of the
systems are on pain and pain mechanisms—much less space is catheters used in Port-Access™ surgery. It details the endocoronary
given to behavioral states or the cardiovascular and respiratory sinus catheter, endopulmonary vent catheter, endoaortic clamp
systems. Aspects of anesthetic action on other systems, such as catheter, endovenous drainage cannula, and the endoarterial return
the renal, gastrointestinal, immune, and hematological systems, cannula and how they are inserted. For each catheter or cannula,
to name a few, are lacking. Most of the chapters have extensive stellar videos of transesophageal echocardiography and fluoros-
and valuable reference lists, most of them updated to 1995 or copy are provided. The description of the coronary sinus anatomy
1996, although some chapters have references no more recent and the endocoronary sinus catheter is very well done and is a
than 1994. strength of this section. The Guidelines for the Anesthesiologist
Overall, the chapters are well written, uniform, and comprehen- section provides procedural guidelines and recommendations for
sive. The design of each chapter is logical with moderate length and the anesthesiologist, which offer a broad, sequential overview of
clear headings and subheadings. There are well selected, clear, and these procedures from the time the patient arrives at the hospital to
valuable figures and tables. The editors and contributors have also postoperative pain management. Some topics in this section could
done a great job in avoiding unnecessary overlapping and appar- have been omitted or reduced (premedication, induction of anes-
ently divergent opinions. Although the quality of all the chapters thesia, etc.), as they are not specifically linked to Port-Access™
obviously is very high, certain chapters are more easy to digest than surgery.
others. This is explained by the fact that the balance between the The section addressing monitoring during cardiopulmonary by-
presentation of necessary facts and necessary clinical orientation pass was disappointing. The authors state that a detailed discussion
varies among chapters. is beyond the scope of their presentation and offer a list of variables
Anesthesia: Biologic Foundations is a new, exciting textbook that that “must be closely followed during cardiopulmonary bypass.”
summarizes knowledge from different scientific fields of impor- This very important topic should have been covered in more detail.
tance to the understanding of anesthesia and anesthetic effects in a The wisdom of suggesting that patients be extubated in the operat-
way not found in any other textbook in anesthesia. The book de- ing room at the end of these cases is also questionable.
serves a place in any reference library covering anesthesia and The program ends with a video library that contains 88 videos
anesthetic mechanisms. It definitely fulfills the aim for the basic (some seen previously, some new) covering all aspects of Port-
researcher and for all those involved in teaching, but it is also of Access™ surgery. Some could have been omitted (atrial septal
great interest to the clinical anesthesiologist. defects, coronary angiography, assessment of mitral valve repair/
replacement, etc.) as they are not specifically linked to Port-
Access™ surgery. Also included in this CD-ROM is a reference
Hans Blomquist, MD, PhD listing of relevant journal articles, book chapters, and abstracts.
Gunnar Dahlgren, MD, PhD From a technical standpoint, this CD-ROM is very user-friendly,
Department of Anesthesia and Intensive Care easy to navigate, and takes approximately 2 h to view. The quality
Karolinska Hospital of the photographs, videos, and sound is excellent.
S-17176 Stockholm, Sweden This reviewer’s main concern regarding this program is that it
does not provide a balanced view of Port-Access™ surgery. Rare yet
©1998 by the International Anesthesia Research Society Anesth Analg 1999;88:235–6 235
236 BOOK AND MULTIMEDIA REVIEWS ANESTH ANALG
1999;88:235–6
devastating complications of the technique (aortic dissection, right In summary, this book houses a wealth of valuable and practical
ventricular perforation, coronary sinus trauma, etc.) are not dis- information that can easily be reviewed by anesthesiologists of all
cussed. It is extremely controversial whether, as the authors state, levels. Pajewski is to be commended for compressing the plethora of
Port-Access™ cardiac surgery represents a “substantial technical facts found in this text, which is a reference worthy of a place in all
advance.” It remains to be seen whether the technique offers any anesthesiologist’s libraries.
tangible benefits to patients. However, for the novice anesthesiolo-
Andrea G. Schellenberg, MD
gist who wants to learn about Port-Access™ cardiac surgery, this
Department of Anestesia
CD-ROM is a superb introduction.
Hospital of the University of Pennsylvania
Mark A. Chaney, MD Philadelphia, PA 19104
Department of Anesthesiology
Loyola University Medical Center
Foster G. McGaw Hospital
Maywood, IL 60153 Clinical Anesthesia Procedures of the Massachusetts
General Hospital.
W. W. Hurford, M. T. Balin, J. K. Davison, et al. 5th ed.
Anesthesiology Pocket Guide. Philadelphia: Lippincott-Raven, 1997. ISBN 0-7817-1523-7, 916 pp.,
T. N. Pajewski. Philadelphia: Lippincott-Raven, 1997. ISBN 0-7817- $34.95.
0141-4.480 pp. $29.95. The fifth edition of this now classic handbook is intended to aid the
Searching for one’s “peripheral brain” to acquire a drug dose or practitioner at all levels. It clearly is, as the preface states, “not
long-forgotten detail about the anesthesia machine is all too com- intended to replace experienced clinical teaching or substitute for
mon an occurrence among anesthesiologists in all levels of training. detailed study (and assumes some prior knowledge of anesthesia
In Anesthesiology Pocket Guide, Pajewski provides a comprehensive and critical care).”
compilation of data in the form of tables and algorithms that serves This reviewer concentrated on newer areas of anesthesia practice
as an excellent reference manual. The text is not intended to furnish to see how well the book has kept pace and how current it is. In the
detailed anesthetic management, but rather to provide a set of tools area of pharmacokinetics and pharmacodynamics of the newer
and guidelines to be incorporated into one’s clinical practice. In muscle relaxants, sedative hypnotics, and narcotics, this is a su-
keeping with the current trend toward perioperative management, perbly up to date manual. The local anesthesia chapter focuses on
the book contains information pertinent to all aspects of anesthesia what is new, as well as what is old and includes new and improved
care. techniques. However, some areas seem not to be covered in as much
The book is organized into seven major sections that address depth as one would want. For instance, laparoscopic cholecystec-
preoperative assessment, pharmacology, physiology of major organ tomy, laparoscopic hernia repair, and even laparoscopy for gyne-
systems, pediatrics, obstetrics, regional anesthesia, and pain man- cologic procedures do not include as much material or even rudi-
agement. Each major section is then subdivided as necessary, e.g., mentary facts as one would like to review the hazards and risks one
into organ system or drug category. The last chapter contains a should be aware of in these procedures. This may reflect a paucity
complete listing of both adult and pediatric advanced life support of those procedures at Massachusetts General Hospital or, perhaps,
protocols. Overall, the tables and algorithms are easy to use and an area has not been updated as of yet.
readily referenced. Nevertheless, this book is clearly the standard against which
Many of the chapters within this text are excellent; they provide similar manuals are compared. The reference list at the end of the
both depth and breadth about numerous key topics of anesthesia. chapters have generally been updated and are excellent sources for
The chapter on obstetrics is particularly well done, with compre- further reading and, like their chapters, most reflect current prac-
hensive coverage of maternal and fetal physiology and their rele- tice, but some clearly have not been updated for several editions.
vant anesthetic implications and management strategies. This re- Thus, this edition of this now classic manual continues the tradi-
viewer expects that future editions would include ropivicaine as tion of being an excellent quick reference source that should be in
part of the drug armamentarium. Similarly, the sections dealing every anesthesiology work area.
with pharmacology and cardiac pediatric physiology are notewor- Michael F. Roizen, MD
thy. The pharmacology chapter’s extensive tables regarding dosing Department of Anesthesia and Critical Care
regimens and physical properties of medications are very helpful University of Chicago
and likely will be the most used section of the book. Both pediatric Chicago, IL 60637
and adult cardiac physiology and related concerns are concisely
expressed in the tables found in the cardiac section; the same is true
for the very inclusive lists of pediatric syndromes and their anes- Books and Multimedia Received
thetic implications.
Despite the overall excellence of this book, a few changes and/or Receipt of the books and multimedia listed below is acknowledged. Selected books and
additions to some of the chapters would increase its utility. Al- multimedia from this list will be reviewed in future issues of the Journal.
though the airway/respiratory physiology section pays superb at- The Journal solicits reviews of new books and multimedia from its readers. If you wish to
tention to the difficult airway, including anatomic and congenital submit a review, before proceeding please send a letter of intent, identifying the book or
multimedia in question, to Norig Ellison, MD, Department of Anesthesia, Hospital of the
abnormalities, the addition of extubation criteria and proper place- University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283. The Journal
ment of double-lumen endotracheal tubes via clinical assessment reserves the right of final decision on publication.
would augment its comprehensiveness. Furthermore, the usefulness
Dershwitz M, ed The MGH Board Review of Anesthesiology. 5th ed. Stanford, CT: Appleton
of the table of lung segments is questionable. The hematologic and Lange, 1998. ISBN 0-8385-6348-1. 402 pages, $47.95.
physiology section contains very helpful information regarding
blood products in deficiencies of hemostasis; the explanation of the Stoelting RK Pharmacology and Physiology in Anesthetic Practice. 3rd ed. Philadelphia:
Lippincott-Raven, 1998. ISBN O-7817-1621-7. 976 pages, $95.00.
thromboelastogram is especially helpful. However, the section lacks
information regarding activated coagulation time and subsequent Tobin MJ, ed. Principles and Practice of Intensive Care Monitoring. New York: McGraw-Hill,
guidelines for cardiopulmonary bypass, as well as a coagulation 1998. ISBN 0-07-065094-2. 1525 pages, $145.00.
cascade diagram. One final suggestion is the addition of an algo- Waldman SD. Atlas of Interventional Pain Management. Philadelphia: WB Saunders, 1998.
rithm regarding the identification and management of hemolytic ISBN 0-7216-7577-8. 564 pages, $175.
transfusion reactions to the immune physiology section.
