Cheap and cheerful anaesthesia | |
Anaesthesia at the district hospital (2nd edition). Michael B Dobson. Geneva: World Health Organization, 2000 (153 pp). ISBN: 92 4154 527 5. |
Anaesthesia in the developed world has, in the past 30 years or so, become a technological juggernaut, with the result that anaesthetists are unable to give the simplest general anaesthetic without $50000 worth of machinery. It is therefore humbling to read a book that is a "recipe book" for safe, cheap anaesthesia in the developing world. The stated aim of the book is to "present anaesthesia in terms that will help [medical and nursing] practitioners in district hospitals world-wide [administer] safe and effective anaesthesia". The author is chairman of the prestigious Nuffield Department of Anaesthetics at Oxford (UK), but I suspect he has had considerable exposure to anaesthesia in isolated and resource-poor regions. He presents anaesthesia in easy-to-understand terms. Beginning with the basics of airway management, he works through principles of fluid therapy to several specific anaesthetic techniques, and includes recovery and postoperative care as part of the anaesthetist's responsibility. There are chapters on paediatric and obstetric anaesthesia, use and maintenance of equipment, and common anaesthetically important medical conditions seen in the developing world. At the end of the book there are checklists for use of equipment and a sample anaesthesia record. The discussion of equipment includes oxygen supplies and concentrators, as well as the impracticality of automatic ventilators. Pulse oximetry gets a passing mention, but with the caveat that it is no substitute for clinical observation. Conduction anaesthesia is covered well, especially spinal anaesthesia. I liked the advice to "scrub your hands more thoroughly than the surgeon. He has only to avoid a wound infection; you have to avoid causing meningitis!". The text is well illustrated with line drawings, which demonstrate the anatomy and techniques better than some video recordings I have seen. The diagram illustrating cricoid pressure should be on the wall of every operating theatre! With the advent of improved transport and communications and the de-skilling of rural general practice, this book would have limited readership and relevance in Australia today. However, I found it interesting reading, and would consider it a "must have" for practitioners who volunteer to work in the developing world.
David Merefield
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