Overview of anaesthetics

This pocket-size book aims to bring together helpful information for safe and effective everyday anaesthetic practice. It is based upon the personal notes of the author and is made up of a series of topics organised in alphabetical order. Many pages are devoted to key areas such as airway management, cardiac resuscitation protocols, emergency scenarios and nerve blocks. The range of topics covered is broad. It includes such things as fluid resuscitation through a rectal tube (in the absence of IV access), how to set up tubing for one-lung lavage through a double-lumen endotracheal tube, and even how to manage the situation when penile turgescence limits the ability to pass the cystoscope! It also includes sections on CXR interpretation and management of asthma in the emergency department that would be better suited to a medical handbook. As a result of this breadth, there is often a lack of sufficient detail to make the book seriously worthwhile.

Although some of the content relates more to the United Kingdom style of anaesthetic practice (which includes more intensive care), the book does contain some interesting case reports and anecdotes (which are well referenced) and does attempt to emphasise the physiological principles upon which many of our interventions are based.

I have several criticisms. The book often fails to emphasise the key points of a topic. For example, the section on the treatment of hyponatraemia recommends the use of hypertonic saline without warning of the dangers of rapid over-correction, and the section on ventilating the asthmatic patient does not consider the issue of dynamic hyperinflation, which can be lethal in these patients. Also, some of the recommended treatments do not reflect contemporary practice (eg, intermittent CO2 inhalation as a treatment for postdural puncture headache).

The book is not particularly well organised and is repetitive in places. Some important areas, such as postoperative nausea and vomiting, are given scant attention. Added to this, the “point form” style in which it is written makes it difficult to read.

Although good in concept, I would find the book difficult to recommend to anaesthetic trainees or anaesthetists. It lacks sufficient detail to be of real use, has many gaps and describes many procedures or ideas more suited to Third World anaesthesia than current Australian practice.

Sesto CairoAnaesthetist, Alfred Hospital Prahran, VIC