Airway Management--Principles and Practice

Airway Management--Principles and Practice. J. L. Benumof, ed. St. Louis: Mosby, 1996, ISBN 0-8151-0625-4, 934 pp, $125.00. Airway Management--Principles and Practice is another in a long series of successful endeavors for Jonathan L. Benumof, MD, who serves as editor and wrote many of the chapters himself, demonstrating a multifaceted expertise in several areas of airway management. The editor's chapters recap his own original research, articles, and excellent lectures. The book is divided into seven parts. Basic science issues are addressed in chapters devoted to anatomy, radiology, physics, pharmacology, and physiology. The pharmacology chapter deserves particular praise for several excellent clinical correlations. These include discussions of topical lidocaine toxicity, upper airway obstruction accompanying airway anesthesia, airway instrumentation as a precipitant of bronchospasm, and aerosolized lidocaine in asthmatics. Similarly, the physiology chapter points out methods of preventing the hypertensive-tachycardic response to laryngoscopy and intubation and discusses the applicability of small tracheal tubes for adult patients. The latter issue is addressed in multiple subsequent chapters as well. Part III, Preintubation-Ventilation Procedures, contains excellent clinical information. The chapter on awake intubation provides a lucid description of sphenopalatine nerve blocks and anterior ethmoidal nerve blocks using the intranasal approach. The chapter on aspiration pneumonitis identifies difficulty managing an airway as a risk factor for this problem. In Part IV, The Airway Techniques, Chapters 11-14 progress logically through oxygen delivery systems, face mask ventilation, indications for tracheal intubation, and conventional laryngoscopy. The chapters on flexible fiberoptic laryngoscopes and esophageal-tracheal Combitubes Registered Trademark contain photographs that reproduce extremely well and add significantly to the reader's comprehension of the text. The chapters on retrograde intubation and the esophageal-tracheal Combitube Registered Trademark are excellent and a related chapter provides a good clinical pearl on performing flexible fiberoptic laryngoscopy via the laryngeal mask airway. Part V, The Difficult Airway Situations, is enlightening. The most notable examples are the chapters on trauma and obstetrics. The trauma chapter is a succinct review of injuries affecting the airway. The obstetrics chapter is very well written. Both discuss numerous important clinical concerns. In Part VI, Postintubation Procedures, three chapters stand out for offering particularly important information that bridges the gap between scientific knowledge and clinical experience. Part VII is especially notable for the chapter by Drs. Sheplock and Dierdorf on computer learning. They describe a computer-based decision-making format for airway management. The program allows learners to explore both correct and incorrect branches of the decision tree. Although the book earns high marks, areas for improvement do exist. The explanation of vocal cord palsies is too brief for such a commonly misunderstood issue and deserves more lengthy and lucid descriptions. The chapter on recognition of the difficult airway departs from the rest of the text in writing style, quality of photographs, and clarity of purpose. Two proofreading errors occur on page 168. Viscous lidocaine is identified as a 1% lidocaine solution instead of a 2% solution, and tetracaine is classified as an amide local anesthetic instead of an ester. The Bullard laryngoscope case study would be better served by presenting a more classic scenario, one in which the patient is not "spitting blood with exhalation." As the text later explains, blood in the airway impairs visualization through Bullard laryngoscopes and, in this reviewer's opinion, is a relative contraindication to its use. Chapter 31 recommends 10% cocaine for nasal use. Four percent cocaine works quite well for this purpose and is associated with fewer adverse side effects. Chapter 32 contains valuable information but tends to describe studies in detail when brief summaries would make the text more enjoyable. Airway Management--Principles and Practice is an interdisciplinary tome, worthy of purchase by medical school, hospital, and departmental libraries. Individuals with special interest in airway management will find its encyclopedic scope of genuine value. Allan P. Reed, MD Department of Anesthesiology Mount Sinai School of Medicine New York, NY 10029-6574