Stoelting's Anesthesia and Co-Existing Disease

Editors: Roberta L. Hines, Stephanie B. Jones, 8th Edition Publisher: Elsevier ISBN: 9780323718608 Stoelting's Anesthesia and Co-Existing Disease is a textbook that provides a very exhaustive and comprehensive overview of a spectrum of co-existing diseases that patients may present with when undergoing anaesthesia. It effectively describes the pathophysiology of conditions that a well-trained anaesthesiologist should seek to remember, and the associated potential risks and complications likely to occur during any possible kind of anaesthesia. Added to this are tips on how to improve the patient's pre-operative status and minimise risks related to anaesthesia and surgery. Peri-operative medicine is a very complex, difficult and multidisciplinary branch. Unfortunately, the anaesthesiologist is the only specialist who is expected to master all its secrets and tricks. Stoelting's Anesthesia and Co-Existing Disease is a precious aid to the achievement of such a demanding and ambitious task. We currently live in a world that is evolving into two extremes. One extreme is the Western World, with a population that is becoming older and weaker, bearing all the consequences of chronic diseases of a wealthy lifestyle such as obesity, atherosclerosis, pulmonary damage from smoking, metabolic syndrome, and also frailty of the elderly. The other extreme is represented by less developed countries with a population exposed to infectious diseases, malnutrition, and many conditions that become malignant and overly dangerous due to the lack of prevention, early diagnosis and a general absence of medical attention. This book covers many conditions and diseases that affect both these extremes and the array of “in between” populations with relative conditions. Readers will not only find a good overview of a given disease, but also a special paragraph about timing of anaesthesia, the best or least risky type of anaesthesia, various ways of optimising the patient before elective surgery, and ways of reducing known risks when facing urgent surgery with insufficient time to optimise the patient. There are many illustrations, tables, and graphs that help to compare different situations, conditions and drugs, giving us a very quick overview when needed. Chapters on pulmonary conditions provide precious suggestions and advice on pre-operative tests, ways to improve fitness before surgery and special ventilation strategies for different types of surgery. I found their considerations and advice very concise, exhaustive and easy to review and remember. Cardiovascular diseases are treated in many chapters covering pathogenesis, diagnostic tests, monitoring and pre-operative evaluation. When it comes to intra-operative monitoring, this textbook offers us a very useful review of haemodynamic measures, several available patented monitoring systems, such as FloTrac, ClearSight, LiDCO, PiCCO and transesophageal doppler imaging. Fluid management is also addressed, both in this particular group of patients and in other chapters. There are special considerations for patients with a ventricular assist device and a section on extracorporeal membrane oxygenation. Patients with a heart transplant provide several other challenges that we can easily revise. Other transplanted organs are dealt with in other chapters. Pharmacological therapy was dealt with in a series of carefully described, yet very usefully summarised mechanisms of action, dosage, dilutions and administration modes, especially in the chapters about cardiovascular diseases and electrolyte disorders. Patients in a critical condition or coming from the intensive care unit may be unstable, and in the presence of multiple organ dysfunction are the ones who face the greatest surgical risk. The reader is given many points to bear in mind and several strategies to try to prevent further damage in these patients. There is also advice about trauma, bleeding/haemorrhagic shock and advice about transport and movement of a critical patient. The authors also included a subchapter about SARS-CoV2 infection, and the different scales of severity that can affect patients. There are indications about elective surgery in this group of patients and about personal protection measures for healthcare workers. Patients affected by a neurological condition, either acquired or congenital, have a variety of potentially dangerous “traps” into which even an experienced anesthesiologist may fall. There is a detailed review of most conditions affecting the brain and the spine, the systemic effects of a neurological condition, indications for eventual neurological drug discontinuation and their interactions with anaesthesia. Many life-threatening events during surgery are also described. Inborn errors of metabolism, gastrointestinal and liver disease are described together with indications of anaesthesia management of these metabolically challenged patients. Patients who have to undergo a liver transplant have many issues and the surgery itself is complex with many phases, but this textbook does not fail to cover all we need to remember. Special consideration needs to be given to pain management. The authors have reserved at least a paragraph for each case due to the enormous complexity of pain disorders affecting patients with different comorbidities undergoing surgery. There is a chapter about chronic pain disorders and many suggestions about specific anaesthetics/analgesics we may use in this particular category of patents. We can find specific indications about pain management in pregnant and breastfeeding women as well as children. Cancer patients also represent a challenge, especially from a pharmacological point of view, and we can find precious advice not only on pain management, but also on various pharmacological implications that are relevant to them. Children are a whole different universe when it comes to anaesthesia management. Paediatric diseases make the prevention and treatment of possible intra-operative complications that much more complex. Not only do authors give us an overview of the general differences between adult and paediatric anaesthesia, but they also offer us subchapters on many frequent diseases that affect children and advice about pre-operative examination, intra-operative management, and treatment of possible post-operative complications. In general, I find this book a precious source for all practicing anaesthesiologists, residents in training, and all physicians that treat patients with chronic conditions who may need to undergo surgery and anaesthesia. It is exhaustive and never lacks precise and updated facts. It is however easy to read and offers figures, tables and comparisons that simplify review and assist learning and recall. Keeping our knowledge updated is a demanding task. There are so many different topics, so many new and “old” diseases our patients bring with them into the operating theatre, and remembering all of them is practically impossible. The authors have successfully completed this task and have given us a textbook we should all have in our offices, on our bookshelves and, why not, in our operating rooms to read between one induction of anaesthesia and anaesthesia emergence. Tamara Jovanovic, MD Dipartimento Di Scienze Dell’Emergenza, Anestesiologiche e della Rianimazione Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy