Cardiovascular and Thoracic Anaesthesia

Cardiovascular and Thoracic Anaesthesia. J. Gothard, A. Kelleher, E. Haxby. Butterworth-Heinemann: London, UK, 196 pp; indexed, illustrated ISBN: 0-7506-5355-8; Price £14.99 (paperback) This is a lightweight book in every sense of the word. It consists of 196 pages divided into 12 chapters and is part of a series of books entitled ‘Anaesthesia in a nutshell’. The book is primarily aimed at UK Specialist Registrars (SpRs) undertaking training units in cardiothoracic and vascular anaesthesia in years 1 and 2. This forms part of the Royal College of Anaesthetists competency-based training programme which dovetails into the syllabus for the Final Fellowship of the RCA examination. The book is easy to read, the paper quality is good, the diagrams and tables for the most parts are simple and it will fit neatly into the pocket of a white coat. Further reading is provided at the end of each chapter and it is relatively up to date. The book is well balanced with six chapters devoted to cardiac anaesthesia, four on thoracic anaesthesia and two on vascular anaesthesia. Whilst we appreciate that this is not a physiology textbook, cardiac anaesthesia is invariably intertwined with physiological principles and there is very little background information such as the principles governing oxygen demand and delivery. There are many sections that go into unnecessary detail counterbalanced by too little information in other areas such as cardiac valve surgery and congenital heart disease. The authors did not suggest performing an Allen's test prior to cannulation of the radial artery and the UK's National Institute of Clinical Excellence (NICE) guidelines relating to central venous cannulation were not included. In general there is a distinct lack of information on practical aspects such as the management of perioperative myocardial ischaemia, aortic cannulation, glucose control, prevention of awareness during cardiopulmonary bypass and temperature control. The diagram of a bypass circuit is unnecessarily complicated. Whilst the section on ‘off-pump cardiac surgery’ was topical and well written, cell salvage devices were not mentioned. Trans-oesophageal echocardiography was included but could have been expanded in view of the fact that it is increasingly important as part of an anaesthetist's armamentarium. We noticed the odd spelling mistake and grammatical error. In the section on vascular anaesthesia the advantages and disadvantages of spinal drains were not discussed in the context of aortic aneurysm surgery and the practicalities of using warm air mattresses during aortic cross-clamping were not mentioned. These may seem petty comments, but they are examination type details of which the reader should be aware. The saving grace to this book is the thoracic section, which is clear and well written with good use of simple diagrams. In conclusion, it would be easy to suggest that this book should be in every SpR's personal possession, but we cannot do this. There are many other textbooks with more information and it fails because it is neither a practical guide to cardiovascular and thoracic anaesthesia nor it is adequately detailed to be considered a revision text. C. R. Bailey M. J. Cook a1London, UK