Sedation: A Guide to Patient Management

BOOK REVIEWS

Sedation: A Guide to Patient Management Stanley F. Malamed St. Louis, 1985 The C. V. Mosby Company, 578 pages, indexed, illustrated. The purpose of this book is to combine, within a single text, the concepts of sedation originally described in the ADA Guidelines for the Teaching of Pain and Anxiety Control and the Management of Related Complications for a variety of sedation techniques. The text is designed to be used by the reader in conjunction with a course in sedation that provides for the clinical management of dental patients in a controlled setting. The book is organized into eight sections dealing with the history and spectrum of pain control in dentistry, physical evaluation of the patient, preparation for emergencies, and special considerations to include care of the pediatric, geriatric, medically compromised, and handicapped patient. Extensive sections covering oral, rectal, intramuscular, inhalation, and intravenous sedation as well as general anesthesia, are included. The material and techniques described are current and extensive. All chapters are well referenced and appropriately indexed. The text presents detailed discussion of the physical properties, clinical characteristics, and use of most drugs available for pain control in dentistry, including the newer agents now on the market. Illustrations, while not extensive, are adequate and pertinent to the text. Discussion of the equipment in current use for monitoring of the patient receiving sedation or general anesthesia is not extensive and must be supplemented by other sources if a good working knowledge is desired. In particular, some discussion with expansion on electrocardiography, dysrhythmia recognition and treatment, and the pulse oximeter would be helpful. The book is effective and well organized and contains a wealth of material on the subjects of analgesia, sedation, and general anesthesia. It meets its stated purpose of describing, in some detail, the variety of techniques available for the management of anxiety and control of pain. It should, as the author states, be used by the postdoctoral student in conjunction with an extensive course in sedation that provides for the clinical management of dental patients in a controlled setting. The text is unique in bringing a discussion of so many methods of pain control together under one cover for use in the dental setting and is recommended for the use intended by the author as well as JANuARY/FEBRUARY 1987

a reference for the practitioner in all clinical settings. I know of no comparable text of this scope or content and feel the author has succeeded in preparing a volume of real value to the profession. Sterling R. Schow, D.M.D. Baylor College of Dentistry Dallas, Texas

Perioperative Cardiac Dysrhythmias Mechanisms, Recognition, Management John L. Atlee, /Il Year Book Medical Publishers, Inc. 1985 Chicago, 451 pages Price $54.95 In the preface to his book, the author states that the purpose of his text is to bring together in one volume the many aspects of the problems of cardiac dysrhythmias, particularly as they relate to the circumstances of anesthesia, surgery, and the postanesthetic recovery period. This goal is achieved in an excellent text which is thorough, organized, and well written. The first chapter presents a perspective of cardiac dysrhythmias and anesthesia and includes a critical evaluation of the type and incidence of dysrhythmias as they pertain to the patient's past medical history, type of anesthetic agents, stages of anesthetic induction and maintenance, and various types of surgical procedures including oral surgical/dental procedures. Subsequent chapters address the anatomic and electrophysiologic aspects of the normal and abnormal electric activity of the heart. A basic review of the surface electrocardiogram follows, which includes the required apparatus and appropriate procedure, normal and abnormal configurations, and the specific effects of cardiovascular disease, electrolyte imbalances, and drugs on the ECG recording. Perhaps the most significant achievement of this text involves four chapters which deal with the (1) dysrhythmiagenicity of certain anesthetic agents, adjunctive drugs, and coexisting disorders; (2) recognition of perioperative dysrhythmias; (3) pharmacologic management of cardiac dysrhythmias; and (4) overall management of specific types of cardiac dysrhythmias. Within each of these chapters, the author has provided a well-referenced comprehensive and current review of the subject complemented by illustrations and tables. A chapter is also devoted to a review of the current indications, designs, and anesthetic management of cardiac pacemakers. 25