Book Reviews
with no apparent acknowledgement that practice differs in other countries, for example, with respect to the drugs available. The text is also plagued by the gratuitous use of abbreviations, acronyms, and jargon. The abbreviations have been used at random by different contributors, for example, PE has been used for physical examination and pulmonary embolism, while both ECG and EKG have been used for electrocardiogram. Some other non-standard abbreviations have been used extensively throughout the text, for example, mgt, HTN, H & P, NPO, and SQ. There is no glossary of the abbreviations used. The book does, however, provide a comprehensive breadth of coverage with some topics, such as phaeochromocytoma, covered in more than one of the five sections: co-existing diseases, critical events, drugs, procedures, and techniques. Within each section, the topics are organized alphabetically which eliminates the need for an index and allows easy accessibility. The style is didactic with topics covered in a bulleted, pointwise manner which makes for easy reference. However, several topics lack the necessary details to make this book a ‘one-stop’ bedside reference, for example, the section on asthma advises preoperative ‘nebulization’ with beta-agonist but does not mention the drug or dose, although later in the chapter metaproterenol and albuterol are cited as examples of beta-agonists. The book may be more useful as an aide memoire when managing patients with less common conditions: the chapters on aortic stenosis and acute renal failure, for example, are well written. The section on ‘procedures’ relates to the surgical requirements and related anaesthetic management of more than 120 operations. For each operation, the indications, procedures, concerns, and expected blood loss are described. The parochial nature of the book is evident in this section: for Caesarean section, the authors recommend bicarbonate as a preoperative antacid; a spontaneous ventilation technique using a laryngeal mask airway is not considered for minor procedures such as knee arthroscopy; and the potential problem of the use of succinylcholine for emergency repair of an open globe injury is not mentioned. The section on critical events divides the individual problems under description diagnosis and management. It is a particular problem for a book marketed in Europe to use the ACLS algorithms in this 2007 edition, which significantly deviate from European Resuscitation guidelines published in November 2005, for example, the ventricular fibrillation guidelines suggest three back-to-back shocks of increasing energy of 200, 300, and 360 J. There is no mention of biphasic energy defibrillation. For some of the critical events, a flow chart would be invaluable. The technique section covers all the important aspects including indications, preparation, anatomy, technique, and complications. For each technique, some practical tips, or ‘pearls’, are included. However, some parts may need updating with the increasing role of ultrasound for vascular access and regional techniques.
In summary, for those based in North America, this manual may be a useful bedside resource, especially trained clinicians managing situations they have not encountered for some time. However, others need to be aware of intercontinental differences before putting the information into practice. For those in the UK and Europe, there are several alternative texts that will be more appropriate. However, this book does provide the non-American anaesthetist an excellent opportunity to gain insights into anaesthetic practice in the USA. P. K. Gupta and P. M. Hopkins Leeds, UK E-mail:
[email protected] doi:10.1093/bja/aen190
Principles of Surgery, Everything you Need to Know but Were Frightened to Ask. S. Andrews and L. Cascarini. Published by TFM Publishing, Harley, Nr Shrewsbury, UK. Pp. 214; indexed; illustrated. Price £25.00. ISBN 978-1-903378-57-1.
The authors have taken on a difficult challenge. The title Principles of Surgery is ambiguous, meaning different things to different people. It could represent standards of surgical technique, details of consent, or when and when not to operate. In order to encompass this, with junior surgeons preparing for the College of Surgeon’s examinations in mind, they have produced a text of patient care along the operative pathway. It is separated into sections outlining preoperative care, the operating theatre environment, and postoperative care and complications. These include summaries of traditionally peripheral concerns such as medicolegal issues, confidentiality, and negligence. The book approaches a broad range of subjects, including theatre environment and equipment, such as diathermy, sutures, and needles. A useful section on pathways and protocols provides information on issues such as clinical governance and audit, integrated care pathways, ATLS, and cancer screening. The text is readable and concise, in clear and informal English, with the contents, layout, and index facilitating rapid access to relevant sections with clear illustrations. Although some areas are well covered, in order to maintain its scope and brevity, it sacrifices detail in others. In pre-admission, for example, an opportunity has been missed to cover some of the difficult perioperative management scenarios such as Jehovah’s witnesses or those suffering from a latex allergy, and pre-donation of blood as an alternative to allogenic blood transfusion is not mentioned. In the operating theatre environment section, diagrams to illustrate hand scrubbing could have complemented and abbreviated the text. The explanation of laser physics and its uses lacks the illustration of measures essential for safe practice. The differential diagnosis of the
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septic postoperative patient should refer to life-threatening peritoneal causes such as bowel anastomotic dehiscence, bowel obstruction, biliary peritonitis, and pancreatitis as early suspicion of these can prompt appropriate investigation and diagnosis. If the authors proceed to a second edition, areas they may consider addressing include the local anaesthetic section where there is no reference to safe maximal doses, and the amount of prilocaine administered for a Bier’s block is quoted as a volume (20 –40 ml) in the absence of concentration or total dose. In addition, the management of tension pneumothorax is described as a needle thoracocentesis in the third rather than second intercostal space in the mid-clavicular line, contrary to British Thoracic Society guidelines designed to minimize the risk to mediastinal structures. The description on insertion of an intercostal chest drain fails to recommend a chest X-ray to check position or offer guidance on its safe monitoring or removal. In the absence of references or recommendations for further reading, an opportunity has been missed to steer
readers towards existing NICE guidelines for the selection of preoperative tests and prevention of venous thromboembolism, along with British Thoracic Society guidelines, GMC guidelines on consent, and so on. This book provides a valuable introduction to this area, but other sources, such as the RCS course manual Clinical Surgery in General, cover most of these topics in detail. It is, however, a useful text for foundation year graduates and undergraduates with an interest in surgery, as an introduction and glossary to perioperative surgical care, and a lead-in to more detailed texts. It may also prove valuable for trainees and practitioners in professions allied to medicine such as operating department practitioners, nursing staff, and clinical support workers, who seek an approachable description of surgical practice. M. J. D. Wagstaff and M. W. R. Reed Sheffield, UK E-mail:
[email protected] doi:10.1093/bja/aen191
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