James C. Eisenach, M.D., Editor

Difficulties in Tracheal Intubation, Second Edition. Edited by I. P. Latto, R. S. Vaughan, London, W.B. Saunders Company, Ltd., 1997. Pages: 393. Price:[pound sterling] 40.00.

The second edition of Difficulties in Tracheal Intubation provides a considerably expanded view of the topic relative to that provided by the first (1984) edition. Lacking the first edition's chapter on case reports, the second edition contains new chapters on pediatric intubation, emergency airway access, cervical spine injuries, difficulties presenting at extubation, the Combitube[registered sign], predicting difficult intubation, fiberoptic techniques, the laryngeal mask airway, and legal aspects of intubation.

There is much to like about this textbook. The chapters are generally well written and of a consistent length and breadth. The illustrations are appropriately numerous. A list of key points is provided at the end of each chapter. On the other hand, this second edition has more “science” than the first edition, a change which is not always for the better. For example, although studies may present conflicting data, few would agree with the comments that “inhaling enflurane at concentrations between 0.85 and 3.2% has no effect on cerebral blood flow”(p 35), or that rocuronium had a “much shorter duration of action” than vecuronium (p 38). Some topics are needlessly repeated in two or more places. There is no need to illustrate the Combitube (R) in chapter 13 when chapter 14 is devoted exclusively to this topic. And, as is often the case, line drawings might have been a better choice than many of the photographs.

One aggravating aspect of the book is the repeated statement that a particular practice is “common in North America.” Curiously, many of the described common practices were new to me. For example, I was unaware that there were many centers where “awake fiberoptic intubations are carried out on all patients requiring intubation by the nasal route”(p 367).

Nevertheless, this is a book with a very high ratio of wheat to chaff and, given the importance of the topic, can be recommended to all who practice anesthesia.

John Butterworth, M.D.

Professor and Vice Chairman for Research; Department of Anesthesiology; The Wake Forest University School of Medicine; Winston-Salem, North Carolina 27157–1009