Anesthesia for Cardiac Surgery, 2nd edition. Edited by James A. DiNardo. Stamford, Appleton & Lange, 1998. Pages: 417. Price:$105.00.
The second edition of Anesthesia for Cardiac Surgery succeeds in updating the inclusive and informative first edition, published some 8 years previously. Significant changes include the fact that Dr. DiNardo authored 11 of the 13 chapters of the second edition. Nevertheless, this book is a prime example that a nearly “one-man show” can result in a fine textbook.
The first two chapters, “Preoperative Assessment” and “Interpreting Cardiac Catheterization Data,” provide a systematic approach to the perioperative evaluation of pediatric and adult patients about to undergo open heart procedures. The combinations of anatomic illustrations combined with pressure-volume loops lend clarity to the presentation of relevant pathophysiology. In chapter 3, “Monitoring,” a remarkably extensive discussion of transesophageal echocardiography is presented using multiple illustrations and pathologic conditions. The advantages and pitfalls of transesophageal echocardiography and the usual invasive monitoring techniques are well defined. A brief but informative section regarding thromboelastography punctuates this chapter.
Chapters 4 and 5 provide an informative background of and a common-sense approach to the treatment of adult patients with coronary artery disease and acquired valvular heart disease. Again, numerous diagrams bring clarity to these well-written chapters. Chapter 6, “Anesthesia for Congenital Heart Disease,” is particularly well done, with the reader first presented with the management of a simple condition such as ventricular septal defect progressing to complex conditions such as transposition of the great arteries. Chapter 8 discusses the differing pathophysiologic features and the anesthetic management of pericardial effusion and constrictive pericarditis in an equally comprehensive manner.
Chapters 7, 9, and 11 are new to this edition and encompass some of the most important changes in practice with regard to technology. The management of one-lung ventilation and advances in mechanical support of the circulation in the setting of thoracic aorta surgery and lung or heart-lung transplantation is explored extensively. Chapter 11 also provides a sweeping presentation of mechanical circulatory assist devices that include devices as simple as the intraaortic balloon pump to those as complex as the total artificial heart. Chapters 10 and 12 provide a comprehensive presentation of the mechanics and management of cardiopulmonary bypass and myocardial preservation. Finally, the subject of neurologic injury in the setting of cardiopulmonary bypass and cardiac surgery is well presented by Dr. Bradley J. Hindman in chapter 13. Dr. Hindman provides a timely discussion of identified risk factors for neurologic injury and its management after cardiac surgery. Issues addressed include management of plasma glucose concentration and acid-base balance and manipulation of systemic arterial pressure, pulsatile versus nonpulsatile flow, hypothermia and circulatory arrest, and hemodilution.
There are only a few criticisms to be made of this otherwise excellent text. Although given a cameo treatment, the timely subject of “Fast-Track” anesthesia could have been discussed to a greater extent, given the growing body of literature and popular interest generated by those in cardiothoracic practice. The text tended to present a predominantly opioid-based anesthetic technique, with little variation between different pathologic conditions (e.g., one anesthetic fits all). A paragraph or two about other viscoelastic monitors (e.g., the Sonoclot Sienco, Inc., Wheat Ridge, CO) of hemostasis could have lent more balance to chapter 3. Finally, the text and tables are occasionally victim to typographic error, an example of which can be found in Table 6-6, wherein the loading dose of esmolol for children is listed as 500 mg/kg intravenous.
The intended audience for this book includes anesthesia residents, fellows, cardiac anesthesiologists, and experienced anesthesiologists that do not care for cardiac patients on a regular basis. The focused, comprehensive prose and excellent illustrations contained in most of the chapters certainly provide a conceptual framework appropriate for anesthesiologists in training. Finally, I would recommend this text as a comprehensive review for experienced cardiothoracic anesthesiologists.
Vance G. Nielsen, M.D.
Associate Professor; Divisions of Cardiothoracic Anesthesia and Anesthesiology Research; Department of Anesthesiology; The University of Alabama at Birmingham; Birmingham, Alabama;vance.nielsen@ccc.uab.edu
