Geriatric Anesthesia. By Frederick E. Sieber, M.D. New York, McGraw-Hill, Medical Publishing Division, 2007. Pages: 370. Price: $105.00 hardcover.
In parallel with the rapid aging of the general population, the volume of elderly patients requiring anesthesia and surgery is growing rapidly. Thirty-five percent of surgeries are performed on patients older than 65 yr, and in general, these patients have higher morbidity and mortality rates after anesthesia compared with their younger counterparts. One of the major challenges of treating elderly patients is the heterogeneity of the geriatric population—and the need to individualize care for each patient to provide the best outcome. This requires a thorough understanding of the consequences of aging and the impact of common comorbidities such as hypertension, diabetes, and heart disease on physiologic reserve. Dr. Sieber's text on geriatric anesthesiology provides an excellent comprehensive discussion on many of the key issues relating to our oldest patients.
Geriatric anesthesiology is a young and expanding field—with many areas of controversy and uncertainty. The textbook addresses several of these controversies very effectively. The chapter on regional versus general anesthesia is both informative and up-to-date, providing excellent tables and references for the reader. In another chapter, the issues surrounding β blockade in elderly patients include a thorough discussion of the pros and cons of β blockade and current recommendations. The book also includes less frequently considered areas of controversy surrounding hemodilution. In addition, there are several classic chapters organized by system describing consequences of aging and the impact on the administration of anesthesia. Although much of this information is not new, it is well organized and, for the most part, emphasizes the anesthetic implications of aging and disease. The pulmonary chapter in this section was particularly well done, providing a detailed discussion on aging physiology, consequences of anesthesia, and recommendations to reduce pulmonary complications in high-risk patients. As in all of the chapters, there was a succinct summary of the key points, followed by a few selected references. This was particularly useful in the chapters with numerous references.
In general, each chapter was well organized and thoughtful. In certain areas, the information was somewhat repetitive, e.g. , opioids were covered by table in the pharmacology section and also extensively in the pain management chapters. However, even in these areas, each chapter emphasized slightly different points, illustrating the complexities of dosing in elderly patients in different circumstances. The local anesthetic chapter provided a comprehensive review of the pharmacology and the practical issues relating to the use of local anesthesia in neuraxial and regional blocks. A few of the chapters, for instance on the cardiovascular system, were heavy on the text and may have benefited from additional tables to break up the text, but the information provided was thorough and well organized.
One of the mainstays of geriatric medicine is the treatment of the whole patient, including the social and functional aspects; some of these issues were addressed in the chronic pain and intensive care chapters. It was also good to see a few chapters devoted to some nontraditional topics such as legal issues, trauma, and anesthesia for patients with dementia.
Education in geriatric anesthesiology must become a priority if we are going to be able to handle the population boom predicted in the next few decades. Going forward, we will need to be able to practice geriatric anesthesiology as seamlessly as we perform pediatric anesthesiology. Dr. Sieber's textbook is a recommended for anesthesiologists—in training or beyond—interested in taking care of older patients. As a reference text, this book is very valuable, providing easy-to-access, up-to-date information with practical suggestions. It is no longer unusual in clinical practice to be expected to anesthetize extremely old and frail patients for major surgery, and we, as anesthesiologists, must be knowledgeable about the challenges inherent to caring for elderly patients.
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts. sbarnett@bidmc.harvard.edu
