Geriatric Anesthesiology, 2nd Edition. Edited by Jeffrey H. Silverstein, M.D.; G. Alec Rooke, M.D., Ph.D.; J. G. Reves; M.D.; and Charles H. McLeskey, M.D. New York, Springer Science and Business Media, LLC, 2008. Pages: 440. Price: $119.00.
A little over 10 years after the first edition, Geriatric Anesthesiology has grown not just in age, but also in scope and maturity with the publication of a second edition. The preface begins with, “The goal of getting older is to age successfully.” To this reviewer, the parallel goal of a second edition is to update the first edition and enlarge upon it. The editors have accomplished that goal.
The book is very naturally divided into four major sections: Introduction to Clinical Geriatrics, Cardinal Manifestations of Aging and Disease in the Elderly, Anesthetic Management of the Aged Surgical Candidate, and Anesthesia for Common Surgical Procedures in the Aged.
Part I will likely be the least read section of the book, but clearly belongs in a text like this. It paints the picture of geriatric medicine in general, and then specifically relates it to our specialty. The authors remind us just how much of our practice is still empirically based while we strive to generate the Class I evidence needed to become more evidence-based in our care of older patients when and where it makes a difference. In the last chapter, Jankowski and Cook do a wonderful job enumerating research priorities in geriatric anesthesiology. They tickle the reader’s brain to think about and participate in getting our minds around the still-to-be pursued questions that deserve to be answered on behalf of the fastest growing demographic population in our specialty.
Part II consists of chapters on the major systems and processes and explains why and how they behave differently in the older patient. The chapters are interestingly written with great detail and are, for the most part, unusually well referenced and current. The postoperative central nervous system dysfunction chapter is a must-read treatment of the topic. The only awkward element is one chapter on operative debridement of chronic wounds, which only touches on intraoperative care considerations and is better suited to a surgery textbook.
Part III tackles risk stratification and reduction and the spectrum of pharmacology topics (opioids, chronic medicines, hypnotics, relaxants, inhalation, regional and pain management). It also includes discussions on fluid management and a chapter on anesthesia considerations for geriatric outpatients. The latter is my first choice for the must-read chapter from this part of the book. Each chapter is again a thoughtful synthesis of the literature and stands on its own, with very little repetition between chapters.
Part IV provides seven chapters tackling topics (e.g., sedation) and procedures (e.g., orthopedic, urologic, thoracic, cardiac, vascular, and abdominal) common to the older patient. I liked that the chapters were not written in a “how to” style, but rather in one that describes the issues and considerations and related published data to provide a framework on which to base one’s own practice.
In summary, the second edition of Geriatric Anesthesiology is a very refreshed and well-referenced second edition with a remarkable number of references from the new millennium. If you are looking for a book on how to specifically do x or y, you will be disappointed. If, however, you want a well-written, easily read textbook on issues ranging from politics, capacitance, and physiology to postoperative cognition, various common procedures and associated medical evidence surrounding the care of older patients, then this book is for you. It fits very comfortably in the “referred to” section of my bookshelf and very capably and thoroughly informs the reader who is interested in both the scope and detail of geriatric anesthesiology. I was struck by how in the age of the internet as a typical first source, this book provides a very efficient shortcut to Web surfing to address geriatric anesthesia questions and topics. The editors and authors are to be congratulated.
* The Jerome M. Modell, M.D., Professor of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida. ngravenstein@anest.ufl.edu
