Essentials of Neuroanesthesia and Neurointensive Care. By Arun K. Gupta, M.B.B.S., Ph.D., F.R.C.A., M.A., and Adrian W. Gelb, M.B.Ch.B., D.A., F.R.C.P.C. Philadelphia, Saunders Elsevier, 2008. Pages: 344. Price: $69.95.
“At present, our ability to pharmacologically protect the brain and make it less vulnerable to ischemic injury is limited. In the operating room, our capacity to exacerbate brain injury, by contrast, is almost unlimited.” These words, taken from Gupta and Gelb’s Essentials of Neuroanesthesia and Neurointensive Care , illustrate the critical importance of understanding the principles of perioperative care for the patient with neurologic disease. In elucidating these principles in a thorough but concise fashion, the book is a success.
Essentials of Neuroanesthesia and Neurointensive Care is organized into six main sections of Anatomy, Physiology, Pharmacology, Neuroanesthesia, Neurointensive Care, and Monitoring, with a primary focus on clinical neuroanesthesia. I found the chapters to be concise, easy to read, and informative. Each chapter has a summary of key points and suggestions for further reading. The graphics were clear, of high quality, and didactic. There was an excellent breadth in terms of subject matter (basic physiology and clinical practice), clinical contexts (operating room, intensive care unit, and interventional suite), and patient populations (adult, pediatric, and obstetric). Furthermore, I found the incorporation of perspectives from neurosurgery, neuroradiology, and neurology to be valuable. As stated in the preface, the book will likely be of most value to the anesthesiology resident. I would, however, recommend this as an excellent review for a beginning fellow or a handy reference for the anesthesia provider who does not routinely practice neuroanesthesia. The book could also serve as an introductory text for interested specialists in related fields.
The appendices are noteworthy. The first is entitled “Clinical Information Resources” and is a unique feature not found in other recent neuroanesthesia texts. This appendix guides the reader through the use of search engines, the electronic acquisition of articles, and the safeguarding of electronic information. It also provides a list of electronic resources related to neuroanesthesia. The second appendix describes four common clinical scenarios in neuroanesthesia—supratentorial craniotomy, neurotrauma, subarachnoid hemorrhage, and cervical spine injury. These cases serve to integrate previously discussed information in a clinically relevant way. Both appendices should be very helpful for the trainee, and both reflect the didactic spirit of the book.
One suggestion for the next edition would be to improve internal consistency. The editors state in the preface that a certain degree of overlap is inevitable, and that a repetition of facts is useful. I would agree, but conflicting data may be especially confusing for trainees. For example, the incidence of venous air embolism during craniotomy in the sitting position is stated as 9 to 43% on page 100, but 30 to 75% on page 122. There are other discrepancies earlier in the text (compare, for example, the first paragraph on page 13 to that on page 21). These relatively minor opportunities for improvement do not significantly affect the overall quality of the book.
In conclusion, I would recommend Essentials of Neuroanesthesia and Neurointensive Care to both trainees and colleagues without reservation. As a practicing neuroanesthesiologist and neurointensivist, I think the book does an excellent job of introducing the reader to the compelling physiology and clinical diversity involved in the perioperative care of the neurologic patient. The editors and authors are to be commended for their valuable contribution to the field.
University of Michigan Medical School, Ann Arbor, Michigan. gmashour@umich.edu
