By Craig M. Palmer, M.D., Robert D'Angelo, M.D., Michael J. Paech, F.A.N.Z.C.A. New York, Oxford University Press, Inc., 2011. Pages: 440. Price: $59.95.
Providing appropriate and safe anesthetic care to the obstetric patient has long been a challenging and controversial endeavor, since the days of Queen Victoria and Fanny Longfellow. In the past, controversy surrounded the ethical and religious implications of providing pain relief for the laboring parturient. Although some of this sentiment lingers to present day, the continued education of the populace and excellent safety record of anesthetic practice is helping to make James Young Simpson's prediction that any opposition to the “superinduction of anesthesia in parturition will be in vain” a reality.
The present challenge for obstetric anesthesiologists involves providing safe and effective labor analgesia and anesthesia in the context of the parturient's unique physiologic, mental, emotional, and social state, all the while trying to provide a nurturing, supportive, and enjoyable environment for delivery. This challenge is further complicated by new factors, such as advanced maternal age, increasing cesarean delivery rate, and the growing number of women with serious comorbid systemic diseases. These factors can confuse acute anesthetic care decisions in situations where a delay in appropriate management has the potential to result in permanent injury or mortality to both mother and baby. In this regard, the importance of evidence-based medical practice cannot be overestimated. Luckily for anesthesia providers, Obstetric Anesthesia by Palmer, D'Angelo, and Paech is available to be an excellent companion on the labor and delivery floor. Although too succinct to be a comprehensive primary text for students or new residents with no exposure to the field of obstetrical anesthesiology, it is a potentially powerful tool for anesthesia providers requiring a detailed, literature-supported overview of the most important areas of anesthetic concern involving the parturient.
The brevity of the book should not be mistaken for incompleteness, as the chapters contain a surprising level of detail and can answer most of the practical questions a reader would pose. Read cover-to-cover, the book places the reader in the shoes of an obstetric anesthesiologist, as the flow of the chapters reflect the daily flow of events on the labor and deliver floor. Many days begin with providing routine neuraxial labor analgesia and anesthesia, which can become complicated by complex patients, unfamiliar diseases, and anesthetic complications, as well as occasional postdelivery management of a critically ill parturient. Taken individually, the chapters contain relevant statistics and facts, as well as many useful tables with practical, technical, and procedural advice one would expect from a face-to-face discussion with a consultant obstetrical anesthesiologist. The authors clearly understand that a one-size-fits-all approach to management of the obstetric patient is ineffective, and thus provide concise descriptions of multiple techniques and modalities that allow an anesthesia provider to personalize his or her practice while remaining safely within the confines of standard anesthetic care.
I would highly recommend this text to any anesthesia provider who desires a portable, yet detailed, discussion of the most recent evidence-based obstetrical anesthesia techniques, theories, and practice. Whether used as a reference to solve an acute problem, or as a manageable method to reorient to the subspecialty, Obstetric Anesthesia will not disappoint. This book will make an excellent companion to anyone interested in navigating the challenging and rewarding field of obstetrical anesthesiology.