Obstetric anesthesiology is an exciting and evolving field. The many advances in anesthetic management of the parturient patient over the past two decades present a challenge to anesthesia providers wishing to practice evidenced-based medicine. In addition, the physiologic changes of pregnancy are unique and can easily complicate various clinical scenarios. The two volumes of the International Anesthesiology Clinics’ Obstetric Anesthesia Update provide a concise, yet surprisingly comprehensive, review of anesthetic considerations in the pregnant patient. It is a well-written appraisal of current teachings in obstetric anesthesiology, focusing on a thorough examination of the recent literature.
This work consists of two volumes, Treatment Protocols and Mechanisms and Complications. The layout of the volumes provides both academic and private practitioners with a guide to improve general care of the parturient and also serves as a reference when medically complex patients, or uncommon complications, present to the labor and delivery suite. The first volume details treatment protocols to help standardize commonly encountered challenges in obstetric anesthesiology, including obstetric airway management, spinal anesthetic-induced hypotension, oxytocin administration protocols for cesarean delivery, opioid dependence in pregnancy, patient safety, and regional anesthetic techniques for postoperative pain control. This volume contains useful visual aids, extensive tables detailing the pertinent findings, detailed decision algorithms, and sample protocols that one may want to consider adopting on an obstetric ward. Indeed, expansion of sections containing algorithm-based care practices would be a welcome addition to this text in future iterations as we learn more about the positive effect clinical protocols have on patient safety and outcomes. Furthermore, the included ultrasound images and techniques are a useful addition that may aid the less experienced anesthesia provider in obtaining the most ideal studies when using this exciting technology on the labor and delivery ward.
The second volume addresses the mechanisms and complications specific to obstetric anesthesiology. For a text that could easily fit in the pocket of a white coat, it covers an impressive range of topics with a fair amount of detail. Any anesthesia provider new to the field or for those who care for obstetrics patients infrequently, the discussions of labor pain mechanisms and pathophysiology, management of postdural puncture headaches, and common comorbid conditions would be quite valuable. Furthermore, the chapter on obstetric-related neurologic complications could prove to be a very useful resource to the occasional practitioner when responding to a patient presenting with a persistent neurologic deficit after receiving a neuraxial anesthetic or analgesic technique.
For those who spend a great deal of time on the labor and delivery ward or who regularly encounter medically complex obstetric patients, this volume should still find a place on the book shelf. It addresses some very complex obstetric anesthesia issues in an approachable manner. From the discussions of maternal blood product management and cell salvage techniques to amniotic fluid embolism and maternal obesity, these chapters offer a detailed review and a good starting point for a more in-depth review of the literature. We were particularly impressed with the inclusion of a chapter on the controversial and frustrating topic of epidural-related temperature elevation and the confounding condition of maternal fever from chorioamnionitis. That a book of such brevity can address these issues so concisely speaks to the authors’ command of the literature and ability to convey the most clinically relevant data and conclusions while not ignoring the current shortcomings in our knowledge of the covered topics.
We applaud the authors’ success at creating a text that is both exhaustive and approachable. The evidence-based protocols and discussion of the peculiarities unique to obstetric anesthesiology written by leaders in the field provide a nice reference text for academicians as well as an accessible guide for anesthesiology trainees or any practitioner who occasionally rotates on the obstetric floor.