Anesthesiology Pocket Guide. By Thomas N. Pajewski. Philadelphia, Lippincott-Raven, 1997. Pages: 465. Price: $35.95.
More than any other medical specialty, the practice of anesthesiology requires factual knowledge at one’s fingertips of pharmacology, physiology, and pathophysiology as it applies to both pediatric and adult surgical patients. While working in the operating room, immediate access to a comprehensive anesthesia textbook for specific fact-finding or drug-dosing information is, in most instances, not possible. However, Pajewski developed the Anesthesiology Pocket Guide , which is a clear, concise pocket reference filled with facts, tables, drug-dosing regimens, and treatment algorithms, covering all areas of perioperative anesthetic management. The book consists of eight sections with various chapters within each section.
Section one of the manual, entitled “Preoperative Considerations,” covers preoperative assessment and anesthesia equipment. The preoperative assessment chapter centers on the evaluation of the cardiac patient for noncardiac surgery. This includes the New York Heart Association functional classification, Goldman Cardiac Risk Scoring system, and other risk stratification tables according to clinical and surgical predictors of cardiac risk. Pajewski also succinctly presents the recommended diagnostic tests, i.e. , 12-lead electrocardiogram, exercise stress, and coronary angiography, and interpretation of their results along with perioperative treatment options. Although prediction and prevention of cardiovascular morbidity are a major focus of today’s assessment practices, a thorough preoperative evaluation of the patient with pulmonary disease or renal disease is also important and, in my opinion, should have been included in this chapter as well. The chapter on equipment contains practical information such as the Food and Drug Administration machine checkout list, the different pacemaker modalities, and a diagram of various Mapleson circuits. However, I found other information in this section to be either impractical for the purposes of this book or incomplete. For instance, the table of typical medical gas cylinders (including cyclopropane), with their corresponding dimensions (A through DD), and capacities is not something I would typically look up while in the operating room. The section on commonly used intraoperative lasers is valuable but perhaps would have been even more helpful if eyewear recommendations were also included. Finally, an extensive table listing capnographic alterations relating to perturbations in carbon dioxide production, circulatory and respiratory changes, and equipment malfunction might have been enhanced with schematic capnograms.
Section two, “Pharmacology,” is divided into subchapters according to drugs used for general and regional anesthesia. These include inhalational agents, opioids, barbiturates and benzodiazepines, neuromuscular blocking agents, and local anesthetics. A separate chapter is also devoted to cardiovascular drugs and infusion protocols for inotropes, vasopressors, and vasodilators. The information in this section is depicted in easy-to-read tables containing pharmacokinetic and pharmacodynamic properties and dosing regimens. Although most chapters seem up-to-date, the chapter on inhalational agents needs to be expanded to include more information on the newer agents, desflurane and sevoflurane.
The mainstay of this pocket reference is section three. Physiology and pathophysiology is discussed according to organ systems in a simple and accurate manner. As in the other sections, unnecessary words have been eliminated and replaced by figures, charts, and algorithms to facilitate a faster reference. For instance, the endocrine chapter cuts to the chase by covering hypoglycemic agents, steroid relative potencies and dosages, thyroid function tests, and pediatric endocrine levels and replacement therapies in a mere six pages. In the respiratory chapter, Pajewski concisely depicts the evaluation and management of the difficult airway using the airway algorithm and illustrations of the Mallampati classification and laryngoscopic view grading systems.
In sections 5–7, the anesthesia subspecialties (regional, pediatrics, obstetrics, and pain) are briefly presented. The regional chapter covers practical information for the trainee such as dermatome sensory charts and recommended levels for spinal anesthesia according to operative site. However, there is no mention of any of the commonly used peripheral nerve blocks, i.e. , axillary, superficial cervical plexus, or ankle blocks. A simple explanatory note on technique with an accompanying anatomic diagram of the specific regional block would have enhanced this chapter. The pediatric chapter has several useful, age-specific tables such as sizes for endotracheal tubes and laryngoscopic blades, resuscitation protocols and dosing regimens, fluid replacement guidelines, and normal values for electrolytes, heart rate, and blood pressure. A 23-page index of pediatric syndromes and their anesthetic implications is also included as a source for quick reference. However, I would advise the reader that this list is not meant to be used in lieu of an abridged textbook of pediatrics when preparing for a child with a rare syndrome.
The remaining part of the book includes a section on malignant hyperthermia, practice standards of the American Society of Anesthesiologists, and current American Heart Association advanced cardiac life support protocols. A bibliography is also provided at the end of the book to facilitate further research.
Overall, Anesthesiology Pocket Guide is a concise, affordable manual that, unlike other “pocket” references, actually fits comfortably in a fanny pack or a back pocket, creating only minor “gluteal enhancement.” Although it is not intended to substitute for an anesthesia text, it has achieved the author’s goal of providing a fast and efficient way to access important clinical and therapeutic information while in the operating room. This manual is well suited for the anesthesiologist in training as well as the experienced practitioner in academic medicine or private practice. For me, the Anesthesiology Pocket Guide has replaced my wad of paper-clipped note cards that once contained pertinent drug-dosing regimens.