A Practical Approach to Cardiac Anesthesia, 3rd Edition. Edited by Frederick A. Hensley, Jr., Donald E. Martin, Glenn P. Gravlee. Lippincott, Williams & Wilkins, Philadelphia, 2002. Pages: 733. ISBN: 0-7817-3444-4. Price: $79.95.

The subspecialty of cardiothoracic anesthesiology has undergone significant change in recent years. Alternative surgical approaches both with and without cardiopulmonary bypass, the increasing utilization of intraoperative transesophageal echocardiography, and the rising popularity of fast-tracking represent but a few of these changes. Editors Hensley, Martin, and Gravlee provide an up-to-date, pragmatic approach to the practice of cardiothoracic anesthesiology with A Practical Approach to Cardiac Anesthesia, 3rd Edition . This multi-authored text is the most recent version of a series that has long been popular with residents, fellows, and practicing anesthesiologists. Although not marketed as a comprehensive, authoritative volume, this paperback is nonetheless a substantial book of more than 700 pages with 55 contributing authors, many with national and international prominence.

Like the previous edition of this text, the third edition is organized in an outline format. Each chapter begins with an abbreviated outline that serves as a table of contents for that chapter. This method of organization enhances the “practical” nature of the book, making information on specific topics easy to locate. Although each chapter is organized as an outline, the amount of information under any given subheading varies from one word to lengthy paragraphs, depending on the subject and authors. The 26 chapters are organized into four sections: (1) Anesthetic Management for Cardiac Surgery, (2) Anesthetic Management of Specific Cardiac Disorders, (3) Circulatory Support and Organ Preservation, and (4) Thoracic Anesthesia and Pain Management. References (some only a year old) are included at the end of each chapter. Many chapters contain multiple pictures, tables, algorithms, and graphs.

A number of changes have been made since the second edition of this text was published in 1995. First, many of the authors of the various chapters have changed. Second, transesophageal echocardiography, which had been discussed in several pages within the monitoring chapter of the second edition, now comprises its own chapter. Third, a new chapter describing alternative surgical approaches to cardiac disease has been added. Fourth, chapters devoted to extracorporeal membrane oxygenation and support in both adults and children have been deleted. Finally, chapters have been rewritten to include current concepts, such as fast-tracking.

As with any text, the interests, biases, and local practices of the contributing authors are occasionally present. For instance, the chapter on valvular heart disease might lead one to conclude that open commissurotomy is the primary surgical therapy for aortic and mitral valvular stenosis. Similarly, this chapter indicates that the primary method for quantifying aortic and mitral regurgitation is angiography, when in fact echocardiography is undoubtedly used more often for this indication. The chapter on alternative approaches to cardiac surgery contains an excessive description of robotic surgery, including a table comparing fulcrum effect, tremor filters, and force ratios, that is unlikely to benefit the practicing anesthesiologist and seems out of place in a “practical” text.

Given the number of contributing authors, the editors have done a commendable job of eliminating duplication and redundancy between chapters. In fact, there is so little duplication of information that at first reading, some chapters seem incomplete. For instance, the chapter on postoperative care of the cardiac patient contains extremely brief discussions of tamponade and pneumothorax. However, these topics are covered in detail in the chapter devoted to cardiothoracic emergencies. Similarly, the chapter on cardiac transplantation does not mention heart–lung transplants, a topic later discussed in a chapter about anesthesia for lung surgery.

Although this book is not designed to compare with other authoritative texts, such those edited by Kaplan and Thys, it is still a valuable resource both for trainees and practicing clinicians. Many chapters, such as those discussing electrophysiology and pacing, congenital heart disease, the pathophysiology of cardiopulmonary bypass, and cardiac transplantation, are quite comprehensive. Numerous recent references and the number of prominent contributing authors lend credibility to the text. A Practical Approach to Cardiac Anesthesia, 3rd Edition , compares favorably with other similarly sized volumes (i.e. , DiNardo JA, Editor:Anesthesia for Cardiac Surgery, 2nd Edition . Stamford, Connecticut, Appleton and Lange, 1998), especially in its discussion of anesthesia and analgesia for thoracic surgery.

In conclusion, I would recommend this book as a thorough yet readable text for the anesthesia trainee and as a quick reference for the practicing anesthesiologist.