Abstract
Medical reference books, like everything else, must evolve with time. At the most basic level, this means that a new book should incorporate the advances in medical knowledge that have occurred in a particular discipline – in this case, anesthesia. One would expect a new reference in this field to include information on recently introduced drugs, drug interactions, novel combinations of drugs, advances in instrumentation and equipment, and new insights into the physiology of the anesthetized patient. This book fulfils this purpose quite adequately.
However, to be really useful, a textbook should do more than document recently discovered facts: it should reflect the changes in philosophy that have gradually crept into a discipline. I found this book particularly helpful in this regard, as it clearly outlines recent trends, including the role of veterinary technicians as the personnel primarily involved in the administration and monitoring of anesthesia (two of the 12 contributors are veterinary technicians), the increasing sophistication and safety of anesthesia in compromised patients; and the benefits and perils associated with the use of analgesics.
One of the things I liked best about this book was the diminished emphasis on the ‘cookbook’ or ‘rule book’ approach to anesthesia and a willingness to convince the reader by means of reasoned argument why a particular course of action should be taken. Nowhere is this more evident than in the chapter on monitoring. The author argues convincingly that patients should be monitored by multiple modalities whenever possible, and to this end there is in-depth discussion of blood pressure monitors, capnography, pulse oximetry, agent analyzers, and pH and blood gas analyzers. This is more than a discussion of facts: the text effectively conveys the philosophy that the more information that is available to the veterinarian, the better the assessment that can be made on the patient's status.
As is inevitable in a book of this length, the treatment of some topics is very brief. This is particularly evident in chapter 1, which over the course of 20 pages makes a heroic effort to discuss equipment used in veterinary anesthesia. In truth, a whole book could be devoted to this topic alone. Wisely, the author focuses the discussion on items that would be of special interest, including newer models of ventilators, trouble shooting anesthetic machine malfunctions, and leak testing anesthesia machines.
In contrast, I found some chapters heavy going and excessively burdened with theory. For example, the chapter on ventilation attempts to convey some fairly advanced physiology on acid-base derangements and hypoxemia. However, even in the midst of a theoretical discourse, the alert reader can find items of immediate relevance to practice, such as the importance of maintaining the patient in sternal, rather than lateral recumbency as much as possible in order to prevent atelectasis. I found myself plowing through another theoretical discussion in the chapter on inhalant anesthetics (this one on uptake and distribution of inhalation agents) and was disappointed that this chapter contained almost no discussion of the risk of occupational exposure to these agents and the options available for monitoring exposure.
Overall, however, the book addresses effectively the issues surrounding anesthesia that are likely to arise in practice. For example, there is a good discussion of breed-related idiosyncracies in anesthesia. The peculiarities of feline anesthesia are very well covered, and anesthesia of cats is given equal or greater emphasis than canine anesthesia. The chapter on cardiopulmonary resuscitation is excellent, in that it doesn't just give current recommendations, but discusses how and why the recommendations have changed over the past few years. The chapter on local anesthetics is particularly well written and packed with useful information, including novel uses for old agents (topical morphine for corneal ulcers?), a good discussion of the potential side effects of local anesthetics, and clear illustrations of placement of nerve blocks.
This book also features a comprehensive discussion of analgesia, with two chapters on this growing field. It was a pleasure to read an entire chapter devoted to the use of non-steroidal anti-inflammatory drugs, including a discussion of COX-2 selective agents which invites the reader to clinically examine the evidence behind the claims made for various agents. This chapter also includes an excellent four page table comparing the indications and adverse effects of the various NSAID agents that have recently come on the market.
Interestingly, the editor chose to include a chapter on physical medicine (acupuncture, veterinary rehabilitation, diet) and its role in recovery from surgery. The chapter is an interesting introduction to the field but does not contain enough material to be truly useful, and some of the information is somewhat peripheral to the field of anesthesia.
Who should purchase this book? There are many practical suggestions for veterinarians in practice, but the book also includes a great deal of theoretical discussion that is probably of more interest to students than to busy practitioners. With the exception of the chapter on clinical techniques, the level of discussion seems inappropriate to veterinary technicians unless they have a particular interest in anesthesia. Overall, however, there is much useful information (and even more important, a good presentation of current philosophy) contained in this small and reasonably priced book.