Abstract
Total Intravenous Anesthesia and Target Controlled Infusions: A Comprehensive Global Anthology comprehensively and authoritatively addresses the intravenous method of anaesthesia and offers a wide ranging dissertation on the basic science, history and clinical application of total intravenous anaesthesia and target-controlled infusions (TCI).
How appropriate is it that this massive text should land on my desk on the 30th anniversary (roughly) of the arrival of propofol (and myself!) in Australia and the 20th anniversary (roughly) of the launch of closed TCI in this region?
Anthony Absalom and Keira Mason have marshalled a truly formidable array of authors from all over the world, many of whom are published authors of seminal work in this field. Bizarrely for a text of this importance, the eponymous originators of the two commonest open TCI programs are notable by their absence (Tomas Schnider (propofol) and Charles Minto (remifentanil)).
The book is divided into six parts and is profusely illustrated with figures and tables of the highest quality and relevance. The parts are: (a) Introduction/Background, (b) Principles of Pharmacological Modeling, (c) Pharmacology of the Intravenous Anesthetic Agents, (d) Practical Conduct of Sedation and Anesthesia, (e) Special Populations and Procedures and (f) Outcome, Education, Safety, and the Future.
There are a number of standout chapters that are unmissable for anyone who has ever loaded a TCI pump and used it on a patient. I particularly enjoyed and would recommend large tracts of this book to even the most occasional total intravenous anaesthesia (TIVA) user:
Parts I–III reveal gems such as:
‘When and How Did It All Begin? A Brief History of Intravenous Anesthesia’, by Sear of Oxford, and ‘Mechanisms of Intravenous Anesthetic Action’ by Hemmings (editor-in-chief at BJA) and Herold. At this point, it is worth noting that mechanisms of action for most intravenous agents are straightforward, unlike their inhalational counterparts. ‘Basic Pharmacology: Kinetics and Dynamics for Dummies’ by Raeder. This is the title I myself would have picked for his chapter, since I firmly believe one need not be a slave to the mathematics to embrace TCI-TIVA and administer them effectively for the good of our patients. ‘Pharmacokinetic–Pharmacodynamic Modeling of Anesthetic Drugs’ by Proost. This chapter underscores and elucidates the nuts and bolts of TCI. ‘Principles of Target-Controlled Infusions’ By Shafer from Stanford. This chapter presents a succinct, well-illustrated and clear exposition of the pharmacokinetics/pharmacodynamics mantra as it applies to TCI. (Shafer was of course there right at the very beginning of TCI research.) The single-drug chapters on propofol (Eleveld), dexmedetomidine (Mahmoud) and ketamine (Roback) are not only fascinating but eminently examinable topics for both Parts 1 and 2 of the Australian and New Zealand College of Anaesthetists Fellowship examination.
Part IV on the practical conduct of TCI-TIVA for sedation and anaesthesia is mandatory reading for anaesthetists at all levels, and I would specifically highlight the chapters ‘Pump Pitfalls and Practicalities’ by Engbers and ‘Adult Case Studies’ by Sutcliffe.
Part V addresses special populations, and these are headlined by the paediatric contributions of Anderson and Bagshaw, together with new information on the management of the morbidly obese.
Finally, in Part VI, the authors address outcomes, education and safety while they look to the future, and here I would highlight the chapter ‘Advantages Disadvantages and Risk’ by Johnson and the chapter ‘Opioid Induced Hyperalgesia’ by Richebe and Rivat. Leslie from Melbourne discusses dreaming and awareness under TIVA in the penultimate chapter.
I recommend this book unreservedly for departmental libraries, but I suspect that many individuals will want their own copy or will download parts of the e-book.
In summary, I enjoyed this book immensely. If there is one criticism to be levelled, it is that the ‘anthology’ format breeds some repetition. However, the editors have successfully controlled this.