Recent Advances in Anaesthesia and Intensive Care

In this, the 24th edition of the ‘Recent Advances’ series, the current editors reproduce the successful formula of previous editions to give generalists and specialists alike a readable, informative, and fully referenced account of the latest developments in anaesthesia and intensive care. The book comprises 13 chapters divided broadly into preoperative assessment, sub-specialist topics and intensive care. The final chapters are dedicated to evaluating clinical performance, acquisition of non-technical skills and the use of simulators in anaesthetic training. Each chapter is written by a recognized authority in their field and the text is supported by an impressive 736 references.

The opening chapter by Drs Older and Hall outlines the pitfalls of using cardiac ischaemia to predict postoperative complication rates after non-cardiac surgery and they present a compelling case for more robust risk stratification using functional cardiopulmonary exercise testing (CPEX). Not surprisingly, their persuasive argument in favour of CPEX forms part of their crusade to tell the world of its virtues. The ‘specialist topic’ section presents well-written accounts of the issues surrounding oesophagectomy for cancer, vascular surgery (highlighting the significant advances in the use of endovascular techniques for the management of major vascular disease) with the last of this trilogy giving a concise description of the conduct of anaesthesia for the elderly.

The NCEPOD (National Confidential Enquiry into Patient Outcome and Death) reassures us that deaths relating directly to anaesthesia are rare, but also warns us that we must never become complacent. The chapter entitled ‘Deaths following Anaesthesia’ suggests that, in order for us to move forward, we sometimes must look back to ‘eliminate the deficiencies from our own practice’. Despite its relatively short length, the issues raised in this chapter provide salutary lessons for all working within anaesthesia. In particular, the current trend towards increasing sub-specialization is discussed in relation to the loss of assumed generic skills, and the consequences that may ensue if this trend continues.

In keeping with previous editions, a dedicated chapter on trauma provides an informative update on the management of pelvic and acetabular fractures. The use of an ATLS-style approach combined with an orthopaedic anatomy refresher lesson will appeal to all those working in an acute trauma setting, but less surgical detail and more emphasis on the anaesthetic management of these patients would have enhanced the chapter enormously for its intended readership.

The intensive care section is made up of four chapters focusing on transoesophageal echocardiography, levosimendan (a novel calcium sensitizer used in the treatment of heart failure), the development of outreach teams, and, given the recent publicity over the H5N1 avian flu virus, an extremely timely and thought provoking chapter on critical care and biological disasters.

The next two chapters present an intriguing insight into the methods used to assess clinical performance and they examine the non-technical skills that make a knowledgeable and technically proficient clinician a better one. These topics are of the utmost importance in this new era of Modernising Medical Careers; therefore, it is not surprising that the issues over current medical training are echoed in the chapter describing the factors influencing perioperative mortality! The final chapter provides a possible remedy by arguing in favour of simulators and simulation as powerful educational tools concluding that their use should complement traditional apprentice-style training to improve patient safety.

I enjoyed reading this book. It has an eclectic range of clinically relevant subject matter and, as the editors suggest, it will undoubtedly appeal to ‘all levels of practicing anaesthetists and intensivists’. From a personal point of view, it would have been nice to see slightly more laboratory-based and translational research themes developing after their ‘guest appearance’ in the previous edition. In terms of value for money, this book provides valuable CME points at a fraction of the cost of attending a national meeting, but it has the distinct advantage that it can be read easily then kept (or loaned!) for future reference.