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Excerpt
No doubt the anesthesia community needs a recent treatise devoted to the perioperative care of the patient with liver disease. Anesthesia and Intensive Care for Patients with Liver Disease was written to fill this void. It is a multiauthored text (28 authors) primarily written by two groups: one from the University of Pittsburgh School of Medicine in the USA and one from Addenbrooke's Hospital in Great Britain. This book is divided into four major headings: Assessment, Pharmacology, Anesthetic Considerations, and Intensive Care.
While preparing a lecture on anesthesia for the patient with liver disease, this reviewer used this text as a source. Generally, the knowledge imparted was current and the content appropriate; however, the book is not particularly user-friendly (it is difficult to acquire information), it is disjointed (multiple styles of writing making reading laborious at times), and it is somewhat disorganized (the editors' job!). Books should obviously contain accurate information, but in addition should convey that information in an enjoyable fashion for the reader.
The first chapter, Normal Liver Function and the Hepatic Circulation, has much important information, but there is not one figure, diagram, table, or algorithm in the entire chapter to facilitate understanding of the material. This chapter could probably be combined with the third chapter, Liver Function Tests. Similarly, the second chapter, Causes of Liver Disease, has two pages on the liver and pregnancy that would be more appropriate in the chapter Obstetric Patients with Liver Disease.
"Bridging the Atlantic" is an interesting and certainly noble endeavor attempted by the editors; however, readers may have some difficulty making the "crossing" since the writing styles are different. The ninth chapter, on liver transplantation, is strictly about the British approach, with no comparisons or contrasts made to the methods used in United States. Terminology is confusing; e.g., drug names like pethidine should have the United States equivalent (meperidine) also in the text. In the chapter Pharmacokinetics and Pharmacodynamics of Nondepolarizing Muscle Relaxants, the text states that pancuronium is "eliminated primarily by the kidney (70%)"; however, a Table in the chapter shows the major route of metabolism to be hepatobiliary.
One of the better chapters is Coagulation in Liver Disease and Massive Blood Transfusion, which is well written as well as up to date. Also, the chapters Acute Liver Failure and Intensive Care of Patients After Liver Surgery are particularly useful for the clinician managing these patients in the intensive care unit.
In summary, although there are deficiencies in this book (noted above), it is still the most current available source on the topic of anesthesia and intensive care of patients with liver disease. This book is best used as a reference text in a departmental library.
John G.
