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Excerpt
Common Problems in Obstetric Anesthesia, a textbook with a clinical focus, contains 46 chapters that cover a wide variety of obstetric anesthesia issues. The early chapters cover the basics of physiology of pregnancy and preparations and procedures for labor analgesia and vaginal or cesarean delivery anesthesia in the healthy parturient. Later chapters consider fetal heart rate monitoring, neonatal resuscitation, and local anesthetic pharmacology and toxicity. The obstetric complications covered include hemorrhage, fetal distress, breech presentation of the fetus, neurologic problems after delivery, and preterm labor. Sixteen chapters are devoted to maternal medical conditions that may complicate pregnancy and influence anesthetic management.
The book uses an interesting format. Each chapter begins with a case or clinical situation to introduce the topic of the chapter and asks a specific question to provide a focus for the chapter discussion. This format lends itself to the presentation of clinically relevant information. How each author uses the case as a take off for his or her chapter varies, and some topics are more conducive to this format than others. For example, the authors of the chapter covering postdural puncture headache present a basic background of the problem followed by treatment options to be considered in the patient. Similarly, the chapter considering the pregnant patient with morbid obesity provides a succinct discussion of issues unique to this clinical problem followed by the risks and benefits of various anesthetic options. The chapters considering perinatal and local anesthetic pharmacology are less conducive to this format, and, as a result, these chapters are not much different from those which appear in standard textbooks of obstetric anesthesia.
Because of the case format, it appears that a goal is for each chapter to stand alone as a complete work. As a result, information is duplicated within the book. The issue of aspiration risk in pregnancy and means to prevent aspiration pneumonitis are presented in several chapters, and the changes in the cardiovascular and pulmonary systems that accompany pregnancy are also repeated throughout the book. The goal for each chapter to be a complete work also results in a great range of writing styles. Some chapters provide comprehensive background information before considering the clinical case linked with the chapter. Others are more succinct and consider only those issues unique to the case presented.
Clearly, the focus of the book is to present clinical management information. The list of authors is as diverse as the clinical recommendations, which leads to differing opinions within the book. For example, there are recommendations for and against the use of continuous spinal anesthesia (with a catheter placed through an epidural needle) in pregnant patients. There are also varied opinions regarding the clinical utility of the bleeding time to assess maternal coagulation status.
When clinical management plans are presented, not all authors clearly indicate when a statement reflects their own biases or a widely accepted practice supported by clinical data. The authors of the chapter discussing postpartum tubal ligation are commended for presenting the clinical data available to guide management of these patients (such as timing of surgery) and then clearly stating when their own unique practice is described. As a result, the reader gains an appreciation that there are not always data available to help with clinical management decisions.
Although the title of the book suggests that only common problems in obstetric anesthesia are considered, the contents are quite comprehensive and include important but uncommon problems such as cardiac valvular disease, significant neurologic disease, and cardiac arrest.
