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Excerpt
The title, Anesthesia for Cardiac Surgery, implies that this text is targeted for anesthesiologists and anesthesiology residents who frequently deliver care to a subset of surgical patients. While the book provides an integration of conceptual frameworks and anesthetic management for specific cardiac surgical patients, chapters such as those covering transplantation, mechanical assist devices and the central nervous system offer an invaluable and up-to-date reference for intensivists, surgeons, perfusionists, and nurses.
This second edition attempts to incorporate all that has evolved in cardiac surgery and anesthesiology since the first publication. The book is divided into 13 chapters, all but two authored by Dr. James Dinardo. The chapters are organized to review relevant physiology, to outline the specific goals toward which the anesthetic plan is oriented, and to describe the functional aspects of the plan through the perioperative period.
Chapters 1 through 3 offer well-edited overviews of the preoperative assessment, interpreting cardiac catheterization and monitoring. While this is standard fare for this type of text, the writing is concise and comprehensive and offers something more for the experienced reader. The chapter on cardiac catheterization contains a balanced combination of diagrams, pressure-volume loops, illustrations and equations to demonstrate the utility of diagnostic procedures performed for adult and congenital pathology. The chapter on monitoring includes an overview of the monitoring techniques commonly used during cardiac surgery. The advantages, limitations, and pitfalls of the various invasive and noninvasive monitoring are presented. Additionally, thromboelastography is reviewed and guidelines for its interpretation are presented. An extensive section on transesophageal echocardiography in children and adults is indicative of the expanding role of the anesthesiologist and transesophageal echocardiography in the perioperative period and provides a useful reference for those individuals with limited transesophageal echocardiographic experience.
In chapters 4 through 6 and chapter 8, physiology, pathophysiology, and pre- and postcardiopulmonary bypass management are united in discussions of myocardial revascularization, valve replacement, congenital heart disease and pericardial disease. In the chapter on surgery for the thoracic aorta, a broad topic is distilled and succeeds in presenting emergent and elective clinical scenarios. Advantages and disadvantages of various modes of one lung ventilation and the management of cardiopulmonary bypass and other circulatory support methods utilized in thoracic aortic surgery are discussed.
Chapters 10, 11, and 12 cover the management of cardiopulmonary bypass, mechanical circulatory assist devices and myocardial preservation. These chapters represent straightforward recitations of state-of-the-art techniques and technology employed in cardiac surgical patients. Special problems and troubleshooting in the clinical setting makes these chapters more than a valuable reference. The book concludes with an in-depth and timely presentation of the central nervous system and cardiac surgery by Dr. Bradley J. Hindman. This chapter underscores the increasing importance of neurologic dysfunction in the aging population presenting for cardiac surgery. The discussions of outcome studies, risk factors, and controversies in perioperative management answer the questions "where have we been?" and "where are we going?" and leave the reader current and "where we are now."
In summary, the second edition of Anesthesia for Cardiac Surgery is a high-quality presentation that is well referenced and well edited. This expanded and updated text reflects the rapid advances in cardiac surgery and anesthesiology. Although there are several other notable textbooks on cardiac anesthesia, this text should be a welcome addition to the personal library of any professional who cares for cardiac patients as it spans the continuum of the perioperative period with conceptual structures, detailed management recommendations, and reviews of the current literature.
