Thoracic Anesthesia, 3rd Edition.

Edited by Joel A. Kaplan and Peter D. Slinger. New York, Churchill Livingstone, 2003. ISBN: 0443066191 Pages: 479. Price: $182.25.

I first reviewed Kaplan’s Thoracic Anesthesia  for the Journal in 1983. With its publication, for the first time those of us interested in the field of noncardiac thoracic surgery had a modern, up-to-date textbook. Before then, with the exception of a few British texts that did not reflect current American clinical practice, discussion of anesthesia for pulmonary surgery was relegated to single chapters in cardiac anesthesia textbooks. Anesthesia for thoracic surgery as a specialty has continued to grow and evolve, and Thoracic Anesthesia  has grown and matured along with it.

In the current, 3rd edition, Peter Slinger, the well-known thoracic anesthesiologist, joins Dr. Kaplan as an Associate Editor. The book has been revised with several new chapters and new contributors. The 26 chapters (723 pages of text and references) of the 2nd edition have been consolidated into a more concise and very readable 20 chapters (462 pages) without compromising overall content. Several chapters have been completely rewritten, while others are revisions of material from previous editions.

For the most part, Thoracic Anesthesia  is extremely well presented. I found the print, and the numerous figures and tables, clear and easy to read. Unfortunately, the book is marred with typographic errors; the most obvious is chapter 4, entitled “The Physiology of the Lateral Decumitus [sic ] Position.” The table of contents lists both chapters 8 and 10 as “Tracheostomy and Tracheal Resection and Reconstruction.” Mistakes like these are more embarrassing than meaningful and probably represent the copyeditor’s rush to publication.

As with the previous edition, Thoracic Anesthesia  continues to retain a four-section format. The first section has been reduced from four to just two chapters and concerns the preoperative assessment of the patient scheduled for thoracic surgery. I believe that every anesthesiologist managing a thoracic surgical patient should examine that patient’s imaging studies. Chapter 2, “Radiology of the Chest,” is an excellent review by specialists for nonspecialists on the basics of interpreting chest radiographs.

The second section of the book, four chapters, discusses pulmonary physiology and pharmacology. This background information is essential to integrate basic principles into the clinical management of patients undergoing one-lung ventilation. The third section of 10 chapters discusses anesthetic management of the entire gamut of noncardiac thoracic procedures. The final section reviews pain management and postthoracotomy complications.

It is probably uncommon for anyone other than a book reviewer to sit down and read an entire reference text from cover to cover. In doing so, the inevitable differences in style and content among chapters become apparent. This is to be expected with any multiauthored text, a format that also allows duplication of material between chapters and an occasional contradiction.

Repetition does occur throughout Thoracic Anesthesia . Hypoxic vasoconstriction is reviewed in varying detail in three chapters. Management of postoperative pain is discussed in both the first and last chapters. Pharmacologic modulation of the pulmonary circulation, an area of current interest, is extensively discussed in the chapter on pediatric thoracic surgery and is briefly considered in several other chapters.

Most of the important changes that have occurred in the field of thoracic anesthesia since the previous edition’s publication in 1991 are included. Discussions on video-assisted thoracoscopy, minimally invasive surgery, modern bronchial blockade, pulmonary transplantation, and postthoracotomy analgesia have been markedly expanded to reflect their importance. Lung volume reduction surgery, not even mentioned in the 2nd edition, is now extensively reviewed. Unfortunately, other subjects are virtually ignored. Only three small paragraphs with no references are devoted to airway stenting. The chapter on pediatric thoracic surgery states that “double-lumen tubes are not available in pediatric sizes,” although tubes as small as 26 F have actually been used for quite a while in many centers.

The editors have allowed some authors to occasionally cite unsubstantiated abstracts—a poor practice for any reference text. Chapter 8 states, “recent studies  have suggested that to increase the accuracy of placement, the stylet should be kept in place in the DLT until the endobronchial lumen is in the bronchus.” This statement is based on the single study cited, which included just 30 patients and has never been repeated or reconfirmed. Far-reaching conclusions based on single reports can be misleading and potentially dangerous.

With few exceptions, the most recent references are from 2001. This is a problem inherent in every reference textbook because of the intervals between chapter submission by the authors, medical editing, and eventual publication. Because of constant and continuous growth in the specialty of thoracic anesthesia, as in any medical field, the Internet with its search engines remains the only practical way to keep reasonably current.

Unlike in 1983, currently the anesthesiologist can choose between several textbooks that deal exclusively with anesthesia for thoracic surgery. Having all of these books in my personal collection and having referred to each on numerous occasions, I believe that the 3rd edition of Thoracic Anesthesia  is still the standard by which these other books should be compared and judged. Despite its minor faults, Thoracic Anesthesia  continues to be an important resource for anyone involved in the management of patients undergoing noncardiac thoracic anesthesia procedures.