Core Topics in Airway Management. By Ian Calder and Adrian Pearce. Cambridge, UK, Cambridge University Press, 2005. Pages: 209. Price: $65.00.
Although many may not recall losing their first tooth, most will never forget their first encounter with an “unable to ventilate and intubate” patient. In a crowded shopping mall, I still find myself instinctively identifying a person who might be difficult to intubate, a sad commentary of sorts! The practice of anesthesia demands the establishment and performance of good airway techniques. Despite a number of preoperative tools proposed to help distinguish patients who may be difficult to intubate from those who should not be, the reliability of such measures remains poor. As a consequence, a simplified plan A approach alone is short on insight. Similarly, persistent and improper instrumentation of the airway have continued to add to the legal consequences of our practice.
Drs. Calder and Pearce have edited a text as part of the broader Core Topics Series that reviews aspects of airway management in a manner the editors themselves state incorporates “little excess fat.” Although the overall content may be less than that present in many texts on the subject, it is no less important in its approach. Each chapter is efficient and focused, including the very first, which discusses the anatomy of the airway. Each anatomical component is offered as a “selected account … as it applies to anesthetic clinical practice.” Likewise, the brief physiology chapter highlights issues relating to hypoxia—no fluff here and certainly no lack of importance.
An area where this text differs from many others is revealed in the most enlightening chapter of the book, titled “General Principles.” This is where Calder and Pearce have brought to the table such controversial subjects as the effectiveness of cricoid pressure and establishing ventilation before dosing muscle relaxants—a must read. The middle portion of the text highlights topics such as routine tracheal intubation, confirmation of successful tracheal intubation, and extubation principles. These topics are required for the young inexperienced learner but perhaps wasted on those with more years in the field. As with any airway text, the bulk of the information presented rests with a discussion of specific airway devices. These chapters are neatly organized and, like the rest of the text, efficient in coverage of the topic. The authors' approach to each device is thorough where it needs to be but still cuts to the chase. A short but effective list of references is added at the end of each chapter for readers who have a taste for more.
There is a nice discussion of the trauma that may result from our manipulation of the airway. With the ever increasing number of tools and techniques available to help establish ventilation and secure the airway, we can only hope that iatrogenically produced trauma will lessen as our knowledge grows. Such a chapter acts as a bit of a wake-up call for all of us to respect the airway and the potential damage that we may cause if we are inexperienced in our care. I applaud the authors for this subtle but effective message.
The relative simplicity of approach embodied in this text may not meet the more comprehensive needs of those practitioners who are avid researchers in the field of difficult airway management. However, this easy-to-read, tightly directed text will find its place is on the desk of clinical anesthesiologists interested in a no-nonsense approach to airway management, as a mandatory read for introductory instruction of anesthesia trainees, and as a source of information for our colleagues outside the field of anesthesia who provide airway management as part of their broader practice.
Mayo Clinic College of Medicine, Mayo Clinic Rochester, Rochester, Minnesota. burkle.christopher@mayo.edu
