Edited by Ian Calder, M.B. Ch.B., F.R.C.O.G., F.R.C.A., Adrian Pearce, F.R.C.A. New York, Cambridge University Press, 2011. Pages: 330. Price: $88.00.
Anesthesiologists are notoriously creatures of habit. Every one of us has a specific way we organize our medications, airway equipment, lines, and so forth. The key word is organization, and this filters down through every aspect of the field. Much of our training is spent learning algorithms and protocols, which are designed to bring a semblance of order into potentially chaotic situations. Although Core Topics in Airway Management has all of the information one might expect from a book on this particular subject, it does not always have the tight sense of organization that most of us crave.
As with most discussions of airway management, the text starts in chapter one with a description of airway anatomy and corresponding figures. The main pitfall in this chapter is the addition of extraneous material that muddies the waters. Between sections of a thorough discussion of basic airway anatomy, airway management techniques are described; the author even comments that he is discussing management rather than anatomy in one section. Although the information presented is very useful, the main objective of the chapter is somewhat lost. There is also a rather extensive discussion of dental injuries, which seems oddly placed in this chapter.
The next few chapters detail important principles regarding airway management, specifically airway reflexes, hypoxemia, the physics of air flow, and the scientific basis behind preoxygenation. The only omission seems to be a lack of discussion regarding intrathoracic airway obstruction, but extrathoracic obstructions are reviewed in extensive detail.
The organizational issue arises again in the subsequent chapters. Individually, each of the chapters accomplishes its assigned task of explaining the relevant subject. The main issue is how all of the component chapters are arranged to achieve the final product. For example, chapter five, a thorough discussion of prion disease and airway equipment decontamination, immediately precedes chapter six, entitled “Basic Principles of Airway Management.” As the book progresses, the individual chapters are excellent, but there is a fair amount of redundancy in the subject matter, and chapters that may have better served the book by being combined. For instance, the information within the chapter “Airway Management with Limited Resources” is interesting, but reintroduces topics already discussed at length earlier in the text.
The highlights of the text are numerous: the discussions on different endotracheal tube types, practical tips for success for fiberoptic intubation of the awake patient, and the not-often-discussed topic of anesthesia for dental procedures are excellent. The two standout chapters are airway management in the intensive care unit and anesthesia for ear, nose, and throat procedures. The chapter on the intensive care unit touches on the subject of the ethics of intubation as well as a good basic discussion of tracheostomies and the timing of their placement. The ear, nose, and throat chapter does an excellent job of explaining vocal cord pathology and airway techniques for the different levels of airway obstruction.
The two chapters that conclude the book, “Ethical Issues Arising in Airway Management” and “Legal and Regulatory Aspects of Airway Management,” broach some of the tougher, less clinical facets of the subject. Do-not-resuscitate orders, patient refusal of specific airway techniques, and patient refusal to allow trainees to care for them are all discussed. Some of the legal concepts regarding malpractice are also covered. Although neither of these chapters is particularly in depth and both are geared toward the legal system in the United Kingdom, the overarching concepts are still widely applicable and are very useful for generating discussion.
The most useful application of this book might not necessarily be reading it from cover to cover, but rather using the individual chapters as concise primers, starting from anatomy for the earliest of trainees to potentially challenging airway cases that may arise in practice long after residency has been completed. Overall, Core Topics in Airway Management is a thorough text with a wealth of both discrete facts and practical tips regarding the management of airways in a variety of different situations. Except for the organizational issues mentioned previously, this is a good resource for anyone involved in airway management.