Fundamentals of Neuroanesthesia: A Physiologic Approach to Clinical Practice, edited by Drs. Keith J. Ruskin, Stanley Rosenbaum, and Ira Rampil, offers a well-organized and clearly written physiologic basis for the anesthetic approach to a broad range of neurosurgical cases. This first edition textbook adds to the current selection of neuroanesthesia texts because of its practicality. The topics covered are comprehensive, including sections on anesthesia for supratentorial and posterior fossa craniotomies, pituitary surgery, craniotomy for skull base and vascular surgery, posterior fossa surgery, epilepsy surgery, awake procedures, stereotactic radiosurgery and intraoperative magnetic resonance imaging, neurointerventional radiology, and the anesthetic implications of patients with other neurologic diseases.
The book is divided into 30 chapters and begins with a discussion of neurophysiology and neuroanatomy. The anatomy chapter is enjoyable to read because the discussion is very relevant to the anatomy of the surgical procedures and neurologic diseases discussed later in the book. The chapter discussing cerebral blood flow and metabolism describes basic physiology and enriches the topic by covering advanced modalities used to monitor cerebral blood flow and metabolism in clinical practice. The next group of chapters covers pharmacology of anesthetic agents. At the end of the chapter on sedative-hypnotics, an awake craniotomy case and a spinal fusion with neuromonitoring case are presented; they facilitate meaningful discussion about the use and administration of intravenous anesthetics in neurosurgical patients.
The next several chapters discuss specific neurosurgical procedures. For each procedure, the chapters cover preoperative considerations, positioning considerations, intraoperative management, complications that may arise, and postoperative management. Practical recommendations based on explanations from current literature are made and, where relevant, current practice guidelines, such as the Brain Trauma Foundation Guidelines for traumatic brain injury, are reviewed. A separate chapter also reviews positioning with a comprehensive group of illustrations of the frames and tables used in spine and intracranial surgery. The book finishes with the management of specific neurosurgical patient populations, including pediatric patients, patients who are critically ill, those with occlusive cerebrovascular disease, and brain-dead patients.
One minor criticism is the repetitive nature of the chapters that discuss the various types of neurosurgical procedures. For example, the basic principles for induction and emergence from anesthesia for a neurosurgical patient and general considerations for anesthetic maintenance in a patient undergoing neuromonitoring are repeated for each type of procedure. This is especially noticeable when reading the book from cover to cover. On the contrary, this repetition may be helpful to those reading one chapter at a time because each chapter is complete. I would also suggest an improvement in the editing for the next edition, as the number of typographical errors was distracting.
As noted in the preface of the book, neurosurgical procedures are now more commonly performed outside the tertiary medical center, and anesthesiologists who have not completed fellowship training in neuroanesthesia may be called upon to take care of patients undergoing craniotomy, spine, and neurointerventional radiology procedures. The authors accomplish their goal of providing a practical and thorough book ideal for the general anesthesiologist and neuroanesthesia trainee confronted with a planned or emergent neurosurgery case.
Overall, Fundamentals of Neuroanesthesia: A Physiologic Approach to Clinical Practice is a textbook whose essence is perfectly captured by its title. It is a well-organized, easy-to-read text that is written specifically for the clinician faced with tough neurosurgical cases. The discussions are clinical, yet well supported by physiology, scientific evidence, and neuroradiology. It is a must read for the general anesthesiologist taking care of neurosurgical patients as well as anesthesia residents and neuroanesthesia fellows.