James C. Eisenach, MD, Editor
Bailler's Clinical Anesthesiology. The Lung in Anaesthesia and Intensive Care. April 1996; 10(1) Edited by R. G. Pearl, M.D., Ph.D.
The Lung in Anaesthesia and Intensive Care is a synopsis of current thinking of the effects of anesthetics on the lungs. It also contains information on the pathophysiology of lung disease and how to treat patients with pulmonary disease undergoing an anesthetic or who are in an intensive care unit (ICU). The authors are well known in America and Europe; many of them have previously contributed significantly to the scientific literature on these topics.
The effects of anesthesia on the respiratory system are complex and include not only the effects on gas exchange, but also those on the smooth muscle of the bronchi and pulmonary vascular system and on the respiratory centers within the medulla and pons. The initial chapter focuses on these areas, providing a succinct and well-written review.
The chapter on monitoring describes in good detail capnography and pulse oximetry. The increasingly computerized nature of ICUs (and of operating rooms) is not addressed, probably for good reason because we currently do not have good noninvasive techniques for measuring patient's tidal volume and respiratory rate. The chapter on respiratory therapy is relatively unconventional in its approach, but it is well written and discusses the topic in detail.
The discussion of anesthesia for patients with lung disease, although adequate, would have benefitted from greater attention to detail. Perhaps combining it with the chapter on anesthesia for thoracic surgery would have been better. The two chapters seemed duplicative at times.
There is an excellent summary and review of embryology in the discussion of anesthesia and the respiratory system in pediatrics.
I was confused as to why in the chapter on anesthesia for trauma would have a discussion (a good one) on managing cardiac contusion and the best ways to protect the spinal cord during thoracic aorta repair. Perhaps the title of the book should have been The Lung and Thorax in Anesthesia and Intensive Care.
The discussion of mechanical ventilation for critically ill patients is thorough and provides an excellent summary of current techniques for using newer modes of mechanical ventilation. In most textbooks, chapters such as this one tend to be dated, but not this one.
The chapter on acute respiratory distress syndrome also is excellent, although it is written from the European approach, with a fair amount of optimism regarding the effects of therapy on survival.
By and large this monograph is a well-written, scholarly review of the topic. Readers need to be aware that this is written and edited in Great Britain, and aside from differences in spelling (anaesthesia, manoeuver, haemoglobin), American readers need to be cognizant of other differences. The British do not distinguish between the correct use of “that” and “which,” and as one proceeds toward the carina from the glottis, one is moving “up” the trachea. Perhaps the author or editor was from Australia?
Most chapters had few typographic mistakes. On a reference check of one of the chapters, I found less than 5% of the references with mistakes; interestingly, three of the five references with mistakes were written by the author of the chapter!
I would recommend the book for pulmonary, anesthesia, and ICU libraries. It is too extensive to be a good review for medical students or for house officers, but it is not in-depth enough regarding molecular biology, etc., to be of much benefit for individuals whose major focus is research on the effects of anesthesia on the lung.
Michael J. Murray, M.D., Ph.D.
Department of Anesthesiology; Mayo Clinic
200 First Street; Rochester, Minnesota 55905
