James C. Eisenach, M.D., Editor.

Textbook of Neuroanesthesia with Neurosurgical and Neuroscience Perspectives. Edited by Maurice S. Albin. New York, McGraw-Hill. Pages: 1433. Price:$165.00.

This is a multiple-authored text edited by a well-known neuroanesthesiologist, Maurice S. Albin, M.D. It is considerably longer than other textbooks in this field and features an eclectic mix of authors. (Slightly fewer than half the authors are neurologists, neurosurgeons, and radiologists.) In addition, it covers many topics not often addressed in anesthesiology textbooks. Whereas other books have separated basic principles of neuroanesthesia from clinical sections, this one is considerably more integrated. Some chapters cover basic physiologic or pharmacologic principles in a given area and the status of basic and clinical research in that area, and then integrate that information into recommendations for clinical care. Other chapters deal primarily with either basic principles, such as separate chapters on chemical neurotransmission, excitotoxicity, and resuscitation of the ischemic brain, or they are clinically oriented, such as chapters on neurologic syndromes and anesthetic implications or on carotid artery disease. There are several topics covered that are not usually included in classic anesthesiology texts, such as chapters on neurobehavioral evaluation, differential diagnosis and causes of coma, and the diagnosis and management of epilepsy. These are useful to anesthesiologists caring for patients with neurologic diseases.

Several chapters are good references for residents, neuroanesthesiology trainees, and practitioners providing care for neurosurgical patients. The chapter on evoked potential monitoring by Tod Sloan, M.D., provides a well-organized, logical, and thorough review of evoked potential monitoring that covers the theory and technical aspects of recording plus indications for monitoring and effects of physiologic changes and anesthetic agents. It is an ideal source for anesthesiologists interested in learning about evoked potential monitoring. A similarly designed chapter by Ira Rampil, M.D., is a valuable review of electroencephalographic monitoring, its techniques, clinical indications, and clinical impact. The two chapters on neurologic syndromes and neuromuscular diseases are succinct and thorough reviews that would interest all anesthesiologists. Each is a well-written and well-organized review of these uncommon diseases and their anesthetic implications. The chapter entitled Effects of Anesthetic Agents and Temperature on the Injured Brain, by David S. Warner, M.D., provides a clear and thorough review of recent research on cerebral effects of these agents. It covers material addressed in several other chapters in the book but provides the best discussion of this area.

The second half of the book consists primarily of chapters that address specific clinical conditions or procedures. In general these chapters are well-written, complete reviews of each disease process, its diagnosis, treatment options, and surgical and anesthetic management. Some chapters provide considerably more information regarding diagnosis and surgical management than anesthetic management, such as chapters on supratentorial tumor surgery and spine procedures. Others, such as chapters on posterior fossa surgery, carotid endarterectomy, and aneurysms, are directed more toward anesthetic issues. The neuroradiology chapter provides a great deal of information about each radiologic technique that would interest those anesthesiologists participating in anesthetizing patients for these procedures, even though there are relatively few pages directed toward anesthetic management. The chapter by William L. Young, M.D., on interventional neuroradiology is also a useful review of both radiologic and anesthetic techniques and problems.

Some chapters give recommendations regarding clinical care that may not be the practice of many neuroanesthesiologists, such as a suggestion for spontaneous ventilation during clipping of posterior circulation aneurysms as a way to monitor brain stem integrity. In the chapter entitled Resuscitation of the Ischemic Brain, recommendations for clinical care are made based on animal data only. This is of concern, considering the long list of treatments for cerebral protection with promising results in animal models and no protection demonstrated in the clinical arena. There are many areas of overlap and duplication from one chapter to another. In his introduction, Dr. Albin recognizes this, but he also notes that this is necessary if each chapter is to deal with its subject matter completely. In a text of this nature, this is not a drawback.

This book will serve as a reference tool to practicing anesthesiologists caring for patients with neurologic diseases by providing information not only on their anesthetic care but general information about neurologic disease. For the experienced neuroanesthesiologist, it is a valuable resource for information about diagnosis and treatment of less common conditions and about neurosurgical and neuroradiologic procedures. It is more extensive than the average anesthesia resident would need who is rotating through the neuroanesthesiology service.

Susan Black, M.D.

Associate Professor; Director of Neuroanesthesiology; University of Florida College of Medicine; 1600 S.W. Archer Road; Gainesville, Florida 32610–0254