Cardiac, Vascular and Thoracic Anesthesia. Edited by John A. Youngberg. New York, Churchill Livingstone, 2000. Pages: 1,010. Price: $195.00.

The title of this multiauthored work (72 collaborators, 71 North Americans) puts it in the tradition of important textbooks that pave the way for anesthesia residents. It is proposed as a major reference volume to read cover to cover to get a comprehensive overview of three of the main specialized areas of anesthesia practice. Therefore, it must start from basic principles and detail their application to the technologic, operative, and anesthetic strategies currently used in the field. Most authors have done a good job in writing with clarity and structure, and some did exceptionally well. The section about cardiac anatomy and physiology (much of the latter, less of the former) could serve as an example of how an intrinsically complicated topic can be clarified and made enjoyable to read. The chapter about continuous quality improvement constitutes an unexpected but refreshing addition. However, sections about anesthetic implications and clinical practicalities do not always measure up to the value of accompanying theory, for example, in the text regarding valvular disease, although of crucial importance for cardiac surgery.

A textbook of such ambition should also bring the reader up to the level of the latest technologies or inform about the current avenues of research likely to influence clinical practice in the near future. Unfortunately, this first edition fails in that respect. Despite being published in the year 2000, it features few references more recent than 1996. Recent guidelines about standard transesophageal echographic examination are not followed, and advice is given to purchase a machine without pulsed or continuous Doppler ultrasonography, starting with a one-plane probe, a clearly obsolete choice. Recent surgical advances are notably absent. Some, such as multivessel aortocoronary bypass with use of malleable stabilizers while avoiding extracorporeal circulation, or the multiple modes of repairing cardiac valves or chordae, already are used so widely in clinical practice that they represent a majority of cardiac procedures in some places. Quite a few chapters mainly reflect local habits and fail to introduce the reader to alternative techniques. For example, the section describing tracheotomy and its percutaneous approach describes only one of three available techniques, and not the most versatile. In contrast, the same chapter offers a brilliant synthesis of tracheal and carinal reconstructions. Important contributions at times are ignored, such as the value of evoked potentials for monitoring patients with cerebrovascular disease undergoing cardiac or carotid surgery or their use in descending aorta repairs. The numerous illustrations are generally of great didactical value but too often are given unfair treatment as a result of a poor printing technique.

This monumental work and undoubtedly ambitious effort falls short of expectations. Neither residents in training nor accomplished practitioners will find the comprehensive reference text they need. It is incomplete, and some sections were outdated before it reached the bookstore. The reasons for these shortcomings may reflect the large volume of material needed to be discussed or the relatively long time to edit and print such a masterpiece, in comparison with the speed of evolving science and technology. Clearly, the hard work and energy invested in this endeavor has resulted in many outstanding sections, and the shortcomings are perhaps inevitable in this time of rapid change in this area.