British Journal of Anaesthesia, 118 (5): 810 (2017)
Oxford Textbook of Vascular Surgery. M. M. Thompson, R. Fitridge, J. Boyle, M. Thompson, K. Brohi, R. J. Hinchliffe, N. Cheshire, A. R. Naylor, I. Loftus and A. H. Davies (editors). eISBN: 9780199658220. Oxford University Press, 800 pp. £44.00 (online), £145.00 (textbook) The Oxford Textbook of Vascular Surgery is written by surgeons for surgeons. The book focuses heavily on diagnosis and surgical technique. The initial chapter on fundamental concepts and basic science covers issues such as ischaemia–reperfusion injury and vascular graft infection. Chapters 2 and 3 cover congenital diseases of the vasculature and vascular trauma, respectively. Chapters 4–10 each focus on a different area of vascular surgery, such as lower limb ischaemia and related conditions (chapter 4) and mesenteric and renal vascular disease (chapter 9). The list of more than 130 contributors includes only the two anaesthetists, who co-authored the section on peripheral neuropathy and post-amputation pain. Given this unequivocal and entirely appropriate focus on the needs and interests of surgeons, I asked myself whether any anaesthetist would wish to turn to the book, much less pay the significant costs of obtaining full access to the text. To my mild surprise, my answer is yes. The perioperative management of high-risk vascular surgery patients requires close working between the surgeon and the anaesthetist. Vascular clamping and unclamping can cause major haemodynamic changes and significant blood loss. A good understanding of the technical aspects of vascular surgery is of considerable value in managing the patient. The book is generally well structured and written, and I found myself drawn into the text and reading several sections with considerable interest. In a multi-author textbook, the tone is inevitably variable and there are areas where the unremitting focus on surgical aspects of care grates somewhat. There is limited discussion of the Multidisciplinary Team (MDT) and of the role of other specialties in decision-making. The impact of multidisciplinary quality improvement programmes in improving surgical outcomes receives little or no discussion. The statement in relation to carotid endarterectomy that ‘the surgeon can use whatever anaesthetic technique he/she prefers’ reflects an unreconstructed approach to the role of the anaesthetist. The same section on carotid endarterectomy discusses a regimen for blood pressure management in the postanesthesia care unit that is described by Stoneham and Thompson in a detailed academic review published in the British Journal of Anaesthesia in 2009, but does not reference these authors, preferring instead a single-author review in a surgical journal.1
As is often the case with large textbooks, the content sometimes lags behind the rapidly evolving evidence base. The statement in the section on the technical aspects of abdominal aortic aneurysm repair that ‘there is some debate around the evidence that routine use of beta-blockers prior to open aneurysm surgery improves cardiac outcomes’ is not consistent with evidence from a recent metaanalysis that pooled data from >30 000 patients and indicates that b-blockade does not improve outcomes in vascular and endovascular surgery. This is quite simply a reflection of the lag time between writing and publication in any large textbook. The same chapter contains a very clear description of the surgical management of the difficult aortic neck in open aortic repair. This is a surgical challenge that has direct implications for the anaesthetic management of the patient. The discussion of perioperative heparinization in aortic surgery is similarly clear and balanced. It makes the case for a fractionated dose of heparin in suprarenal clamping and discusses the use of a lower dose of heparin combined with strategies to clear thrombus from the iliac arteries. Both of these discussions will be of interest and value for the vascular specialist anaesthetist. I was asked to review the Web-based version of this textbook. I found the Oxford medical website a little difficult to navigate, and it took me a few minutes to find the book. The layout of the textbook itself was clear and accessible, with an interactive contents list and effective search function. In summary, this is an expensive book that will be of limited appeal to the majority of anaesthetists. The vascular specialist will find much of interest and relevance. Many will balk at the cost of the book as an individual purchase, but it can certainly be recommended as a useful book for a department or library to buy. S. J. Howell Leeds, UK E-mail: [email protected]
Reference 1. Stoneham MD, Thompson JP. Arterial pressure management and carotid endarterectomy.. Br J Anaesth. 2009, 102: 442–52.
C The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. V
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