Textbook of Obstetric Anaesthesia

Textbook of Obstetric Anaesthesia

British Journal of Anaesthesia 90 (4): 529±532 (2003) Book Reviews International Anesthesiology Clinics. W. E. Hurford (editor in chief). Vol. 40: Nu...

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British Journal of Anaesthesia 90 (4): 529±532 (2003)

Book Reviews International Anesthesiology Clinics. W. E. Hurford (editor in chief). Vol. 40: Number 4: 2002: Obstetric Anesthesia. W. Camann and M. C. M. Pian-Smith (editors). Published by Lippincott Williams and Wilkins, Philadelphia. Pp. 156; indexed; illustrated. ISSN 0020-5907.

DOI: 10.1093/bja/aeg547

Textbook of Obstetric Anaesthesia. R. E. Collis, F. Plaat and J. Urquart (editors). Published by Greenwich Medical Media, London. Pp. 338; indexed; illustrated. Price £45.00. ISBN 1900151-774. Some books say `read me', and I think this is one of them. The excellent opening chapter on the history of obstetric anaesthesia foretells a book that is interesting, informative, and stimulating. It is an attractive book that has been carefully illustrated. Each chapter has an introductory index, which makes it easy to ®nd what you are looking for, whether you are a specialist registrar in the run up to the Final FRCA, or a DGH obstetric anaesthetist wanting to know how to handle a problem. It is a book that would also be useful for a doctor undertaking background research before commencing a project, for many chapters are extensively referenced. Early in the book, there is a concise chapter on the use of audit and research, which tells one how to set up an audit of obstetric anaesthetic activity, and has a useful preÂcis of the Con®dential Enquiry into Maternal Deaths. As recently as 1930, the UK Maternal Mortality rate was 500 per 100 000, with many deaths being attributable to puerperal sepsis. The rate is now 12.2 per 100 000 maternities. The chapter cautions us against complacency at home and abroad, and points out that the rate is still 344 per 100 000 in Zimbabwe. Anaesthetists who give talks on pain relief in labour to expectant mothers will ®nd Wee's chapter useful in handling not uncommon questions on alternative methods of pain relief. Few of these techniques do much harm, although they appear not to do that much measurable good in relieving the pain of labour. Fernando and Price's chapter on regional anaesthesia is a model of good construction and common sense, with the anatomy, pharmacology, indications, technique, and complications and their management laid out in order. They do believe in test doses (p. 78, hooray!). Their references are extensive and modern.

Ó The Board of Management and Trustees of the British Journal of Anaesthesia 2003

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This book is a slim, hardback North American text, consisting of 156 pages divided into eight short chapters. It covers a variety of topics relating to modern-day obstetric anaesthesia, with an emphasis on those concerned with safety of the mother and newborn. It aims to provide a current update both for the experienced and occasional obstetric anaesthetist, with contributions from 12 authors from anaesthetic, intensive care, nursing and academic backgrounds. The book has a de®nite North American ¯avour, with references to North American drug usage and epidemiology, but the issues addressed are nevertheless wholly relevant to practice in the UK. The eight chapters are well referenced and consist of short subsections, beginning with a short historical introduction and ending with concise summaries. On the whole, there is little use of illustrations and the bulk of information is presented as text. The ®rst chapter discusses maternal mortality and its anaesthetic implications. The epidemiological data presented is from the American National Pregnancy Mortality Surveillance System, but there is limited reference to the more extensive UK data. Some of the conclusions highlight differences from UK practice, for example the decline in anaesthetic related deaths in the mid-1980s was attributed to the withdrawal of 0.75% bupivacaine. Airway management skills are appropriately emphasized. The controversial issue of epidural analgesia and the progress and outcome of labour and delivery is addressed in the second chapter with a thorough literature review. Methodological dif®culties of research are well presented and some interesting physiological explanations of the effects of epidurals on the duration of labour and outcome are proposed. The chapter on the combined spinal epidural (CSE) technique for both labour analgesia and Caesarean section is informative and contains some basic illustrations. The evolution of the CSE technique, together with advantages and complications are also included. However, more detail on the newer commercially available CSE locking needle sets that are thought to reduce the incidence of movement of the spinal needle during injection would have been welcome. The next chapter deals with the effects of both regional and systemic labour analgesia on the neonate. Maternal pyrexia, neonatal sepsis and effects on breast-feeding are topics included along with a rather lengthy account of neonatal scoring systems, which are of limited interest in this context. A comprehensive account of neurological complications of labour analgesia and anaesthesia is the most useful chapter in terms of practical signi®cance. It focuses on lower extremity neurological complications and covers the evaluation, treatment and prognosis of common peripheral nerve lesions. There is much descriptive text of detailed anatomy, often dif®cult to assimilate, whereas more illustrations would have been useful. Another chapter of some practical use is the update on postdural puncture headache. This is a particularly well-referenced chapter covering its incidence, the symptoms, diagnosis, morbidity, pathophysiology and prevention. The chapter on pharmacological means of pain relief for labour and delivery provides an insight into more alternative approaches initiated both antenatally and in labour. The authors acknowledge the lack of scienti®c evidence to

support many of the techniques discussed but give an interesting perspective on less common methods of analgesia for example, hypnobirthing, and antenatal acupuncture. The chapter on pre-eclampsia is interesting, again with an extensive literature review. Aetiology, pathogenesis and risk factors are particularly well covered. Principles rather than speci®cs of treatment protocols and anaesthetic techniques are discussed, but this chapter is more of academic interest than of practical relevance. The ®nal chapter deals with the drug-abusing parturient and focuses on the current epidemiology of drug use in the USA. It details pharmacological data and clinical consequences of recreational drugs often seen also in the UK including cocaine, marijuana and amphetamines. As long as the reader is not looking for an updated `user-guide' to obstetric anaesthesia, they will ®nd this book interesting and informative. It has less emphasis on practical guidance but provides instead extensive literature reviews, opinions and updates on modern-day practice. In this respect, it achieves its aims but it is more appropriately suited to the dedicated obstetric anaesthetist who is looking for an update in clinical practice. J. Bray and R. Fernando London, UK

Book Reviews

should attract, inform, stimulate and challenge its readers, even if one disagrees with it at times. This one does all that. It is good value at £45. J. S. Sprigge Wirral, UK DOI: 10.1093/bja/aeg545

A Guide to Pain Medicine. J. C. S. Yang and S. L. Stui (editors). Published by Hong Kong University Press, China. Pp. 420; indexed; illustrated. Price US$35. ISBN 962-209-544-5. This interesting book has been written with the stated intention of educating medical professionals in pain medicine so that they, in turn, can educate their patients. The authors also suggest that candidates for higher quali®cations may ®nd it useful as a foundation on which to build their knowledge of what they describe as a very important, yet dif®cult, subject. The preface points out, quite rightly, that many modern diseases are unlikely, in the long term, to have a good treatment prognosis, and therefore that pain control will be an important component of overall disease management. All the contributors are from Hong Kong or neighbouring Kowloon, and write on ®elds in which they are experts. Many chapters are extensively referenced although there are relatively few references after 1999. The book is laid out systematically, with useful chapters on the mechanisms and assessment of pain, on neuropathic pain, and on various common types of chronic pain and their management. Other chapters deal with the various multidisciplinary methods of managing chronic pain. Psychological, social and behavioural pain management are addressed together with the management of disability. A chapter on the side-effects and adverse effects of various pain treatments is particularly useful. There is some variability in the style and depth with which individual chapters treat their subject. The chapter on acute pain management is long and extensively referenced with a good treatment algorithm. A chapter on radiotherapy for cancer pain provides more detailed information than anyone other than a radiotherapist would need, but is very instructive in clarifying the decision as to what and when to treat. Some chapters, such as the ones on headache and facial pain, could well provide some new information even to experienced practising pain consultants, giving in depth cover of their subject with extensive references. Others are, by comparison, simpler general overviews of larger topics, which would serve only as an introduction. The chapter on pharmacological management of chronic pain is, inevitably, an overview, but includes useful hints in some areas. The drug nomenclature may not be entirely familiar to the UK reader, as it has more of a US base. A relatively short section on the use of gabapentine in neuropathic pain probably relates to limited experience of the drug at the time of writing. The chapter on Pain Control in Traditional Chinese Medicine is very interesting, although it is not clear how or if this is to be integrated with the other management modalities. Overall, this book is a useful, well researched, and relatively up-to-date addition to the comparatively small collection of simpler texts to which trainees and non-pain anaesthetists and physicians can be directed as an introduction to the topic of pain medicine. As such, it would provide a useful addition to the pain management section of many departmental libraries. In some areas, it will also provide useful and more speci®c advice on the clinical management of individual pain problems. D. E. Dickson Yorkshire, UK


DOI: 10.1093/bja/aeg550

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Those who wish to establish `walking epidurals' in their units could start by reading Plaat's chapter on ambulatory anaesthesia. She commences with the question why do women in Western Europe end up on their beds when in labour? The combined spinal epidural technique of analgesia allows the woman to walk if she wants to. But there is a price. It is a different from conventional epidural analgesia, and it is clear from the text that it is a dif®cult and demanding technique to administer and to supervise. The chapter on the use of general anaesthesia has a chilling statistic that following the introduction of succinylcholine as the relaxant of choice in 1959, there was a doubling of the death rate attributable to anaesthesia in the 1964±1966 Con®dential Enquiry. However, general anaesthesia is an essential practice for obstetric anaesthetists. The text explores modern issues, such as how do trainees gain supervised experience in general anaesthesia when it is less frequently practised. The text cautions against the regular use of laryngeal masks in obstetric anaesthesia, because they do not prevent regurgitation. The text also has sensible cautionary paragraphs about the risks of pulmonary aspiration of gastric contents. The text advocates the strong points of the use of succinylcholine for intubation. It is the only muscle relaxant which works rapidly, and whose effect is also normally transient. My two quibbles are ®rstly with the mention of the capnograph, which could be more prominent (p. 116). The use of the capnograph has made general anaesthesia safe for obstetrics (see p. 45). Second, the algorithm for failed intubation is comprehensive, but quite complex (p. 123). In practice, the management is usually fairly simple. Have two good goes, possibly three, and if unsuccessful, wake the patient up: failure to intubate is not failure, but failure to stop intubating is. The chapter on regional anaesthesia for Caesarean section advocates the advantages of the technique both for mother and baby. It has useful paragraphs for example on how to prevent aortocaval occlusion. The combined spinal epidural technique is described in instructive detail. However, in the section on epidural anaesthesia, I must admit to feeling unease when top-ups of 20 ml of epidural solution are mentioned (p. 141). Surely epidural doses should be given as increments, in case the catheter has migrated (p. 86)? I liked the chapter on intrapartum fetal monitoring which has a readable section on intrapartum fetal physiology. Who would choose to be a fetus, surviving on an umbilical venous oxygen partial pressure of 4.0 kPa (p. 166)? There is a nice explanation of fetal carbohydrate metabolism, showing how lactate may accumulate, and there are some useful graphs on fetal distress, which help to highlight the obstetrician's dilemma on when to intervene during labour. This is a comprehensive obstetric anaesthetic textbook, which has useful chapters on the management of pre-eclampsia, and the anaesthetic management of the pregnant patient with intercurrent disease. There is an important chapter on the management of the pregnant patient in the intensive care unit, which is an area where good liaison between intensivists and obstetricians is essential. Howell's chapter on the diagnosis and management of amniotic ¯uid embolism is simply excellent, even if there is not much one can do to prevent it, or do about it when it happens. The editors have done well to assemble a large group of authors, who write in styles that are not discordant with each other, and whose chapters generally do not overlap or repeat themselves, but rather complement each other. In places, there is didactic script that would have bene®ted from references. For example, the chapter on anaesthesia for the distressed fetus has further reading rather than references. In contrast, thyroid disease in pregnancy has nine references. There are occasional lapses in punctuation. However, the authors are in their prime, and I expect that we may be seeing further editions. A textbook