A Practical Approach to Cardiac Anaesthesia

This is an update of a well-established book in the popular Practical Approach series. Senior cardiac or cardiothoracic anaesthetic fellows are the most likely to gain benefit from this book. It is easy to navigate and find relevant information. While there is perhaps too much detail for junior anaesthetists preparing for the final FRCA examination, as a reference text, it will address any weaknesses in knowledge. There are Key points at the beginning of each chapter which summarize the main themes. The style of formatting, which uses a mixture of Roman numerals, letters, and numbers, does not always work, as in some instances, it is artificial and therefore hinders the flow of reading. The opening chapter is a good addition as physiology forms the basis of clinical practice. Anaesthetic Management during Cardiopulmonary Bypass (CPB) covers the typical CPB sequence for most common procedures. The anaesthetist is an integral member of the surgical team and it is important that they are cognisant of the procedures of the surgeon and perfusionist in order to help manage a critical incident. The checklist before separation from CPB is perhaps over-complicated and could be simplified in practice. The chapter on the post-CPB period is very informative, but there is no mention of acute kidney injury under complications in the first 24 h after operation. There is a thorough explanation of CPB equipment, circuits, and potential problems during CPB, although there is inevitably some overlap with aforementioned chapters. The authors have included separate chapters on paediatric and adult congenital heart disease and these complement each other. The book is clearly aimed at the American market with references to the Physician Desk Reference, FDA, and Surgical Care Improvement Project and our society meaning the USA. This is no criticism of the book; it just makes it less attractive to a UK or European readership. There is inconsistent use of drug names (phelylephrine and Neo-Synepherine) and bisoprolol does not get a mention under β-blockers. In Monitoring the Cardiac Surgical Patient, there is a disproportionate (10 pages) emphasis on the pulmonary artery flotation catheter, which may reflect its continued popularity in North America. In the same chapter, there is only one paragraph devoted to near-infrared spectroscopy; however, there is more information in Protection of the Brain during Cardiac Surgery. The authors omit to explain how near-infrared spectroscopy may be used in an algorithm to improve cerebral oxygenation. Thromboelastography is mentioned throughout the book but only in limited detail. This topic merits a more detailed discussion as it is central to the aetiology and management of cardiac surgical bleeding. The book is available in e-format, although there is little reference to online resources in the paper copy. Naturally, some chapters in a Practical Approach book will place the emphasis on How to do it rather than the evidence that underpins cardiac anaesthetic practice. Nevertheless, the book is rich in experience and useful tips and covers the most important aspects of cardiac anaesthetic practice. It will be a very good addition to any department's library.