Anaesthesia, 2000, 55, pages 731±734................................................................................................................................................................................................................................................

Book reviews

Handbook of Difficult AirwayManagementC. A. Hagberg (Ed.)

Churchill Livingstone, 2000. 411 pp.

This pocket-sized book is aimed as an

easy guide to practical management of

difficult airway problems. The 17 chap-

ters are written by 16 contributors and

edited by Dr Hagberg. The first three

chapters discuss airway anatomy, pre-

diction of the difficult airway and the

ASA Difficult Airway algorithm. The

fourth chapter on preparation of the

patient for awake intubation is useful

but rather long. All the possible airway

nerve blocks, some unnecessary in

clinical practice, are described in

detail, giving an impression that local

anaesthesia of the upper airway is a

difficult task.

Five chapters discuss practical tech-

niques for difficult airway management.

These are on flexible fibreoptic intuba-

tion, retrograde intubation, airway gad-

gets, laryngeal mask airway (LMA) and

Combitube, and surgical approaches to

airway management. The chapter on

fibreoptic intubation is excellent with

useful practical advice. The retrograde

intubation chapter details all the possible

methods rather than giving a simple

practical guide to one or two techni-

ques. The imbalance in the paper space

allocated is obvious; for example, the

chapter on retrograde intubation (infre-

quently used) occupies 34 pages com-

pared to the LMA and Combitube

chapter's 14 pages. The UK anaesthe-

tists' favourite aid, the gum elastic

bougie, is only briefly mentioned.

The chapters on clinical postopera-

tive and medical conditions affecting the

airway discuss the clinical scenarios well

but lack practical advice. The four

chapters on difficult airway in paedia-

trics, obstetrics, trauma and intensive

care cover a lot of ground. The best is

on paediatrics, which discusses the

problems and their solutions in a

practical, easy to follow style. This is

the only chapter that states that the

techniques should be learnt in work-

shops and practised on normal patients

before they are used in difficult airway

patients; this very sound advice should

have been a recurring theme in this

book. The last two chapters deal with

extubating the difficult airway and

dissemination of critical airway infor-

mation.

Dr Hagberg's aim is for this book to

serve as a quick reference during an

encounter with a difficult airway pro-

blem. I put this aim to test when

encountered with an adult patient with

Down's syndrome and a previously

known difficult intubation but easy

mask ventilation. With a trainee, I

tried to use this handbook to find out

ways of intubation through the LMA

since this patient was unsuitable for

awake intubation. The index easily

guided us to the relevant chapter and

page numbers. We settled on a fibreop-

tic-assisted technique but there was no

cross-referencing to the fibreoptic chap-

ter. Various techniques were discussed

but in the trainee's words `the chapter

mentions what can be done but doesn't

explain how I should do it'. In the end,

we settled for a fibreoptic technique,

one that I have practised and taught, of

using an Aintree Intubation Catheter

(not mentioned in the book!).

The book is lightweight and easy to

carry but the small text is difficult to

read. The content lists chapters and

subheadings with page numbers, which

is useful. The index is thorough and

well presented. The text is well refer-

enced but cross-referencing is poor.

The line diagrams are of good quality

but some chapters have too many

(retrograde and surgical techniques)

and some too few (LMA). The quality

of endoscopy pictures is satisfactory in

the fibreoptic chapter but extremely

poor in the intensive care chapter.

Many illustrations have been repro-

duced from other books, compromising

quality in the process. For someone

who has read the original work, I found

this reproduction very disappointing.

In summary, this book presents more

as a mini reference book rather than

a quick practical guide. The target

specialists for the book are anaesthesi-

ologists, surgeons, emergency and cri-

tical care physicians. I don't think all

anaesthetists need this book in their

pockets although a copy in the depart-

mental library would be useful. This

book will best serve as a cheaper

substitute to reference textbooks.

M. Popat

Peripheral Nerve Blocks. AColour AtlasJ. E. Chelly (Ed.)

Lippincott Williams & Wilkins, 1999.

240 pp.

This beautiful book reflects the growing

interest in peripheral, as opposed to

central, nerve blockade, and therefore

makes no mention of spinal or epidural

injections. The book is divided into

four sections: General Concepts; Single

Injection; Peripheral Blocks: Continu-

ous Peripheral Blocks; and Paediatric

Peripheral Blocks.

Section One deals briefly with pre-

paration, well with the use of a nerve

stimulator and very briefly with local

anaesthetic solutions. It does not set out

to be a pharmacology textbook, but

makes sensible suggestions as to the

choice of local anaesthetic, additives and

the avoidance of toxicity.

The bulk of the book is made up of a

beautifully illustrated practice guide to

nerve blockade with over 200 of the

240 pages being dedicated to sections 2,

3 and 4. Each section is logically laid

out, dealing with upper limb, lower

limb and other blocks, in that order.

Where there are several methods, these

are given in the author's choice of order.

Despite being a multi-author publi-

cation, the style is uniform throughout,

q 2000 Blackwell Science Ltd 731

and most descriptions are clear and

understandable even by the inexper-ienced.

As you read you feel that the authorsare describing what they practice.

Having said that, some blocks, theanterior approach to the sciatic nervefor instance, are much more easily

described than performed, and I amunsure of the value of the author'svariation on Beck's original approach.

The sections on catheter techniques

and paediatric blocks are a joy and adelight even for those who, like me, nolonger practice paediatric anaesthetics.

To have catheter techniques together inone section is valuable, and childrendefinitely are different.

References are limited in numberwith between two and eight being citedat the end of each description, but aresufficient to give depth to each section if

required. Predominantly drawn onAmerican publications, there is also areasonable number from British and

other European sources, especiallyFrench. Many of the English languagereferences will be familiar to those

interested in peripheral blocks butthose in French may be less wellknown. The index is more than ade-quate, despite my best efforts to catch it

out.

There are, of course, oddities andniggles. It is surprising to find that Raj's

supine approach to the sciatic nerve,which has the ischeal tuberosity, and thegreater trochanter as landmarks, merits

only three lines under `AnteriorApproaches'. Metatarsal block isreferred to as a successful alternative toankle block, but not described.

One manufacturer of insulatedneedles is named 60 times in the text,which eventually I found very annoying;

I realised I was scanning each page forthe offending name before I could readit. Other companies are also acknowl-edged but in what appeared to be a

rather haphazard fashion, and certainlyvery much less often. Infinitives are splitwith gay abandon throughout, which

still grates an old fashioned pedant likeme. However, these are small pointswhich do not, in the end, detract

significantly from the value of thebook, nor my enjoyment in reading it.

Aimed at trainees and those more

senior who wish to refresh or extend

their knowledge of block techniques, it

provides clear instruction in the art of

peripheral nerve blockade which will

support and underpin practical training.

Every theatre where peripheral nerve

blockade is practised should have a copy

on the shelf and there will be many

anaesthetists of all levels who will enjoy

the book, because it is a lovely book,

and learn from the descriptions, even of

the blocks they do routinely.

J. D. R. Connolly

Complications of RegionalAnaesthesiaB. T. Finucane (Ed.)

Churchill Livingstone, 1999. £35.00.

340 pp.

It has been a real pleasure to review this

book on the complications of regional

anaesthesia. The editor has assembled a

group of authors of international repute

and has produced an authoritative yet

very readable reference work. The

resurgence of interest in regional anaes-

thesia has produced many benefits for

patients but, inevitably, as its use has

increased so has the risk of complica-

tions ± mostly minor but on rare

occasions, major and permanent dis-

ability. The risk in writing a book solely

about complications is that it might

distort the balance of benefit and risk

and discourage the reader from using

regional anaesthesia. However, the

editor has skilfully maintained a sense

of proportion with this in-depth review,

balancing it well against the overall

value of regional anaesthesia.

Chapter 1 is an overview of safe

practice looking at pre-operative assess-

ment, the side-effects of regional anaes-

thesia, equipment issues and some

psychological aspects of safety, and it

offers some sensible guidelines to safe

practice. Chapter 2 is a synopsis of the

benefits of regional anaesthesia on out-

come from surgery and then follows a

systematic review of complications in a

series of chapters based on specific

techniques, clinical subspecialties

(obstetric, paediatric, acute and chronic

pain) and problems (local anaesthetic

toxicity, infection and neurologicaldamage).

Every chapter is worth reading,

although the value of each chapter willbe determined to an extent by theparticular interests of the reader. The

ophthalmic chapter should be compul-sory reading for all anaesthetists engagedin this field and the chapter on brachialplexus complications, written by the

editor, is outstanding. Some chapters gofurther than just reviewing complica-tions; the chapter on paravertebral,

intercostal and interpleural blocks notonly covers the complications (whichare few) but is also a useful tutorial on

how to perform these under-utilisedtechniques.

The review of obstetric complica-

tions is excellent and with such a highproportion of these patients having aregional technique, the authors rightly

remind us of the numerous causes ofnerve damage and other complicationsthat are caused by the birth process itselfrather than the block. As with other

areas of practice, it is often easier toblame `the block' than investigate thecause of the problem properly.

Major, permanent nerve damage is avery rare but catastrophic complicationof both general and local anaesthesia and

the potential to render a patient para-plegic lurks just below the surface inmany anaesthetists' minds when we

make decisions about the use of centralneural blockade. The chapter on majorneurological injury is only nine pages

long but it distils out all the essentialinformation on this issue and is one ofthe highlights of the book. In combina-

tion with the chapter that follows onthe evaluation of neurological injury, itprovides a valuable source of knowledgeand guidance on this area of major

concern.

The book is well produced, with aclear layout, good indexing and com-

prehensive references, although some ofthe most up to date literature is notincluded. The line drawings are concise

and helpful, complementing the textwell. There are a number of MRIimages, which are well reproduced and

add greatly to the chapter on evaluatingnerve damage. Much of the information

Book reviews Anaesthesia, 2000, 55, pages 731±734.................................................................................................................................................................................................................................................

732 q 2000 Blackwell Science Ltd

contained in this book is already avail-

able in other published literaturealthough often fragmented and difficultto find; the real strength of this book isthat it concentrates a wealth of data into

one practical, informative and readableresource which is without equal in itsfield. At £35 it is a bargain ± buy it for

yourself and your department.

H. B. J. Fischer

Paediatric Anaesthesia, A QuickPocket Reference, 2nd ednE. Bloch & B. Ginsberg (Eds)

Butterworth Heinemann, 1999

The demands on the anaesthetist'spocket are incessant. A `pocket' refer-

ence book must be clear about itsintended use and target readership if itis to nestle alongside the phone, perso-

nal organiser and means of paying forlunch. This is a conveniently sizedbook, expanded in its second edition

to include aspects of pain managementand anaesthesia outside the operatingroom. Its origins are to be found innotes prepared for trainees in paediatric

anaesthesia at Duke University MedicalCentre in North Carolina. Informationis organised in a logical fashion and

ranges from pre-operative preparationto treatment of common peri-operativeproblems. There are blank pages for the

reader to add notes. The authors do notset out to discuss the management ofspecific surgical problems.

As with any pocket book, detail mustbe sacrificed to the range of material tobe presented. The authors have, never-

theless, managed to include a great dealof relevant information. The sections onfluid management and blood products

stand out in terms of content andpresentation. Much space is devoted todrugs and their doses. It is astonishing,

however, that paediatric equipmentbarely rates a mention. We are givensizes for tracheal tubes, for instance, butthere is no mention anywhere of

suitable laryngoscopes, face masks orventilators.

In mitigation, the text is well refer-

enced and there are guidelines forfurther reading. Syndromes aredescribed in an appendix togetherwith their anaesthetic implications.

Much useful information is also con-tained in an appendix of normalphysiological variables. However, the

lists of generic and proprietary names ofdrugs will be of little value to readersoutside North America. Indeed, there is

such a strong North American flavourthroughout this book that its appeal toothers will be limited. Some attempt is

made to address this by including asection on SI units, but the inconsis-tencies start to irritate. We are giventracheal tube lengths in centimetres, for

example, but height above sea level infeet.

In short, this could be a useful pocketbook for a trainee planning to spendsome time working in North America.

Trainers might also dip into it as asource of MCQ questions. However,anyone wishing to buy a new pocketguide to paediatric anaesthesia is best

advised to shop around because thisbook, by itself, will not be sufficient.

M. Stokes and L. Khor

Final FRCA: Multiple ChoiceQuestionsM. D. Brunner, P. N. Robinson and H.

Williams

Butterworth Heinemann, 1999. £16.99.

302 pp.

Having recently passed the Final FRCAExamination myself, I did not expect tobe scrutinising yet another collection of

multiple choice questions quite so soon.However, had this volume been avail-able while I was studying, I am certain it

would have made an excellent additionto my ever expanding collection.

In order to pass the MCQ paper, thecandidate must adequately prepare andpractice. In preparation he must betested, but it is arguably more important

that he is educated, both in terms ofincreasing his factual knowledge and

improving his technique. This book in

the most part fulfils all these criteria.The book is formatted into five sampleexamination papers, each containing 90multistemmed questions as in the

FRCA examination.The examination syllabus, as every

candidate knows to their chagrin, is

both enormous and eclectic, and theMCQ paper aims to test both thecandidate's breadth and the depth of

knowledge. These practice papers emu-late the actual examination closely inthe breakdown of subject matter: 40

questions in anaesthesia, pain manage-ment and applied basic sciences, 20questions in medicine and surgery,10 questions in clinical measurement,

and 20 questions in intensive ther-apy. The latter is perhaps slightlyunderrepresented.

As in the examination itself, thequestions and stems vary in theirdifficulty to read and understand; one

word stems aiming to test facts, whilstcomplicated statements test the candi-dates ability to deduce answers from

basic knowledge. The answers areprinted conveniently on the facingpage which allows easy and quick self-testing, and whilst the answers given are

succinct, they appear to provide suffi-cient detail to aid understanding. How-ever, it is unfortunate there are no

references to commonly used texts toenable the candidate to read further onthe subject if desired. Also, although

there is an index, it would be eminentlyuseful to list questions under subjectheadings to allow candidates to con-centrate on known areas of weakness.

These minor criticisms aside, com-pared to equivalent books currentlyavailable, the authors have created a

very useful and relevant aid to anycandidate's examination preparation.and as the final question illustrates, not

only can intelligent, grown menbecome obsessed with red jerseys kick-ing a white ball, but that there is life

after exams!

A. Campbell

Anaesthesia, 2000, 55, pages 731±734 Book reviews................................................................................................................................................................................................................................................

q 2000 Blackwell Science Ltd 733