Perioperative Care in Cardiac Anesthesia and Surgery

摘要

Perioperative Care in Cardiac Anesthesia and Surgery Cheng DCH, David TE, eds. Philadelphia: Lippincott Williams & Wilkins, 2006. ISBN 0-7817-5774-6. 376 pages, $69.95. The preface describes this handbook as targeted for all personnel involved in the perioperative care of the cardiac surgical patient. The main objective is to provide the reader with an updated succinct viewpoint of current perioperative care of the cardiac surgical patient. Much of the information is the “collective view” of the editors’ cardiac care teams and is reported to have a strong evidence base. The book is divided into 6 major sections, including an introduction and appendices with 1 to 19 chapters per section. While this book proposes to offer a practical approach to clinical problems in cardiac anesthesia and surgery based on recent research and clinical experience, there are no numbered references used in the text, leaving the reader to inspect the short reference section ranging from 1 to 19 references (mostly around 8) after each chapter and then try to identify which articles are the appropriate reference for a given statement. Most references are current, although a number date back to the 1990s and beyond. The authors take a refreshing and unusual approach by not starting the book with the usual physiologic and pharmacologic chapters. It is assumed that the reader has this basic knowledge. Instead the authors have divided the sections into chapters dealing with the various modes of care to which the patient is exposed. The first section deals with the management of anesthesia and cardiopulmonary bypass, followed by sections that mirror the course a patient might take from induction of anesthesia to discharge. This allows for a book that reads easily with a logical and predictable course of information. The sections are as follows: Introduction, Anesthesia and Cardiopulmonary Bypass, Surgical Technique and Postoperative Consideration, Cardiac Surgical Recovery Unit, Surgical Ward Management, and Appendices. The section on anesthesia and cardiopulmonary bypass provides a fairly good overview of the anesthetic management related to the more common cardiac surgical procedures and also seeks to address the more frequent “hot topics,” such as weaning from bypass, heparin-induced thrombocytopenia, blood usage and conservation, and the management of pulmonary hypertension. The surgical section provides an excellent basic review of the major surgical concerns anticipated in the various procedures. In this section the nonsurgeons are given a basic description of the surgical aspects related to the various procedures. The section on the recovery unit is very useful in discussing the concerns for the cardiac surgical patient during the tenuous transition phase from the operating room to the intensive care unit. The penultimate section deals with the care of the patient in the ward setting. While this does not directly impact the anesthesiologist, it does provide them with information that may help answer questions that patients may raise in the preoperative period. In this reviewer’s opinion, the final section is the most useful to the hands-on provider caring for cardiac surgical patients. This section contains a number of protocols from the Toronto General Hospital and the London Health Science Centre. Of importance are the tables listing the dose, physiologic effects, indications and contraindications, anesthetic effects, and mechanism of action of drugs used in the care of cardiac surgical patients. Excellent chapters include those relating to fast-track management (although there is an unfortunate misquote on page 13 suggesting that fast-tracking increases morbidity), heparin alternatives, postsurgical pacing therapy, and the surgical aspects of cardiac surgery. Cardiac surgery patients are becoming increasingly complex, which makes it difficult for a superficial review such as this to achieve its desired objective because important information is om