Handbook of Clinical Anesthesia Procedures of the Massachusetts General Hospital. Eighth Edition.
Article Type: Book review
Subject: Books (Book reviews)
Author: Balkin, L.
Pub Date: 09/01/2011
Publication: Name: Anaesthesia and Intensive Care Publisher: Australian Society of Anaesthetists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 Australian Society of Anaesthetists ISSN: 0310-057X
Issue: Date: Sept, 2011 Source Volume: 39 Source Issue: 5
Topic: NamedWork: Handbook of Clinical Anesthesia Procedures of the Massachusetts General Hospital, 8th ed. (Reference work)
Persons: Reviewee: Levine, W. C.; Allaine, R. M.; Alston, T. A.
Accession Number: 269028899
Full Text: Handbook of Clinical Anesthesia Procedures of the Massachusetts General Hospital. Eighth Edition. W. C. Levine, R. M. Allaine, T. A. Alston, P. F. Dunn, J. Kwo, C. E. Rosow. Wolters Kluwer Health; Lippincott Williams & Wilkins, Suite 1801, Level 18, 9 Hunter Street, Sydney, NSW 2000; $53.90; 127x203 mm; pp. 704; ISBN 9781-60547-460-1.

A compact paperback pocket manual can be an invaluable resource in the armamentarium of the anaesthetic trainee and consultant anaesthetist. The Massachusetts General Anesthesia Handbook has provided such a resource since 1978 and this latest edition continues the tradition with a well presented, comprehensive, contemporary guide to anaesthetic practice.

This successor to the 2007 seventh edition has been diligently updated by the staff of the Harvard Medical School Department of Anaesthesia at Massachusetts General Hospital, successfully incorporating current evidence into clinical practice. Within its 704 pages it manages to cover the breadth of principles, considerations and issues that are likely to face anaesthetists in their daily practice in a concise and very readable format. The plethora of information is neatly presented in a very portable 127x203 mm soft cover book.

The logical format of the considerable textual content makes for easy reading and topics predictably accessible. The sequential use of bold headings and subheadings effectively divides content into concepts and appreciable points, facilitating effortless comprehension of the fundamentals of each chapter. Illustrative diagrams, pictorial representations and images are richly instructive but are unfortunately exiguous. When present, they are very instructive and of high quality. The ample use of tables to effectively summarise information is regrettably undermined by their occasionally haphazard placement within the text. This often interrupts the flow of the paragraph, unnecessarily impeding appreciation of the information and potentially distracting from the concept being presented.

The handbook is again sensibly divided into three sections. The first relates to preoperative consideration including specific comorbidity-related issues. Section two pertains to the administration of anaesthesia with a focus on monitoring and machinery, the breadth of anaesthetic techniques, and the nuances of anaestheia for specific surgical subspecialties including paediatric, neurosurgery and remote location/off the floor anaesthesia. The final section discusses the management of postoperative issues and pain management. The inside covers feature the ASA "Pre-anaesthetic Checkout Procedures" recommendations and a concise management guideline for Malignant Hyperthermia. Regrettably, additional concise guidelines of anaesthetic emergencies such as Advanced Cardiac Life Support (ACLS) or Difficult Airway Society guidelines are not immediately accessible or intuitively found.

The first section of the handbook details the preoperative evaluation of the patient. It outlines the preoperative assessment principles including a discussion of consent. This chapter addresses common comorbidities, their implications on anaesthesia, evaluation of examinations and investigations, risk stratification and perioperative management strategies.

The second section on the "Administration of Anaesthesia" contributes the bulk of the handbook's 708 pages. Included is an interesting discussion of risk in anaesthesia and the topical areas of quality assurance and safety with good references. It discusses the anaesthetic machine in detail with effective addition of diagrams. Anaesthetic monitoring is broadly summarised with some valuable guides on insertion and use of common and novel monitoring modalities including pulmonary artery catheters and arterial pulse contour analysis. The remainder of the second section deals with anaesthetic techniques. There is a discussion of local anaesthetic pharmacology as preface to a more detailed chapter on neuroaxial and regional techniques. Including within this are some quality anatomical representations and ultrasound images to aid illustration of regional techniques. The tables within this section are especially useful, including a quick reference guide for anticoagulant administration and neuroaxial blockade.

The third section encompasses the principles of postoperative care, resuscitation, analgesia, ethics and complementary medicine. The postoperative issues explored are far from exhaustive but the principles discussed can be broadly applied. A nice, succinct explanation of ventilation modes, their indications and pros/cons is given but the discussion of noninvasive ventilatory techniques is perfunctory. Current ACLS guidelines are discussed in this section with supporting evidence well referenced. Disappointingly, the guidelines are not readily obvious on glancing through the handbook but are at least well referenced in the index and table of contents. Appendices include a basic drug formulary and rudimentary antibiotic table.

The handbook is written, reviewed and updated regularly by the residents, fellows and anaesthetists at the Massachusetts General Hospital and is intended as a guide, reflecting the current clinical practices at their hospital. As a result there are foreseeable deviations from some guidelines, units of measure, pharmacological agents and formulations familiar to Australasian readers. This is common in most journals and textbooks and should not detract from the handbook's value.

The eighth edition of the Handbook of Clinical Anesthesia Procedures of the Massachusetts General Hospital is a well-structured, concise and current guide to preoperative anaesthetic practice. Its strength lies in its structured intuitive format, breadth of topics and compendious explanations. I recommend it to trainees and anaesthetic nurses, as well as busy specialists wanting a quick update. It should be available in all teaching hospital department libraries.


Melbourne, Victoria
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.