British Journal of Anaesthesia 106 (4): 610–12 (2011)
BOOK REVIEWS
Care of the Critically Ill Surgical Patient, 3rd Edn. I. Loftus
(editor). Published by Hodder Education, London, UK. Pp.
256; indexed; illustrated. Price £50.00. ISBN 13 978-0-340-
98724-7.
The Care of the Critically Ill Surgical Patient course aims to
teach surgical trainees a safe, pragmatic, and standardized
approach to assessment and treatment of the deteriorating
surgical patient. Many anaesthetic consultants (including
this reviewer) will have some experience of teaching on
this course, and will be familiar with the ATLS style approach
of ABC assessment and intervention, with constant
re-assessment of the critically ill patient as a cornerstone
of the process.
At 256 pages, this third edition is considerably larger than
the 168 pages of the second edition, and it is noteworthy the
contributors are different for all three editions, although
much of the text remains identical. The increased size of
the third edition is in part due to expansion of some topics,
for instance, the single chapter on Respiratory Failure is
now expanded to three chapters on Airway Management,
Respiratory Compromise, and Arterial Blood Gas Inter-
pretation. A chapter on Assessment of Surgical Risk has been
added, and the chapter on Sedation has been removed.
Aside from these expansions, the new edition is laid out in
a less cluttered style, with clearly identifiable breakout
boxes indicating important practice points and case-scenario
descriptions.
The chapters are clear enough to read in isolation,
although, as this is a course manual, it is best that they are
read in the order presented of general assessment, ‘ABC’
interventions, followed by other considerations such as nutri-
tion and fluid balance. The information is mainly clear and
non-controversial, as one would expect when teaching
junior colleagues. The style of language in this book is
relaxed and friendly, is supportive of the trainee and the par-
ticular problems and stresses they experience, and makes
the reader feel involved. This format runs the risk of border-
ing on the patronizing at times, but in this case that has been
skilfully avoided, and I felt comfortable reading it.
One minor concern is the presence of some typographic
errors which should have been eliminated at the proof-
reading stage, but these do not distract from the overall
quality of presentation. A more major concern from my
point of view as an anaesthetist was the new chapter on
assessment of risk; an 11-page chapter at the end of which
over six pages were devoted to the management of diabetes,
with scarce description of the other more significant risk
factors such as heart failure.
As this is a course manual primarily aimed at the surgical
trainee, it is of any use to the anaesthetist? I think that it is,
and would strongly recommend it to any anaesthetic trainee,
& The Author [2011]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
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especially at the Core Trainee stage, as it provides a struc-
tured and concise introduction to critical care management
of the surgical patient, with principles that apply to many
other situations. The more experienced trainee may feel
they want something with a bit more depth, but I think
anyone who understands and follows the advice in this text
will be practising good medicine and on that basis I can rec-
ommend it to any anaesthetist involved in looking after high-
risk surgical patients.
R. J. T. Wilson
York, UK
E-mail: rjtw@mac.com
doi:10.1093/bja/aer038
Single Best Answer MCQs in Anaesthesia, Volume 1 Clinical
Anaesthesia. C. Mendonca, M. Chaudhari and J. James
(editors). Published by Tfm Publishing, Shrewsbury, UK. Pp.
197. Price £30.00. ISBN 978 1 903378 75 5.
A good book will fill a niche. In this book, we have a gem. In
2007, the Postgraduate Medical Education and Training
Board (PMETB) challenged the Royal College of Anaesthetists
(RCOA) to ‘Reconsider the format and marking of its examin-
ations’. The College had previously relied on True/False ques-
tions as a test of factual knowledge. PMETB wanted a change
in emphasis to test candidates understanding of subjects.
The Single Best Answer (SBA) question forces candidates to
use facts in a clinical context, applying knowledge to
deduce the best answer. From the September 2010 sitting
of the Final FRCA, the RCOA will include 30 SBAs per exam,
20 dealing with clinical anaesthesia, five in intensive care
medicine, and five in pain management. Candidates will
want to have as much exam practice of this type of question.
Apart from the examples in the RCOA website, there has
been little for them. This book offers six complete sets of
30 questions with comprehensive referenced answers.
Ideally, these questions should follow the rules described
by Case and Swanson.
† Each item should focus on an important concept or
problem. Questions will not appear in the FRCA unless
they are mapped to sections of the curriculum.
† Each item should assess the application of knowledge,
not simply recall of a fact.
† The stem should pose a clear question and it should be
possible to arrive at the answer with the options
covered.
† Distractors should be homologous. By this, the candi-
date should not be able to identify the correct answer
because it contains more detail than the others.
Book reviews
† Items should avoid technical flaws that would benefit
the test-wise candidate.
The vast majority of the questions comply with these rules.
Questions are well structured with several of the stems poss-
ible; this challenges the candidate to choose the ‘Best’
option. A wide range of clinical areas are covered, these
include many of the classic anaesthetic conundrums, emer-
gency scenarios, and the implications of medical
co-morbidity. However, there does appear to be a preponder-
ance of questions from the field of obstetrics and some ques-
tions are not well mapped to the Final FRCA curriculum.
In the majority of cases, the answers are well referenced.
Candidates for the Final FRCA are advised to study the recent
review articles from the major anaesthetic journals, so they
understand the current thoughts of best practice. References
used in the book are drawn from a great number of BJA CEPD
Reviews and BJA CEACCP editions; in addition, there are fre-
quent references from NICE, SIGN, and the GMC publications.
These are a great source of information for the candidate,
pointing them to areas for further reading. However, a min-
ority of questions are referenced to isolated publications or
non-peer-reviewed on-line resources (eMedicine) for their
answers, these could have been improved upon.
Are the questions of a suitable difficulty? The ideal paper
should have a mixture of easy, medium, and hard questions.
This should challenge the gifted candidate while allowing the
borderline candidate to show their knowledge. These papers
offer a good mixture of question difficulty that is comparable
with the examples available on the RCOA site. The questions,
if anything, are slightly more difficult, but I am sure that this
will entertain the candidates.
I. C. Shaw
Sheffield, UK
E-mail: ian.shaw@sth.nhs.uk
doi:10.1093/bja/aer036
Anesthesiologist’s Manual of Surgical Procedures, 4th Edn.
R. A. Jaffe and S. I. Samuels (editors). Published by Wolters
Kluwer Health/Lippincott Williams & Wilkins, Philadelphia,
USA. Pp. 1526; indexed; illustrated. Price £118.00 (US
$179.00). ISBN 10: 0-7817-6670-2.
Many, if not most, comprehensive textbooks of clinical
anaesthesia are written mainly from the perspective of the
anaesthetist with little surgical input. Anesthesiologist’s
Manual of Surgical Procedures, now in its fourth edition, suc-
ceeds uniquely in bringing together the two, sometimes dif-
fering points of view of these two inter-reliant specialities,
into one excellent volume.
Despite increasing sub-specialization in anaesthesia, most
anaesthetists will, day to day, encounter a wide variety of
surgical procedures, many of which will be new to them.
Other procedures may be familiar, but the clinical consider-
ations pertaining thereto may need some revision. This text
BJA
ably synthesizes the clinical considerations, both anaesthetic
and surgical, of a vast array of procedures from multiple sur-
gical specialities into one coherent whole.
The stated goal of the manual is to provide ‘an easily
accessible source of clinically relevant information about a
wide variety of both common and not so common surgical
procedures’. The format of the text will be familiar to those
who have had contact with previous editions. Each chapter
is co-written by a surgeon and an anaesthetist.
The scope of the book is massive. Specialities as diverse as
neurosurgery, obstetrics, and office-based anaesthesia are
covered. Each sub-speciality chapter is often first preceded
by a general introduction to the field. The surgeon then
describes the background to, the epidemiology, pathology,
and course of a given condition, followed by common surgi-
cal techniques, special procedural considerations, and a
description of the course of surgery.
The surgical considerations section concludes with a
summary of procedures. This section provides a fascinating
insight into the surgical perspective on perioperative care.
Aside from information on positioning, special instrumenta-
tion required, the incision, and predicted surgical time, a
valuable information mine is present in the form of the
‘unique considerations’ section. These sections often reveal
the operating conditions that the surgeon is expecting to
be provided by the anaesthetist. While mainly being extre-
mely useful, especially in the cases of surgical procedures
unfamiliar to the reader, sometimes surgical requirements
appear more than a little prescriptive, perhaps due to the
slightly different dynamic in the relationship between the
American surgeon and the anaesthetist. Nowhere is this
more apparent than the postoperative care sections.
Anaesthetic considerations are always divided into the
familiar headings of preoperative, intraoperative, and post-
operative. These sections are clearly and very competently
written and provide concise information on anaesthetic tech-
nique, pathophysiology relevant to individual conditions, pre-
operative investigations, and postoperative complications.
The book concludes with a section entitled ‘Emergency
Procedures for the Anesthesiologist’, which outlines tech-
niques for performing procedures such as pericardiocen-
tesis and arterial cutdown. This chapter appears a little
ectopic, and is well covered in other, more conventional
textbooks of anaesthesia. Similarly, the appendices cover-
ing topics as diverse as preoperative laboratory testing,
perioperative beta-blockade, and ‘standard adult anesthetic
protocols’, while well and clearly written, are quite heavily
influenced by local practice and again are better covered
elsewhere.
The authorship of the book is almost exclusively from
Stanford University and allied institutions. This may of
course introduce a little west coast bias into the information
written into the text, though on the whole the authors
manage to avoid too much localism in their writing.
Anesthesiologist’s Manual of Surgical Procedures fourth
edition remains to be highly recommended as a clear, rel-
evant, broad, unique, and highly detailed textbook of surgical
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