British Journal of Anaesthesia 109 (3): 470–2 (2012)
BOOK REVIEWS
Kaplan’s Cardiac Anesthesia—The Echo Era, 6th Edn.
J. A. Kaplan, D. L. Reich and J. S. Savino (editors). Published
by Elsevier, USA. Pp. 1202; indexed; illustrated. Price
£191.00. ISBN 978-1-43377-1617-7.
Five years have passed since the 5th edition of Kaplan’s
Cardiac Anesthesia in 2006. Over the past 15 yr, perioperative
transoesophageal echocardiography (TOE) has revolutionized
the management of the cardiovascular patient, by develop-
ing not only into an intraoperative, real-time diagnostic
tool, but also an excellent haemodynamic monitor. The 6th
edition of this textbook has therefore seen a name change
to acknowledge the important role played by imaging techni-
ques in the management of patients undergoing modern
cardiac surgery. To maintain its place as the prime reference
textbook of cardiovascular anaesthesia, this edition has been
completely revised and updated, with a significant focus on
the use of TOE in perioperative decision-making. In addition,
this edition now has full online access to all the information.
This Kaplan is once again of considerable size. It has an at-
tractive cover and is well illustrated with an abundance of
colour diagrams, photographs, and tables. The book’s font
size is small and does make the reader to reach for their spec-
tacles. The TOE images are clear, well labelled, and easy to
understand. The inclusion of colour Doppler and three-
dimensional (3D) images is refreshing and keeps the reader’s
attention. This edition has 106 expert contributors who all prac-
tice in North America, apart from one. The multi-disciplinary
distribution between anaesthetists, surgeons, physicians, and
perfusionists makes for valuable cross-fertilization of knowl-
edge. In spite of the multi-author format, the editors have
managed to limit repetition reasonably well.
The book is divided into seven sections with several chap-
ters less than the previous edition, to prevent it from becom-
ing unmanageable. Most of these topics, however, have been
incorporated into other chapters, which mean it remains a
bulky, comprehensive reference textbook. There are also
several chapters of new material. Each chapter is very well
referenced to recent peer-reviewed literature.
The first section covers preoperative assessment and
management of the patient with cardiac pathology. Apart
from explaining different cardiac imaging modalities very
well, the shift of modern anaesthetic practice to the catheter
laboratory is clearly demonstrated by all the information on
new interventional procedures and electrophysiology. Al-
though physiology and pharmacology have always been
the scientific basis of the anaesthetist’s clinical practice,
this information has been excellently described in the
second section. Detailed discussion of molecular and
genetic cardiovascular medicine together with myocardial
preconditioning theories brings basic sciences back to the
patient’s bedside.
& The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
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Sections 3 and 4 are called ‘Monitoring’ and ‘Anesthesia
and transesophageal echocardiography for cardiac surgery’.
The carefully selected chapter topics demonstrate the im-
portance of perioperative echocardiography not only as a
diagnostic tool but also as the gold-standard haemodynamic
monitor in our modern clinical practice. Although it runs the
risk of trying to cover a comprehensive echocardiography
curriculum inside the main textbook, TOE is appropriately
viewed in the context of the global management of the
cardiac surgical patient. A lot is covered, from the history of
echocardiography to advanced scanning modalities like 3D
echo and how to perform myocardial deformation imaging.
Recent developments in point-of-care coagulation monitor-
ing are also well described in Section 3.
The fourth section focuses on anaesthesia and the use of
TOE for surgical procedures in patients with specific cardiac
conditions. Chapters on advanced practice, including adult
congenital heart disease, heart –lung transplantation, pul-
monary thromboendarterectomy, and surgery for end-stage
heart failure, are evidence of the importance of anaesthesia
in modern cardiovascular medicine. A comprehensive ex-
planation of mechanical circulatory support devices educates
the reader whose institution may not have all these
advanced devices available. The chapter on procedures in
the hybrid operating theatre is a refreshing indication of
the dynamic future of cardiovascular anaesthesia, while
new interventions such as percutaneous valve replacement
and transapical aortic valve implantation are also covered.
Section 5 comprises bread and butter topics for the
cardiac anaesthetist, and makes excellent reading. Cardio-
pulmonary bypass devices and management, blood transfu-
sion, and coagulation disorders are all well explained and a
useful update for the practicing clinician. The chapter on dis-
continuing cardiopulmonary bypass, in particular, shares
useful advice on how to deal with some difficult intraopera-
tive situations.
The sixth section addresses postoperative care and sys-
temic complications and outcomes after cardiovascular
surgery. The chapters on cardiovascular, respiratory, and
central nervous system management after surgery are edu-
cational and important principles are well explained by
flow diagrams and case reports.
The final section, ‘Education in cardiac anesthesia’, covers
training, education, and certification in cardiac anaesthesia
and TOE together with a chapter on reducing errors in anaes-
thetic practice.
With this edition, the complete text is available to the
reader online, at www.expertconsult.com, along with the
accompanying images. This makes the information much
more accessible, informative, and dynamic from any com-
puter. The book is also functional on an iPAD. The online
site is intuitive, easy to navigate through, and searches
Book reviews
for key words are easy. All the 2D and 3D echo images un-
fortunately appear as stills and a big advance in the next
edition would be to have them in the dynamic movie
format. The ECG atlas at the end of the book is a useful
educational tool.
Having now used this 6th edition of Kaplan over the past
several months as a reference textbook, it has answered
99% of questions put to it. This is the authoritative textbook
on cardiovascular anaesthesia and should be high on the pri-
ority list of all practicing anaesthetists with an interest in this
field, and also medical libraries. Overall, this is a worthy
update of a fine textbook that will be valuable to practi-
tioners and trainees in cardiac anaesthesia.
J. Swanevelder
Cape Town, South Africa
E-mail: justiaan.swanevelder@uct.ac.za, justiaan@hotmail.com
doi:10.1093/bja/aes271
From Acute to Chronic Back Pain: Risk Factors, Mechanisms
and Clinical Implications. M. I. Hasenbring, A. C. Rusu and
D. C. Turk (editors). Published by Oxford University Press,
Oxford, UK. Pp. 590; indexed; illustrated. Price £85.00. ISBN
978-0-19-955890-2.
A triumvirate can be defined as ‘any association of three in
office or authority’: the political alliance of Gaius Julius
Caesar, Marcus Licinius Crassus, and Gnaeus Pompeius
Magnus being perhaps the most famous. In pain medicine,
almost universal acceptance is given to the bio-psycho-social
model and few would argue against this three dimensional-
ity. It is the basis of modern pain management and is at the
core of education as endorsed by the Faculty of Pain Medi-
cine, the British Pain Society, and the International Associ-
ation for the Study of Pain. Its usefulness and application
to patients with back pain is, of course, no exception. It is
unusual and disappointing, therefore, that this book leaves
out one of those limbs and this is a major weakness. It con-
tains very little on the ‘bio’. There is no information or discus-
sion of diagnosis, differential diagnosis, exclusion of serious
pathology, examination, or investigation. There is almost
nothing regarding any anatomical site of origin of pain or
pathological process.
The most basic requirement of any piece of research is
that like is compared with like. Back pain is a symptom, not
a diagnosis. It can be caused by disc degeneration, muscle
pain, uterine fibroids, retroperitoneal tumours, a slowly
expanding aortic aneurysm, to name but a few. To ignore
its differential diagnosis means that any piece of research
looking at ‘back pain’ must be interpreted with extreme
caution. This is not mentioned in the book.
Muscle activity is discussed in an excellent chapter on
deconditioning. But if this can be done why is little said
about changes in joints, intervertebral discs, and peripheral
nerves? The zygapophyseal joint, sacroiliac joint, and inter-
vertebral disc are all proven sources of back pain and yet
BJA
only two of these structures are mentioned in a single
page and on one illustration. A reference to 1992 that ‘only
in a minority of cases (approximately 15%) can the
patho-anatomical source of low back pain be identified’
(Chapter 28) ignores the work of many scientists, scores of
excellent publications, and reviews emanating not just from
research groups, but from bodies such as the International
Spine Intervention Society and the World Institute of Pain.
It is not just pain physicians but rheumatologists, musculo-
skeletal physicians, and surgeons who have their practices
ignored.
What this book does very well is psychology and social
aspects of chronic back pain which reflects the !50% of
the authors who are psychologists or rehabilitation experts.
As a standard pain clinic doctor, I have to admit to being
overwhelmed by psychological theory and detail. The
advances in psychology are superbly described and argued
and current and future research is laid out.
Many chapters are very detailed, some are somewhat eso-
teric, for example, dysfunction of the hypothalamic– pituit-
ary –adrenal axis in chronic low back pain (which is
fascinating), and some are rather long. Boxed learning
bullet points would have been very welcome.
As a review of chronic pain psychological and social
research, this book is very strong. It is misleading that this
is by no means reflected in its title. For professionals or stu-
dents within these disciplines, I think that it is highly recom-
mendable. For the multidisciplinary pain physician, it does
not provide a balanced picture.
J. Richardson
Bradford, UK
E-mail: docjohnnyr@hotmail.com
doi:10.1093/bja/aes272
History of Anaesthesia VII: Proceedings of the 7th Inter-
national Symposium on the History of Anaesthesia.
H. Askitopoulou, K. E. McGoldrick, R. N. Westhorpe and
D. J. Wilkinson (editors). Published by the University of
Crete Press, Heraklion, Greece. Pp. 585. Price E60.00. ISBN
978-960-524-370-8.
There have been international symposia on the history of
anaesthesia every 4 or 5 yr since 1982. The 7th symposium
was held at Heraklion, Crete, Greece, in 2009. This well-
produced book publishes the 47 presentations. The essays
are by individuals about individual topics and are linked
only by their historical theme. The essays are in English,
but this is not the first language of many authors and
there are a number of misprints, although they do not
detract from the value of the book. It is divided into four
historical sections with a final section about anaesthetic
pioneers. It has an extensive index. There is a good
summary of the symposium in the first chapter by the
senior editor, Helen Askitopoulou, titled ‘From Greek An-
tiquity to the Twentieth Century’.
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