Books, Multimedia, and Meeting Reviews
Section Editor: J. Lance Lichtor
E BOOK REVIEW
Post-Anesthesia Care: Symptoms,
Diagnosis, and Management
Heitz JW, ed. Cambridge, UK: Cambridge University Press,
University Printing House, 2016, 382 pages, $79.99 (USD),
ISBN: 978-1-107-64221-8
Downloaded from http://journals.lww.com/anesthesia-analgesia by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsI
Ho4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 03/21/2023
A s anesthesiologists, management of patients in the post-
anesthesia care unit (PACU) is an integral part of our
practice. Therefore, it is critical to know the common, yet
potentially life-threatening, pathologies that occur in the
PACU to rapidly develop a differential diagnosis and treat-
ment plan. Post-Anesthesia Care: Symptoms, Diagnosis, and
Management provides a novel and common sense approach
to the challenges faced by PACU clinicians. By focusing on
the initial presenting symptoms, the book facilitates the
development of a differential diagnosis and an appropriate
plan of action. Section I covers the challenges of the postsur-
gical patient as well as the American and European guide-
lines for PACU care and discharge. Section II dedicates each
chapter to presenting symptoms ranging from common
issues such as hypertension, hypotension, dysrhythmias,
postoperative nausea and vomiting, and pain, to less com-
mon findings like jaundice and electrolyte disorders. Section
III is focused on special considerations such as mechanical
ventilation and the pregnant, pediatric, and morbidly obese
patient. This textbook is a valuable update when compared
with the other anesthesiology PACU textbooks that have a
more traditional format focusing on surgery type or organ
system.1,2 Of note, the editor, James W. Heitz, accomplishes
an impressive feat of authoring or coauthoring 25 chapters
with most of the other contributors coming from his home
institution or nearby.
The strengths of the book are its writing style, format,
and practical tables and figures. The writing style is simple,
direct, and easy to read, with an aim of providing a quick
reference guide for the clinician instead of exhaustive treat-
ment of each subject. Chapters are short and well organized,
and key points are presented upfront in bullet-point format
with sections clearly labeled. There are references to epide-
miology, pathophysiology, and pharmacology, but the bulk
of each chapter is devoted to the clinical presentation and
management based on current evidence-based guidelines.
The symptoms-based organization lends itself to clini-
cal takeaway points that are easily summarized in tables
or flowcharts that walk the practitioner through manage-
ment algorithms. These tables and charts reflect the strength
and purpose of the book: to be a practical reference with
a systematic approach to a specific, postoperative clinical
problem. An additional strength is a focus on the postsurgi-
cal patient while avoiding the larger differential diagnosis
attached to a medicine patient, as seen in the chapters con-
cerning delirium and hyperglycemia.
There are several areas for improvement, including a
redundancy in material, inconsistencies in chapter format,
DOI: 10.1213/ANE.0000000000002042
2080 www.anesthesia-analgesia.org June 2017 • Volume 124 • Number 6
Copyright © 2017 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited.
dated references, and the need for more tables, graphs, and
images to make the book more engaging and accessible for
visual learners. The symptoms-based structure inevitably
lends itself to frequent overlap in material, and some chap-
ters are more complete than others. For example, pneumo-
thorax is discussed in the introduction and the chapters
exploring chest pain, hypoxia, tachypnea and hypopnea,
dyspnea, and mechanical ventilation. Although each chap-
ter addresses pneumothorax as a potential cause of the
symptom, only the chapters on chest pain and tachypnea
and hypopnea present comprehensive treatment strategies.
It would have been useful to highlight where to find a com-
plete assessment and treatment of the given pathologies in
each chapter. With regard to chapter format, there are edito-
rial inconsistencies with notable variation between authors.
For example, the chapter on dysphonia and airway trauma
is the only chapter in bullet-point format. Another incon-
sistency is that some symptoms are separated out, while
others are compiled into 1 chapter. As an example, hypo-
glycemia and hyperglycemia have separate chapters, yet all
the electrolyte disorders are combined into one. Regarding
dated material and references, 1 example is that Hetastarch
is listed as a source of pruritus despite its minimal use due
to increased risk of kidney injury and death, which is not
mentioned in the text. Additionally, each chapter has mul-
tiple references dated from the year 2000 or before and few
within the past 5 years. Finally, the book is not available
electronically.
In summary, the symptoms-based format presents a
unique and practical textbook that is a useful reference for the
clinician. Overall, it is a helpful resource as an e­ xamination
review, as a quick guide for the junior anesthesiologist see-
ing a problem for the first time, or for the more advanced
practitioner seeking a thorough, practical treatment for a
clinical dilemma in the PACU or Surgical Intensive Care
Unit. Future editions should put more emphasis on ensur-
ing uniformity in chapter structure, provide a more direct
means to identify the most thorough descriptions of the
diagnosis and management of pathologies, should include
more of this edition’s excellent flow diagrams and figures,
and should be made available online.
Stephen C. Haskins, MD
Jemiel A. Nejim, MD
Genewoo J. Hong, MD, JD
Department of Anesthesiology
Hospital for Special Surgery
New York, New York
HaskinsS@hss.edu
REFERENCES
1. Anthea H. The Complete Recovery Room Book. 5th ed. New York,
NY: Oxford; 2014:1–590.
2. Eltringham R, Durkin M, Andrewes S, Casey W. Post-Anaesthetic
Recovery: A Practical Approach. 2nd ed. London, UK: Springer-
Verlag; 1989:1–193.