© The Board of Management and Trustees of the British Journal of Anaesthesia 2005
BOOK REVIEW |
Essentials of Airway Management. S. Dolenska, P. Dalal, A. Taylor. Published by Cambridge University Press, Cambridge. Pp. 140; indexed; illustrated. Price £17.50. ISBN 1-841-10153-2
E-mail: andy.bodenham{at}leedsth.nhs.ukThis small handbook (pocket size, 140 pages) has been published by a consultant anaesthetist and two specialist registrars. The stated aim is to provide a small textbook on basic airway management for the novice trainee. The target audience is anaesthetic senior house officers and operating department practitioners.
Does this book achieve this aim? The answer is undoubtedly ‘yes’. I am unaware of any previous small book that covers so much in relation to airway care in so small a space. The book starts with chapters on airway assessment, anatomy and routine intubation. The reader then is taken through a series of different anaesthetic/surgical scenarios including abdominal surgery, trauma and burns, paediatrics, obstetrics, head and neck and ENT surgical procedures. The book finishes with chapters on airway management without intubation, the prone position, the difficult airway, extubation and postoperative airway management. All the information is very up-to-date and I was pleased to see some traditional practices being challenged (e.g. the routine use of succinylcholine in all obstetric cases undergoing anaesthesia).
In general, all chapters give a reasonably comprehensive coverage of the stated subject. My only reservation about the book is really the definition of ‘essential’. The title of the book might be better termed ‘Essentials of Anaesthetic Airway Management’, as the authors have apparently chosen not to include anything about airway management outside the operating theatre environment, the only exception to this being a section on Trauma and Burns. There is no mention of airway management in the cardiac arrest situation, for the patient with respiratory failure outside the operating theatre, and no discussion of tracheostomy except to say that it is a specialist area of practice.
I think it is regrettable that airway care in ITUs and tracheostomy management are not covered. Although outside the operating theatre these are routine large areas of practice in all acute hospitals. This includes patients who require emergency airway management by trainee anaesthetists, nurses, surgeons, physicians and paramedical staff. Such staff, for example, should be competent to change a blocked tracheostomy tube even if they are not competent to actually perform the tracheostomy procedure itself. Equally, junior trainees may be called to the ICU, to deal with airway problems and should be aware of some of the differences in practice, for example the avoidance of succinylcholine in certain patient conditions, the high frequency of glottic oedema and different choices of tracheal tubes for longer-term use. Similar considerations apply in wards and A & E departments. If book space is limited, I would suggest such discussions are probably of more value than descriptions of, say, the oesophageal obturator device.
I was surprised by one or two other omissions in the postoperative section, notably no mention of airway obstruction after haemorrhage into the neck after procedures such as thyroidectomy. There was no discussion of prediction of which patients are likely to require postoperative ventilation after surgery. In the area of non-specialized surgery it is usually problems outside the airway that lead to the requirement of postoperative ventilation (e.g. limited cardiorespiratory reserve, sepsis, massive blood or fluid loss, suppression of conscious level, or hypothermia).
Despite the reservations about airway care outside the operating theatre, I think this book will prove popular with anaesthetic trainees, as a useful introduction to airway management. With the inclusion of information about critical care, it could also be attractive to non-anaesthetists undertaking training in intensive care medicine, and critical care nurses.
Leeds, UK
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