Kaplan's Cardiac Anesthesia, 5th Edn. J. A. Kaplan, D. L. Reich, C. L. Lake and S. N. Konstadt (editors). Published by Saunders, Philadelphia, PA, USA. Pp. 1276; indexed; illustrated. Price £165. ISBN 1-4160-0253-7.
Since first publication in 1979, this textbook has served as the standard reference in cardiac anaesthesia. The fifth edition sees a subtle name change from Cardiac Anesthesia to the eponymous Kaplan's Cardiac Anesthesia. In addition to a name change, the book has undergone radical revision reflecting the ongoing changes that the subspecialty has seen since the publication of the fourth edition 7 yr ago. Whereas most of us put on weight as we get older, this book has resisted middle age spread and rather than the anticipated progression to two volumes the book is actually 135 pages shorter than the previous edition. We also see a more youthful appearance with a bright illustrated cover rather than the previous sombre dark blue. Chapter by chapter Key Point listings and innumerable Teaching Boxes add to the contemporary feel.Although this is a multi-author textbook with 94 different contributors there is a uniform prose style throughout, and little in the way of repetition, reflecting tight editorial control. All but one of the contributors practices in North America. This comment is simply intended as an observation, not a criticism, as UK practice tends to follow the lead set on the other side of the Atlantic. Many of the contributors are acknowledged experts in their field and seven have been guest speakers at meetings of the UK Association of Cardiothoracic Anaesthetists in the past 5 yr.
The book is divided into eight main sections and starts with a fascinating new section entitled Past, Present and Future. This looks at historical developments in cardiac surgery and cardiac anaesthesia and then turns to current and potential future developments. The implications for the speciality of the current global trend towards percutaneous revascularization, concerns over long-term patency rates for coronary stents and the consequences of an ageing population are all discussed. The authors conclude that the speciality has a bright future but this may well see anaesthetists increasingly involved in cardiac catheter laboratory work. Sections follow on physiology and pharmacology, preoperative evaluation, monitoring, anaesthetic techniques, extracorporeal circulation, postoperative care and practice management.
The monitoring section includes nearly 100 pages specifically devoted to the practice of transoesophageal echocardiography and its role in the surgical decision-making process, a reflection of the importance of this technique in North American practice. In addition, guidelines for training in perioperative echocardiography are included in an appendix. The chapter by Murkin, in the postoperative care section, on central nervous system dysfunction after cardiopulmonary bypass is a particular tour de force. The practice management section also includes a chapter devoted to the financial aspects of patient care and cost accounting systems which might, until recently, have seemed irrelevant to UK practice but in the present NHS financial climate seems only too apposite. The chapter concludes with the stark warning ‘physicians can no longer assume that caring for patients will automatically provide an income’.
I set the book a number of challenges. Could it tell me what the options are for anticoagulation for bypass in a patient with heparin-induced thrombocytopenia? Could it give me a clear description of the Mustard operation for transposition of the great arteries? Does it outline the evidence for and against thoracic epidural analgesia in cardiac surgery? The answer to these three questions was, in each case, a resounding yes.
In conclusion, this is the most authoritative and up to date collection of material in the field and as such represents an essential purchase for any practicing or intending cardiac anaesthetist. There is a wealth of information of relevance to patients with cardiac disease undergoing non-cardiac surgery and as such this book also deserves a place on the shelf of every departmental library.
Sheffield, UK
E-mail: Nick.Morgan-Hughes{at}sth.nhs.uk
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