Anaesthesia, 2010, 65, pages 872–873 Book review . ....................................................................................................................................................................................................................
where further investigation may be useful. As an aid to rationalising decisionmaking, the authors have tried to include some information about the sensitivity and specificity of many tests, but I found it a little lacking in some areas, such as prediction of the difficult airway. Indeed, on occasion (I suspect, due to the varied authorship), the statistical terminology used could have been more standardised throughout. I would have also liked to see an additional chapter covering the statistical theory of using tests in rational decision-making, taking into account for example knowledge of pre-test probabilities, sensitivity and specificity, likelihood ratios, etc., but its absence from the book does not in my opinion detract from its usefulness. M. Mackenzie Consultant Anaesthetist John Hammond Department of Anaesthesia East Surrey Hospital Redhill UK Email:
[email protected] doi:10.1111/j.1365-2044.2010.06417.x
Neurocritical Care J. P. Adams, D. Bell & J. McKinlay (eds) Springer-Verlag: London 2010, ISBN 9781848820692, 193 pp., Price £58.99
This book is primarily intended for intensive care clinicians working in a non-neurological centre who have occasion to look after patients with a wide variety of neurological pathologies. The text is well laid out and the editors have kept to an agenda throughout, highlighting the importance of rapid and efficient primary management of brain injury. This includes early attention to ÔABCÕ and the maintenance of oxygenation, carbon dioxide and blood pressure control with an awareness of potential metabolic and non-neurological complications. The references are up to date and there are several websites towards which the reader is directed for further information.
The introductory chapter eloquently explores the difficulty facing the providers of healthcare in the UK: adequate provision of neuro-intensive care (NICU) beds against a background of NICE recommendations for the management of head-injured patients, with the limited resources available. The bookÕs main emphasis is to encourage clinicians to avoid harm due to act, omission or delay, and through the use of care bundles, protocols and good documentation, facilitate communication with the local neurosurgical centre and smooth the process of appropriate, timely and safe transfer. Most of the authors are from the Yorkshire region and I found the US spelling throughout rather strange for a book intended for a UK readership. The editors have limited the total number of chapters to 15 which means that each of them has fairly broad remits. I think this is a positive and welcome move and makes the book very easy to read. Some clinicians might conceive NICU to be a ÔnarrowÕ topic and yet there is very little overlap between the chapters as they set out to Ôdemystify the common pathologies that compromise brain structure or functionÕ. Each chapter is clearly subdivided and the key points that appear at the start of each give a foretaste of what to expect whilst making the book easy to dip into when searching for a particular subject. A particular strength is the liberal use of colour throughout in line drawings, graphs and photographs. I particularly liked the frequent use of shaded boxes to highlight important tables or learning points. Chapter 3 covers the secondary management of traumatic brain injury and has a colourful nomogram of how to stabilise a brain injured patient on an ICU, with clear instructions on dealing with pyrexia, sedation, monitoring and fluid therapy. Further flow charts are very clear and concise, and give the occasional reader easy-to-follow instructions on the management of raised intracranial pressure, including the use of hypothermia and barbiturate coma. The chapter on subarachnoid haemor-
2010 The Authors Journal compilation 2010 The Association of Anaesthetists of Great Britain and Ireland
rhage uses good examples of the authorsÕ own experience and audits to illustrate the problems associated with delayed ischaemic deficit associated with cerebral vasospasm. There are a few specialist issues that could have been more strongly stressed in subsequent chapters. For example, clinicians could have been reminded that cases of intracranial infection, in particular brain abscesses, can occasionally take many weeks to show any signs of regaining consciousness (similarly with posterior fossa pathologies affecting the brainstem). In a non-specialist setting it is conceivable that ongoing aggressive management may on occasion be thought to be futile and yet experience teaches us to have great patience in such cases. The chapter on weakness in NICU could have explored the pain syndrome associated with Guillain-Barre patients, that can be difficult to manage. The use of MRI imaging in unconscious patients before cervical spine clearance could have been emphasised more since many hospitals now have access to such imaging. These points should in no way detract from this bookÕs overall value. The chapters on seizures and on imaging are engaging and informative and again superbly illustrated. Following a chapter on brain death and organ donation, the final chapter on ethical dilemmas uses some real life examples to elucidate some important points of law and ethics. This succinct book will demystify the thought processes that lie behind what can appear to be random decisions when patients are referred to regional neurological centres. For this reason I thoroughly recommend it to all clinicians working in referring institutions as well as those who need a rapid Ôhow toÕ guide to NICU. J. Andrzejowski Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK Email: John.Andrzejowski@sth. nhs.uk doi:10.1111/j.1365-2044.2010.06445.x
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