Ⅵ REVIEWS OF EDUCATIONAL MATERIAL

Mark A. Warner, M.D., Editor

Manual of Emergency Airway Management, 3rd Edition. Peripheral Nerve Blocks: A Color Atlas, 3rd Edition. By By Ron M. Walls, M.D. and Michael F. Murphy, M.D. Philadelphia, Jacques E. Chelly, M.D., Ph.D., M.B.A. Philadelphia, Lippincott Lippincott Williams & Wilkins, 2008. Pages: 432. Price: $59.95. Williams & Wilkins, 2009. Pages: 496. Price: $110.00.

Dealing with the expectation of providing a secure airway in a Regional anesthetic techniques have long been employed as a means routine setting such as the operating room can often be a challenge. of providing operative, postoperative, and chronic analgesia. They However, maintaining the same level of skill and confidence in patients have also been used as adjuncts to general anesthesia to reduce anes- with presumed difficult airways or worse, the dreaded unexpected thetic requirements, which may be especially useful in patients with difficult airway, can be problematic. In settings outside the operating underlying disorders such as coronary artery disease. More recently, room, difficult airway management can be even more demanding. evidence indicating potential benefits in decreasing the incidence of Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/111/3/683/247780/0000542-200909000-00041.pdf by guest on 27 September 2021 The Manual of Emergency Airway Management, now in its third certain postoperative complications with the use of regional anesthesia edition, is an excellent resource to better understand a stepwise has contributed to a renewed interest in these techniques. The devel- approach to successfully provide airway management in a wide variety opment of safer local anesthetic agents, the use of ultrasound guid- of emergent situations. The stated objective of the authors is to provide ance, and the availability of continuous block techniques have also healthcare professionals such as internists, emergency department played a role in the increasing application of regional anesthesia. As the providers, intensivists, anesthesiologists, and first responders with a scope of regional anesthetic practice continues to expand, references concise, reproducible, stepwise approach to airway management that that incorporate information on new techniques and applications of regional anesthesia are needed to keep the practitioner up-to-date. is based on literature review and complemented by clinical expertise. In this regard, Peripheral Nerve Blocks: A Color Atlas, Third Edi- The authors have updated this third edition with simplified yet tion, edited by Jacques Chelly, provides well-organized and updated comprehensive airway algorithms. The pharmacology of the many information encompassing current regional anesthetic practices. It is induction and paralyzing agents that can be used in the emergency suitable for the novice student of anesthesia as well as for the experi- airway setting have been amended. Detailed, practical information enced anesthesiologist. The book is divided into sections that cover regarding the technological advances that are beginning to revolution- general topics such as equipment and medications used in regional ize airway management has been greatly expanded. Finally, the section anesthesia, single-shot and continuous nerve block techniques specific on prehospital emergency airway management has been broadened, as to body regions, ultrasound guidance for peripheral nerve blocks, the this is an area where the difficult airway may be more common. use of regional anesthetic techniques in the pediatric population, and The manual is extremely easy to read. Important ideas and themes even a section that covers common regional block techniques used in are often emboldened in blue type. Each chapter has easy-to-read a pain management practice. graphs, figures, tables, and photography. The book is coherently di- The author provides a concise and easy-to-follow guide for block vided into seven broad sections, including Approach to the Airway, performance. Block technique descriptions are accompanied by a Difficult and Failed Airways, Pharmacology of Airway Management, variety of anatomic illustrations and photographs that demonstrate Pediatric Airway Management, EMS Airway Management, Special Clin- needle placement and landmarks used in performance of the block. ical Circumstances, and lastly, Mechanical Ventilation and Monitoring. Block techniques that can be accomplished by numerous anatomic Each chapter follows a logical sequence, beginning with an introduc- approaches are well covered in distinct sections. Each description of a tion, clinical challenges, approach to the airway, techniques, and often block technique begins with a summary of clinical indications, patient a Tips/Pearls section. However, what sets this manual apart may be the positioning, needle size and type, volume of local anesthetic to be Evidence section at the end of each chapter. The authors provide administered, anatomic landmarks, approach and technique, block updated literature detailing the reasoning behind some of the more contraindications and side effects, and helpful technical tips. In addi- controversial recommendations. The authors do not shy away from tion, this reference is linked to an interactive Web site that provides some potentially debatable topics and long-held beliefs, such as the access to the entire content of the book online, including a fully recommendation to not routinely use atropine before succinylcholine searchable and downloadable image bank. This provides the purchaser in the pediatric population. with ready remote access to the material when a hard copy of the text There are several chapters of particular interest to the anesthesiol- is not immediately available. ogist. The chapter on video laryngoscopy provides detailed informa- Beyond the sections describing single-shot and continuous periph- tion on many of the current commercially available devices. The eral nerve block techniques, there are chapters dedicated to nerve authors detail the use of each video laryngoscope with a summation of mapping techniques and the performance of ultrasound guided re- the positives and the negatives for each. Helpful information on cur- gional anesthetic techniques, which have become more widely used rent literature regarding video laryngoscopy is provided in the Evi- over the past decade. Both of these modalities are noninvasive and can dence section. The section on pediatric airway management spans only facilitate nerve localization before needle insertion. The nerve map- three chapters, but provides a concise yet relatively all-inclusive review ping chapter includes a good discussion of the physical principles of techniques available to better ensure successful airway management involved in nerve stimulation such as electrical pulse frequency, cur- in this population. This section also offers useful new and updated rent amplitude, electrical pulse duration, and tissue electrical imped- information regarding the pediatric difficult airway. ance, which play important roles in nerve mapping and localization. Overall, this manual hits its intended mark by providing an easy-to- Likewise, the section on ultrasonography for peripheral nerve block read, succinct, yet comprehensive approach to the patient in need of guidance includes a good description of how various tissue properties emergency airway management for all healthcare providers, be it an may influence the quality of the images, as well as how different types anesthesiologist, internist, intensivist, hospitalist, emergency depart- of tissue (such as nerves and vessels) may be distinguished from one ment physician, or emergency medical service first responder. another when using ultrasound. Each chapter dedicated to the perfor- mance of a specific ultrasound-guided block includes images of ana- Ty A. Martindale, D.O., M.H.S.,* Lauren Berkow, M.D. *The tomic cross sections paired with ultrasound images for anatomic ref- Johns Hopkins Hospital, Baltimore, Maryland. [email protected] erence. The comprehensive section on pediatric peripheral nerve (Accepted for publication March 10, 2009.) blocks also includes a discussion on the use of nerve mapping and

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ultrasound techniques in children, and fully describes the use of single- this book, while the third edition had only one author and two shot and continuous nerve block techniques in this patient population. contributors. That 2002 edition had 24 chapters, while this edition has The last section of the book is dedicated to pain blocks. This section only 23 chapters. In this latest edition, the chronic pain management is relatively brief but covers some common procedures performed in a and obstetrical anesthesia chapters have been removed. A new chapter pain management clinic setting, such as various sympathetic blocks, on the use of regional anesthesia for ambulatory surgery has been facet injections, occipital nerve blocks, trigger point injections, and added. The 2002 edition had 113 figures and 23 tables, while the 2009 sacroiliac joint injections. It includes information on the use of fluoro- edition has 145 figures and the same number of tables. There is a scopic guidance as well as drugs used for neurolytic procedures. As significant increase in the number of comprehensive figures, diagrams, with the sections on peripheral nerve block techniques, the injection schemes, and photographs illustrated in the different chapters. These descriptions are accompanied by a brief description of technique- facilitate the reader’s understanding and provide a more pleasant specific considerations such as patient positioning, needle selection, reading experience. A further enhancement is the use of color in medications used, anatomic landmarks, approach, potential complica- figures and tables in this new edition. tions, and tips for block performance. This format provides a quick The book’s first two chapters, Local Anesthetics and Local Anes- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/111/3/683/247780/0000542-200909000-00041.pdf by guest on 27 September 2021 overview of the procedure and can be used as a ready reference for thetic Clinical Pharmacology, are excellent. The author covers up- review before performance of a specific block technique. dated local anesthetics pharmacology in a very concise and effective Dr. Chelly has provided a useful and updated reference for the manner. The chapters reviewing complications of regional anesthe- performance of regional anesthetic techniques. The book is well sia, premedication, and monitoring provide concise and updated designed and the format makes it easy for the reader to quickly ideas relevant to clinical practice, allowing readers to master the review the techniques described while still providing comprehen- essentials of these topics. sive information about each block. It includes a large volume of The chapters dealing with spinal, epidural, and caudal anesthesia figures, tables, and photographic images which enhance the con- are very informative, well written, and updated with recent refer- tent and usefulness of the book. It is a welcomed addition to the ences. These chapters also include very good illustrations and available regional anesthesia literature. images. The intercostal and terminal nerve anesthesia of the trunk and the paravertebral chapters were updated in this edition with Jennifer A. Elliott, M.D., University of Missouri-Kansas City School of more references and multiple figures, including advanced ultra- Medicine, Kansas City, Missouri. [email protected] sound-guided blocks images. The airway, cervical plexus blocks, (Accepted for publication March 10, 2009.) ophthalmic anesthesia, pediatric regional anesthesia, ambulatory surgery and postoperative pain management chapters were written in a concise and very informative manner. The block choices and descriptions are supplemented by excellent A Practical Approach to Regional Anesthesia, 4th Edition. illustrations as well as photographs of ultrasound guidance, anatomy, By Michael F. Mulroy, M.D., Christopher M. Bernards, M.D., Susan surface anatomy, and needle positions. One of my favorite chapters B. McDonald, M.D., and Francis V. Salinas, M.D. Philadelphia, that showed the authors’ experience described anesthesia of the bra- Lippincott Williams & Wilkins, 2009. Pages: 356. Price: $85.00. chial plexus. In the chapters on peripheral nerve blocks of the upper extremity, lumbar plexus blocks, and sacral plexus–sciatic nerve This book is not a traditional textbook that contains considerable detail; blocks, the authors did a great job of incorporating recent advances in rather it is more of a hands-on book intended to provide the practical using ultrasound guidance and insertion of catheters. However, they essentials of regional anesthesia blocks performed in the Virginia Mason omitted other techniques for performing these blocks, mentioning Medical Center, Seattle, Washington. The first edition appeared in them only as references. The authors only discussed the use of an 1996. This is the fourth edition, which reveals that it has been repeat- in-plane transverse middle scalene approach. These narrowed discus- edly updated to include the rapid development of the practice of sions led me to conclude that the text might be better titled as the regional anesthesia. For example, this edition includes new sections on Virginia Mason Manual of Regional Anesthesia Techniques. ultrasound-guided regional anesthesia and the use of peripheral nerve One of the difficulties of rewriting new editions of a textbook is the catheters. Both are essential, because they represent very important need to include new and important references. In this case, however, advances in the practice of regional anesthesia and improve its safety I could not find any important omissions. The book is comprehensive and reliability. and refreshingly uniform and nonrepetitive. In conclusion, this book is I believe that the authors have covered these new advances fairly worthy to be included in the library of all anesthesiology departments, well in this book, especially in their descriptions of equipment and a especially to support the education of trainee anesthesiologists. variety of regional blocks including the brachial plexus, peripheral nerves of the upper extremity, lumbar plexus, and sacral plexus-sciatic Ahmed Ghaleb, M.D., University of Arkansas for Medical Sciences, nerves. In comparison to the third edition, this edition has more Little Rock, Arkansas. [email protected] authors (four authors and one contributor) who have added strength to (Accepted for publication March 10, 2009.)

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