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Perioperative Medicine. Managing Surgical Patients With Medical Problems

A. Nicholls, I. Wilson. Oxford University Press, Oxford, 2000. 384 pages. ISBN 0-19-202975-1

Montreal, Quebec

This pocketbook is meant primarily to aid surgical trainees handle medical issues in adult surgical patients, but also meant to be appropriate for anesthesiologists in training, It does not cover surgical techniques, or management, or specialized medical or surgical fields. It is divided in three sections, the first dealing with general medical issues in perioperative care, the second giving information about specific medical problems by systems, and the third providing data about specific medical emergencies. There are 26 contributors, including anesthesiologists, internists, one surgeon and clinical nurse specialists. This gives the book a multi-disciplinary approach. Pocketbooks must give clear, succinct and useful information that is easily accessible. This book does, but only to some extent in some specific sections.

The first section covers medical issues in perioperative care such as patient consent, nausea and vomiting, management of pain, fluid balance, etc. The information given is not detailed enough to be of assistance, and would be more appropriately learned in a longer and more complete text or, even better, with actual experience.

The second section deals with care of surgical patients with chronic medical disorders, from the most common such as ischemic heart disease to the most uncommon such as Conn's syndrome. There is a good balance between brevity and detailed information. A clear preoperative and postoperative approach to diseases is achieved in many chapters, most well-done in the chapter dealing with respiratory disorders. Unfortunately some other parts are poorly covered.

The third section discusses medical emergencies in surgical patients. In this part the common problems are dealt with appropriately and in a rapidly accessible format that proves invaluable to residents faced with medical emergencies like oliguria, dyspnea, etc.

The last section, describing drugs, gave no dosing information, and because the drugs were grouped according to class, it did not act as a rapid reference for specific medications. The index, when searching for specifics, often was not in-depth enough. The large number of contributors resulted in a certain amount of duplication.

Overall, the book presented a thorough basic set of information, but not in a very specific or succinct way. Any pocketbook, ultimately, must have enough rapidly accessible useful information to justify its pocket use, and with the exception of the last section on medical emergencies, this book does not.

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