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Book Review |
Toronto, Ontario
In the preface to this book, Dr. Popat states that this "book is intended to form a ready source of practical advice to anaesthetists of all grades contemplating using fibreoptic intubation techniques...(and) to other specialists such as intensivists and accident and emergency physicians involved in airway management". Has he succeeded? Over and over again, this reader found himself comparing this book to Ovassapian's "Fiberoptic Endoscopy and the Difficult Airway" and sections of Benumof's "Airway Management Principles and Practice" but such comparisons are unfair. The latter books are comprehensive textbooks with very detailed bibliographies. Most readers will be unable to achieve mastery of them in their entirety. This book, on the other hand, is practical, as the title proposes. It is filled with useful anecdotal and published information about common problems and solutions. The bibliography is limited but carefully selected. One senses the author's enthusiasm for the subject yet exercising restraint in his account.
It is also a very readable 180 pages in length and includes chapters on equipment, a structured approach to acquiring and teaching fibreoptic intubating skills, useful aids, techniques for fibreoptic intubation of the anesthetized and conscious adults and children as well as a discussion of some applications in critical care. The text is concise, almost sparse yet clear and accompanied by excellent illustrations and photos.
In the UK, an awake intubation is performed in a very limited number of patients, even those in whom the ASA Task Force and Canadian Airway Focus Group would advocate securing the airway prior to induction. The reluctance of the British anesthesia community to embrace fibreoptic endoscopy is implicit throughout the text. There are several references to reports of confidential enquiries into perioperative deaths which highlight the problem of failed intubations and misplaced endobronchial tubes. The book also encourages the use of "conduits" such as the laryngeal mask airway (LMA), intubating LMA, Ovassapian and Berman airways, which will make the task less daunting.
This reviewer cannot help but express his disappointment that the subject of extubating the difficult airway is dispatched as a single (and the final) sentence in the book. There is no discussion of rigid fibreoptic devices (e.g., Bullard, WuScope, Uphserscope, Shikani) or videolaryngoscopy. The chapter on critical care is superficial but as its authors state "beyond the scope of the text." Nonetheless, it is an excellent primer on fibreoptic techniques and is recommended for those wishing to acquire or increase their skills.
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