Book, Multimedia, and Meeting Reviews

The IASP research volume by Paice et al. is by no means

divorced from clinical practice. It is coedited by 4 accomplished clinical researchers (1 nurse and 3 physicians) each
with extensive hands-on experience in the management of
cancer pain. Although the expressed purpose in writing the
volume was to bring together current research related to
cancer pain, it contains much information with everyday
clinical applicability. In contrast to the Fitzgibbon-Loeser
text, this book makes no mention of anesthetic or surgical
interventions. However, the chapters on opioid rotation,
management of opioid tolerance, radiotherapy, and the
importance of patient attention to pain as a basis for
nondrug management, all provide useful pearls for busy
clinicians involved in the management of acute and chronic
cancer-related pain syndromes. Other chapters may not at
first glance seem relevant to clinical practice, for example,
those on education of healthcare providers, the design of
clinical trials of analgesic medications, or reducing regulatory barriers to adequate pain control particularly in developing countries, but these topics are extremely important in
caring for patients with cancer-related pain.
Inevitably, both books have some minor flaws. Neither
book devotes appreciable space to the management of acute
procedure-related pain even though this can be a major
management problem for patients with cancer. The
Fitzgibbon-Loeser book discusses the serotonin syndrome
within its chapter on opioid analgesics when it would seem
better placed within the chapter on adjuvant therapies (e.g.,
antidepressants). The authors statement of the superior
efficacy of palliative cordotomy over neuraxial opioids (p.
278) concludes with the cryptic statement that health care
is largely a social convention and neuraxial opioids are
the standard. The implication is that patients would be
better served if cordotomies were performed more frequently, yet one is left to wonder why the authors stopped
short of stating that. The chapter on specialized pain
management that this reader assumed would present criteria for when to refer a patient to a cancer pain specialist
devotes minimal space to that topic. Instead, most of its
content concerns late sequelae of cancer treatment and the
gap in certification processes for expertise in cancer pain
control, both topics that could be distributed among the
other chapters in this monograph. As the proceedings of an
international symposium, the IASP volume inevitably, deliberately even, makes no attempt to speak with a single
voice, but instead presents a wide assortment of topics
without achieving the clinical comprehensiveness and unifying narrative of the Fitzgibbon-Loeser book. Both volumes devote valuable space to nonessential photographs of
external beam radiotherapy machines.
The strengths and the shortcomings of both volumes are
well recognized by the editors. In his erudite foreword to
the Fitzgibbon-Loeser text, Cahana states that This book is
not a theoretical journey it is a story of the authors
constant desire to comfort the uncomfortable and care for
those whom, sometimes, we have difficulty caring. Sir
Michael Bond, a past President of IASP, writes in his
foreword to the IASP volume that the breadth of the field
[of cancer pain management] is revealed by the wide
ranging topics and the volume itself [that] are at the
cutting edge of knowledge.

September 2011 Volume 113 Number 3

In summary, the Fitzgibbon-Loeser text is a must have

for anyone treating cancer pain who wants a coherent,
time-tested, yet up-to-date account of exceptional clinicians practice. The IASP text is a must have for anyone
who wishes to gain an international perspective on where
key research in this area is headed, including in developing
countries, and who might wish to join this global effort to
alleviate cancer-related pain.
Daniel B. Carr, MD, DABPM, FFPMANZCA (Hon)
Saltonstall Professor of Pain Research
Department of Anesthesiology
Tufts Medical Center and Tufts University School of
Medicine
Boston, Massachusetts
Daniel.Carr@tufts.edu

Clinical Manual and Review of

Transesophageal Echocardiography,
2nd ed.
Mathew JP, Swaminathan M, Ayoub CM. New York:
McGraw-Hill Medical, 2010. ISBN: 978-0-07-163807-4.
642 pages, $149.00
s anesthesiologists bookshelves become more crowded
with echocardiography texts, it is important for potential buyers to identify the specific purpose that any new
textbook will serve. Some books are meant to function as a
comprehensive reference text and typically sit on a shelf
until the need to answer a specific question arises. Other
books provide a basic roadmap for trainees and are typically read cover to cover during their postgraduate training
period. In this respect, the Clinical Manual and Review of
Transesophageal Echocardiography, second edition, falls a bit
in the middle. With 27 chapters and more than 600 pages,
this book covers a wide array of topics and is more
comprehensive than an introductory text. At the same time,
the writing style is succinct and delivers a right-to-thepoint message not typical of large reference works. In the
opinion of this reviewer, this book would serve as an
excellent source of up-to-date clinical information on transesophageal echocardiography (TEE) for trainees and more
experienced anesthesiologists preparing for board examinations in both basic and advanced perioperative echocardiography.
This second edition of the Clinical Manual and Review of
Transesophageal Echocardiography is significantly expanded
from the first edition published in 2005, with the addition
of 8 new chapters and approximately 50% more pages. The
increase in size is partially accounted for by the increased
use of figures and illustrations, which are generally very
well done. New chapters covering epiaortic, epicardial, and
3-dimensional ultrasound highlight the additional material.
However, in keeping with the books concise style, the
material serves more to familiarize (or refresh) the reader
with the basic concepts of TEE rather than provide extensive background material on the topic or a detailed stepby-step guide to using TEE in clinical practice. Potential

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BOOK, MULTIMEDIA, AND MEETING REVIEWS

buyers should keep this in mind to avoid being disappointed. Of course, this book is not meant to sit idly on the
shelf as a reference, but rather to be used in an interactive
manner.
Interactive use for board examination review implies
practice questions, and this book provides plenty of them.
Readers of the first edition will be familiar with the
numerous multiple-choice questions (up to 70) after almost
every chapter. By and large, the questions are well written,
with a wide range of difficulty. Some answers contain
extensive explanations in the back of the book, detailing
important calculation steps. Unfortunately, these extended
explanations are not provided for every question, and the
reader is left to wonder why certain answers are incorrect.
Owners of the first edition should also be aware that a fair
number of questions have been repeated in the second
edition.
If studying practice questions in preparation for a board
examination is one of the primary reasons for purchasing
this text, then the CD-ROM that is provided with the book
is a definite highlight and unique feature of this TEE book.
It contains both written and practical multiple-choice
tests that both can be taken as a timed, simulated board
examination. I was particularly impressed with the practical portion that includes actual video clips that play as an
integrated part of the question screen. Both sections can
also be taken at a more leisurely pace with full explanations
for incorrect answers.
All in all, the second edition of the Clinical Manual and
Review of Transesophageal Echocardiography is a very solid
entry into what I would consider the board preparation
category of echocardiography textbooks. The chapters are
concise and well illustrated, and most have an extensive
number of questions that allow readers to identify topics
that they may need to review in greater depth. With expert
contributing authors and sound editing, the second edition
of this book would be a valuable addition to the library of
anesthesiologists interested in a text covering the breadth of
topics related to perioperative echocardiography.
Roman M. Sniecinski, MD
Department of Anesthesiology
Emory University School of Medicine
Atlanta, Georgia
roman.sniecinski@emory.edu

Core Topics in Thoracic Anesthesia

Searl CP, Ahmed ST (eds). Cambridge, UK: Cambridge
University Press, 2009. ISBN-10: 0521867126, ISBN13: 978-0521867122. 230 pages, $81.00.
his book in the Core Topics series is aimed primarily at
trainees gaining experience in thoracic anesthesia. More
than 20 authors, predominately from the Thoracic Anesthesia Department of the Freeman Hospital in Newcastle, UK,
contributed articles to this book. The book is divided into 3
sections: preoperative considerations, anesthesia for operative procedures, and postoperative management. Although
the text material is not referenced in the typically detailed
manner used in published articles and major textbooks,

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each chapter concludes with a short list of references that

are generally up to date and cover the important publications from respected authors in the field. These references
are an excellent starting point for further reading. Some
chapters have key or learning points in boxes, which
would have been good to see used consistently throughout
the entire book.
The first section of the book provides the basics for
thoracic anesthesia practice, and logically begins with a
review of basic pulmonary anatomy and physiology, as
well as an excellent discussion of common respiratory
diseases. The perioperative assessment chapter is comprehensive and covers all tests relevant to patients scheduled
to undergo thoracic surgery. Developing a practical and
sensible approach to the preoperative assessment of thoracic patients is one of the most important aspects of clinical
practice, and often presents a challenge to the trainee.
Therefore, an algorithm-based approach would aid the
trainee in tying together the important aspects of this
process. Lung isolation is covered in detail, from history to
appropriate sizing of double-lumen endotracheal tubes and
use of clinical versus fiberoptic techniques to ensure correct
positioning of the double-lumen tube. An approach to lung
separation in the difficult airway is very important and
concludes this excellent chapter. One-lung ventilation is
covered in adequate detail, but would benefit from additional discussion of the controversies surrounding this
topic, and the different ventilatory strategies that are frequently used in clinical practice.
In section 2, anesthetic techniques for specific thoracic
procedures are discussed. Whereas most of the important
subjects are covered in adequate detail, the chapters covering lung transplantation, pulmonary endarterectomy, and
frequently performed pediatric thoracic procedures are
necessarily covered at a rather superficial level in this
introductory book. The chapter on video-assisted thoracoscopic surgery is comprehensive and relevant because this
approach to thoracic surgical procedures is increasing in
popularity for both pediatric and adult patients, and will
constitute the bulk of many anesthesiologists thoracic anesthesia practice. The chapter on the management of patients
with mediastinal masses requires more in-depth discussion
because these patients are generally considered to be high
risk, and at least a basic approach to induction of anesthesia,
potential pitfalls, and the importance of a multidisciplinary
team approach to managing these cases (i.e., cardiac surgeons,
perfusionists) would have been helpful.
In section 3, the postoperative management is discussed,
with important chapters on fluid and pain management.
Fluid management is a critical and contentious aspect of the
clinical management of the patients operative course. This
chapter, written by one of the editors, deals with the
historical background for fluid management in thoracic
surgery through modern concepts that guide fluid therapy.
Pain management is divided into discussions dealing with
both acute and chronic pain. It is heartening to see a
separate chapter on chronic pain with the increasing recognition of this entity as a consequence of surgery and
poorly controlled acute pain, and the important role of the
anesthesiologist as a perioperative physician in the management of this common postoperative complaint. All the

ANESTHESIA & ANALGESIA