Edited by: Joseph E Arrowsmith & John Simpson

Hardcover - 300 pages. 55 B&W illustrations
Published April, 2002. Martin Dunitz
ISBN: 1-84184-138-2

Price:  £52.50  US$80  CDN$115 e60  ¥10.825

Preface
A case-based format distinguishes the test in this series, examining and providing guidance for a number of problematic clinical scenarios. This book will be of interest equally to a qualified specialist and to a general trainee in anaesthesiology.

Foreword

Cardiothoracic surgery anesthesia has become more complex as a more diverse set of conditions are now treated surgically, and as technology has changed so that very different approaches to even common problems can be used.  This book brings to the reader a better understanding of the breath and depth of modern-day cardiothoracic anesthesiology.

This essayist believes that the best way to learn is from experience.  The experience need not be first-hand, but can be learned from others.  The format of this book is to present a case and then an approach to the case.  Some of the cases and topics are the result of things that did not go well.  One always learns more from complications and problem cases because there is generally a lesson on what not to do.  When things go completely well there is no lesson and one is left wondering what, out of the many things done, was the difference between success and failure.  Many of the topics covered in the book are here because the authors have learned from their experiences what to do and, more importantly, what not to do!

The format of the chapters makes for an organized and helpful presentation.  The case-based teaching relates the material to the clinic and the discussion explains the options in approach.  The conclusion of each chapter highlights the essential tips in dealing with the various cases.  The cases themselves range from the common (for example, off-pump coronary artery bypass) to the rather rare (for example, anesthetic management of the patient with carcinoid heart disease).  There are many topics, all important to the current-day practitioner.

A final point about this book is that, unlike many textbooks, it has a generous representation of anesthesiologists (anesthetists) from both sides of the Atlantic.  This is a vitally important aspect of the book because it shows that, despite our global knowledge and the information age in which we live, we still have variable practices.  It is reassuring to know that medicine has still not advanced to the point where there is only one way to do things, particularly in difficult cases as most of these are.  This leaves room for more investigation and continued advancement of the field.

JG Reves MD FRCA
Professor of Anesthesiology, Dean of Medical School & Vice President for Medical Affairs
Medical University of South Carolina, Charleston, SC, USA

"Up from the ashes, grow the roses of success"
(R & R Sherman in Chitty Chitty Bang Bang, MGM, 1968)

Cynics have described anesthesiology as '99% boredom and 1% sheer terror'.  It is perhaps fortunate that few patients shre this perception.  Expereince has taught the anesthesiologist to expect, and prepare for, the worst-case scenario.  With luck he will learn, not from his own misfortune, but from the successes and failures of other.  'It's hard to learn ...', Reves and Hall remind us in Common Problems in Cardiac Anesthesia, '... when all goes well'.

In this volume an international panel of authors have used illustrative case histories to describe a variety of problems encountered in the practice of modern cardiothoracic anesthesia.  The brief was simple - present a case history, describe how you dealt with the problem, reveal the outcome and justify your course of action.  Other than seeking expansion and clarification in some areas, and influencing the manner in which information has been presented, editorial 'interference' has been kept to a minimum.  Although the reader, an indeed the editors, may not agree with every course of action taken, we have encouraged our contributors to support their decisions with reasoned scientific and evidence-based argument.  It is the reader who must decide whether this has been achieved!

The editors come from two generations of anesthesiologists; one has used pen, paper and a wheezing fax machine; the other the full range of tools available to the 'paperless' generation.  It is fortunate that most of our contributors fall into the second category and we are indebted to them for their hard work.  We thank our families for their great forbearance during th epreparation of this volume.  Lastly we thank Annick Ireland of Martin Dunitz Ltd, and Maire Collins and Rowena Milan of Harwood Academic Publishers for their patience and encouragement.

Having digested the cases presented, we suspect that you the reader will have in mind an interesting case or clinical scenario of your own.  If you would like to share your experience with others, we would encourage you to send brief details either to the publisher or by email to JArrowsmith@doctors.org.uk.

Joe Arrowsmith MD MRCP FRCA
Consultant Anaesthetists, Papworth Hospital, Cambridge, UK
John Simpson MB FRCA
Honorary Consultant Anaesthetist, Royal Brompton Hospital, London, UK

Contents

Anesthesia for Cardiac Surgery during Pregnancy.  EL Hill & CR Grebenik (UK)

Tumor Extraction from the Inferior Vena Cava and Right Atrium during Cardiopulmonary Bypass.  AD Sharma, G Sreeram & TF Slaughter (USA)

Cardiopulmonary Bypass in a Patient with a Brain Tumor.  HP Grocott & A Grigore (USA)

Cardiothoracic Trauma: a Case of Traumatic Aortocoronary Saphenous Vein Graft Occlusion.
E Jacobsohn & TWR Lee (Canada)

Severe Aortic Atheromatous Disease in Cardiac Surgery.  GW Roach (USA)

Anesthesia for Transmyocardial Laser Revascularization.  HP Grocott (USA)

Port-access Cardiac Surgery.  CG Koch & MJ Capdeville (USA)

Off-pump Coronary Artery Bypass.  NM Gibbs (Australia)

Mediastinitis.  GR McAnulty (UK)

Perioperative Transesophageal Echocardiography.  BJCJ Riedel, AT Lovell & S George (UK)

Transesophageal Echocardiography: its Role in Assessing the Hypotensive Patient Undergoing Cardiac Surgery.  AT Lovell, BJCJ Riedel & S George (UK)

Adult Congenital Heart Disease.  MJ Barnard (UK)

The Fontan Circulation.  MJ Barnard (UK)

Heparin Resistance in a Patient Requiring Cardiopulmonary Bypass.
RJ Mills & HM McKeague (UK)

Heparin-associated Thrombocytopenia and Thrombosis.
G Sreeram, AD Sharma & TF Slaughter (USA)

Management of Bleeding following Cardiac Surgery: the Thrombelastographic Approach.
AM Cohen & S Tomkins (UK)

Renal Failure following Cardiopulmonary Bypass.  WT McBride (UK)

The Inotropic Action of Glucose-insulin-potassium Infusions.
CJ Broomhead, SJ Wright & MP Colvin (UK)

Severe Bronchospasm following Cardiopulomary Bypass.  JE Arrowsmith (UK)

Neurological Complications of Cardiopulmonary Bypass.  MJ O'Leary & DJ Bihari (Australia)

Anterior Spinal Artery Syndrome following Coronary Artery Bypass Graft Surgery.
VS Sidhu (UK)

Anesthesia for Left Ventricular Volume Reduction Surgery.  SJ Pryn (UK)

Neuraxial Analgesia for Thoracic Surgery: High Risk Thoracic Surgical Patients with Bleeding Disorders.  M Stafford-Smith (USA)

Lung Volume Reduction Surgery.  SJ Gold & DJR Duthie (UK)

Bronchopleural Fistula in the Presence of Empyema.  JLC Swanevelder & C Horst (UK)

Living Related Lobar Lung Transplantation.  K Grichnik (USA)

Broad Complex Tachycardias after Coronary Artery Bypass Surgery.
RA Sayeed, AJ Ritchie & AA Grace (UK)

Ventricular Assist Devices.  B Mets (USA)

Cardiac Surgery for Jehovah's Witness Patients.  MJ Platt, CJ Broomhead & AC Shukla (UK)

Anesthesia for Pulmonary Thromboendartectomy.  AI Gardner, JJ Dunning & A Vuylsteke (UK)

Chronic Pain following Cardiac and Thoracic Surgery.  AI Gardner & I Hardy (UK)

Anesthesia for Esophageal Surgery.  M de Kock (Belgium)

Respiratory Syncytial Virus in the Perioperative Period.  R O'Donnell & PJ Murphy (UK)

Complication of a Percutaneous Tracheostomy in a Patient with Adult Respiratory Distress Syndrome.  SA Millar, VU Narvapurkar & RD Latimer (UK)

Acute Respiratory Distress Syndrome following Cardiac Surgery with Cardiopulmonary Bypass.  DP Stansfield & M Messent (UK)

High Frequency Oscillatory Ventilation.  HP Duncan & AR Wolf (UK)

Resuscitation of the Multi-organ Donor.  CJ Rozario, MK Prasad & JD Kneeshaw (UK)

Two Stage Repair of a Stab Wound to the Heart.  FM Gibson (UK)

Anaesthetic Management of the Patient with Carcinoid Heart Disease.
MK Prasad, CJ Rozario & JE Arrowsmith (UK)

This title examines and provides guidance for a number of problematic clinical scenarios in cardiothoracic surgery anaesthesia.  The growing complexity of the field, arising from the increasingly diverse set of conditions that are now treated surgically, and developments in technology leading to different approaches to even common problems, means that this book will be of interest equally to the qualified specialist and the general trainee in anesthesiology.

The book's format is to present a case and then an approach to the case, utilizing the various experiences of anesthesiologists from both sides of the Atlantic.  The case-based teaching relates the material to the clinic, and the discussion then explains the options in approach.  Each chapter concludes with a series of essential tips in dealing with the various problems.  Cases covered range from the common (e.g. off-pump coronary bypass) tot he rare (e.g. anesthetic management of the patient with carcinoid heart disease).

The aim of the book is to allow readers to learn from both the successes and the complications within the cases covered, and in this way disseminate knowledge amongst those working in the field as well as pave the way for further investigation and continued advancement.