Topics in neuroanaesthesia and intensive care

Topics in Neuroanaesthesia and Intensive Care aims to review important experimental and clinical data with emphasis on up-to-date references in the fields of neuroanaesthesia and neurointensive care. The book contains 12 chapters: three chapters on neurophysiology and clinical measurement, five chapters on neuropharmacology, one chapter on the sitting position in anaesthesia, and three chapters relating to neurointensive care. In each chapter, the authors have aimed to provide the evidence base from both animal studies and human studies. The major attraction of the book is the summary of a large number of studies on various aspects of neurointensive care and anaesthesia, accompanied by a detailed bibliography at the end of each chapter. It thus provides a quick access to the medical literature on a specialized area of intensive care and anaesthesia, some of which may not be available on Medline or Pubmed. There are some good chapters, particularly those on measurement of cerebral blood flow and acute head injury. However, some drawbacks do exist. The main limitation of the book is the style of presentation. The layout of the headings and the subheadings makes it difficult for the reader to follow the sequence of presentation, and every now and then one has to go back a few pages to pick up on the theme. For example, the simple style of presentation found in chapter 1 is lost in chapter 2, where regulation of cerebral blood flow (arterial oxygen tension) and metabolic regulation of cerebral blood flow are discussed as separate subheadings. In the latter subsection, the coupling between oxygen consumption and cerebral blood flow is again reviewed. Important sections of neurointensive care such as status epilepticus, neuromuscular disorders and cerebrovascular diseases are not covered. The authors in the section on cerebral ischaemia mention that, as stroke patients do not come to the neurointensive care unit, these areas will not be discussed. However, with the advent of thrombolysis for ischaemic cerebrovascular accidents and more aggressive surgical drainage of intracerebral haematomata, these patients are increasingly being referred to the neurointensive care unit. Another notable limitation is the relative inequity in the apportioning of the discussion to experimental data versus current clinical practice. For example, the discussion on triple-H therapy for vasospasm occupies one page, while a discussion of experimental therapies spans more than three pages. A few factual errors and omissions have crept in. Page 236: acute lung injury is defined as the …