Book Review: Challenging Topics in Neuroanesthesia and Neurocritical Care

Book Review: Challenging Topics in Neuroanesthesia and Neurocritical Care In Challenging Topics in Neuroanesthesia and Neurocritical Care, Dr Zahid Khan has assembled a series of chapters tackling highly specific issues faced by those caring for critically ill neurologically injured patients. This collection is clearly thoughtfully crafted, reflecting the wisdom of an experienced, attentive, and reflective practitioner of neurocritical care. Dr Khan aims this book at those intensivists encountering challenging neurological cases. I feel the level of sophistication, detail, and nuance contained in these chapters is especially beneficial for advanced residents, affiliate providers, fellows, and attendings in a neuroICU/neuroanesthesia setting. This book is published by Springer. I reviewed the hardcover edition, which is a superb production with excellent use of clear, well-organized tables, graphs, and diagrams. There are numerous multicolored images/pictures and high-quality neuroimages. The 27 chapters are divided into 3 sections: Traumatic and Spinal Cord Injury, Airway and Pain Management, and Neuroanesthesia and Neurocritical Care. Topics range from the broad subject of Airway Management in Neurocritical Care to the more focused Venous Air Embolism in Neurosurgical Patients. Despite how frequent or rare a subject—I was pleased at the thoughtful treatment and level of detail highlighting the complexity of these issues without getting bogged down in layers of minutiae. I was also pleased at the even-handed treatment of the subject matter—this is not a series of narrow perspectives on controversial issues, for which I am grateful. Section 1 covers traumatic intracranial and spinal injuries including traumatic brain injury and spinal cord injury, but also includes chapters on brain death, aneurysmal subarachnoid hemorrhage, and sympathetic hyperactivity. The opening 2 chapters on Intracranial Compliance and Advanced Monitoring briefly present the physiology fundamental to brain injury. The writing is succinct, clear, and measured. I was struck by the how intracranial compliance is clearly and quickly explained then followed by a brief exposition on how compliance has been tested in various studies—all in 2.5 pages. Later in this chapter, challenges in determining compliance at the bedside are presented and thoughtful suggestions for management are presented. Certainly, this is not an exhaustive chapter on the topic—but it is well-referenced for further study, and offers a nuanced perspective that is thought-provoking in a clinically useful manner. If there is 1 weakness to this section, the chapter on aneurysmal subarachnoid hemorrhage is too brief and general and thus lacks a focus on any one of the numerous and evolving clinical challenges facing those caring for aneurysmal subarachnoid hemorrhage patients. View largeDownload slide View largeDownload slide Section 2 presents 4 chapters on airway and pain management issues facing neuroICU providers. It has been my experience that ventilator and airway management practices are typically driven by experiences based in nonneuroICUs. These chapters clearly layout some of the specific issues faced in neurosurgery and neurology intensive care unit (ICU) patients. For example, in various hormone-secreting pituitary tumors, difficult intubations are frequent due to hypertrophy of facial structures. Though not mentioned, understanding the nature of an endoscopic/endonasal approach in pituitary surgery, for example, helps one understand why noninvasive positive pressure ventilation must be avoided in the postoperative setting. The final chapter in this section covers pain management in the postoperative craniotomy patient. This is a timely topic given the reevaluation of the widespread use of opiates for pain management. Multiple pharmacologic strategies are presented including patient-controlled analgesia and use of opiate and nonopiate strategies. Though only 7 pages, the chapter is well-referenced and states clearly the importance of this topic as well as areas for further study. Given this importance, however, this chapter would benefit from significant expansion. Additionally, substantial space is given to the efficacy of tramadol in the postoperative craniotomy patient. That tramadol is associated with increased risk of seizures is not discussed and is an important cautionary note missing in this chapter. The final section comprises 16 chapters ranging from anesthesia considerations in specific neurosurgical cases (acromegaly, posterior fossa surgery) as well as more neuroICU-related topics (sedation, blood glucose management, sepsis/shock). As noted above, the chapters in general are well-written and succinct. The neuroanesthesia-focused chapters are an excellent review for neurointensivists from neurology or medical backgrounds. For example, the chapter on airway and fluid management in the prone positioned patient helps to bridge the odds ratio (OR) to ICU divide, offering insight into possible or expected postoperative complications unique in this situation. This is one of the most outstanding aspects of this book: the clear acknowledgment of the unique continuum between the neurosurgical patient in the operating room and the NeuroICU. In sum, Challenging Topics in Neuroanesthesia and Neurocritical Care is series of well-written chapters that span the continuum from OR to the neuroICU. I have recommended this book to our neurocritical care fellows as each chapter easily serves as a starting point for a journal club, practice review, or discussion during ICU rounds. Additionally, this format would easily serve as a recurring series published in book form (volume 2, for example) or as a recurring journal article series. Disclosure The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Copyright © 2018 by the Congress of Neurological Surgeons This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Book Review: Challenging Topics in Neuroanesthesia and Neurocritical Care

Neurosurgery , Volume Advance Article (6) – May 10, 2018

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Publisher
Oxford University Press
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1093/neuros/nyy083
Publisher site
See Article on Publisher Site

Abstract

In Challenging Topics in Neuroanesthesia and Neurocritical Care, Dr Zahid Khan has assembled a series of chapters tackling highly specific issues faced by those caring for critically ill neurologically injured patients. This collection is clearly thoughtfully crafted, reflecting the wisdom of an experienced, attentive, and reflective practitioner of neurocritical care. Dr Khan aims this book at those intensivists encountering challenging neurological cases. I feel the level of sophistication, detail, and nuance contained in these chapters is especially beneficial for advanced residents, affiliate providers, fellows, and attendings in a neuroICU/neuroanesthesia setting. This book is published by Springer. I reviewed the hardcover edition, which is a superb production with excellent use of clear, well-organized tables, graphs, and diagrams. There are numerous multicolored images/pictures and high-quality neuroimages. The 27 chapters are divided into 3 sections: Traumatic and Spinal Cord Injury, Airway and Pain Management, and Neuroanesthesia and Neurocritical Care. Topics range from the broad subject of Airway Management in Neurocritical Care to the more focused Venous Air Embolism in Neurosurgical Patients. Despite how frequent or rare a subject—I was pleased at the thoughtful treatment and level of detail highlighting the complexity of these issues without getting bogged down in layers of minutiae. I was also pleased at the even-handed treatment of the subject matter—this is not a series of narrow perspectives on controversial issues, for which I am grateful. Section 1 covers traumatic intracranial and spinal injuries including traumatic brain injury and spinal cord injury, but also includes chapters on brain death, aneurysmal subarachnoid hemorrhage, and sympathetic hyperactivity. The opening 2 chapters on Intracranial Compliance and Advanced Monitoring briefly present the physiology fundamental to brain injury. The writing is succinct, clear, and measured. I was struck by the how intracranial compliance is clearly and quickly explained then followed by a brief exposition on how compliance has been tested in various studies—all in 2.5 pages. Later in this chapter, challenges in determining compliance at the bedside are presented and thoughtful suggestions for management are presented. Certainly, this is not an exhaustive chapter on the topic—but it is well-referenced for further study, and offers a nuanced perspective that is thought-provoking in a clinically useful manner. If there is 1 weakness to this section, the chapter on aneurysmal subarachnoid hemorrhage is too brief and general and thus lacks a focus on any one of the numerous and evolving clinical challenges facing those caring for aneurysmal subarachnoid hemorrhage patients. View largeDownload slide View largeDownload slide Section 2 presents 4 chapters on airway and pain management issues facing neuroICU providers. It has been my experience that ventilator and airway management practices are typically driven by experiences based in nonneuroICUs. These chapters clearly layout some of the specific issues faced in neurosurgery and neurology intensive care unit (ICU) patients. For example, in various hormone-secreting pituitary tumors, difficult intubations are frequent due to hypertrophy of facial structures. Though not mentioned, understanding the nature of an endoscopic/endonasal approach in pituitary surgery, for example, helps one understand why noninvasive positive pressure ventilation must be avoided in the postoperative setting. The final chapter in this section covers pain management in the postoperative craniotomy patient. This is a timely topic given the reevaluation of the widespread use of opiates for pain management. Multiple pharmacologic strategies are presented including patient-controlled analgesia and use of opiate and nonopiate strategies. Though only 7 pages, the chapter is well-referenced and states clearly the importance of this topic as well as areas for further study. Given this importance, however, this chapter would benefit from significant expansion. Additionally, substantial space is given to the efficacy of tramadol in the postoperative craniotomy patient. That tramadol is associated with increased risk of seizures is not discussed and is an important cautionary note missing in this chapter. The final section comprises 16 chapters ranging from anesthesia considerations in specific neurosurgical cases (acromegaly, posterior fossa surgery) as well as more neuroICU-related topics (sedation, blood glucose management, sepsis/shock). As noted above, the chapters in general are well-written and succinct. The neuroanesthesia-focused chapters are an excellent review for neurointensivists from neurology or medical backgrounds. For example, the chapter on airway and fluid management in the prone positioned patient helps to bridge the odds ratio (OR) to ICU divide, offering insight into possible or expected postoperative complications unique in this situation. This is one of the most outstanding aspects of this book: the clear acknowledgment of the unique continuum between the neurosurgical patient in the operating room and the NeuroICU. In sum, Challenging Topics in Neuroanesthesia and Neurocritical Care is series of well-written chapters that span the continuum from OR to the neuroICU. I have recommended this book to our neurocritical care fellows as each chapter easily serves as a starting point for a journal club, practice review, or discussion during ICU rounds. Additionally, this format would easily serve as a recurring series published in book form (volume 2, for example) or as a recurring journal article series. Disclosure The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Copyright © 2018 by the Congress of Neurological Surgeons This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

NeurosurgeryOxford University Press

Published: May 10, 2018

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