ian/North American, which, for this topic, makes it less easy for others to relate to, and much of the advice for medical care is generic, not especially related to the pregnant woman. Chapter 6 tackles ultrasound, how it works and how to do it. It is a good account, while not being limited to the possibly controversial place of ultrasound in obstetric anaesthesia. The chapter is based on practice in the UK, and I wonder how it applies to colleagues in North America. Chapter 3 covers pre-eclampsia, but I found the initial terminology confusing. This is an important topic which trainees nd difcult, so we must get it right for them. Unfortunately, this chapter fails in this respect. Chapter 2 is an excellent review of cardiac disease in preg- nancy and Chapter 4 gives a comprehensive account of obstetric haemorrhage and its management at a level of suf- cient detail to be interesting to those more experienced but also of use to trainees. The latter is relatively UK-based in its advice, and some elements (e.g. prophylactic arterial balloons) could be argued still to be controversial, requiring more discussion. Chapter 8 is well written, covering the pros and cons of regional analgesia in the light of coagulopathies. Chapter 9 looks at air vs saline for the identication of the epidural space and is a beautifully constructed text, with a rm recommendation at the end to teach residents to use saline. Another chapter looks at ambulatory epidural anal- gesia and even for those of us well versed in its use, it is worth reading. The following chapter comprehensively tackles the ephedrine vs phenylephrine question. The chapter on oxytocin usage is also very good, quoting inter- national usage and data. Of those less controversial topics, Chapter 19 looks at the need for/use of oxygen supplemen- tation at regional block for Caesarean section; while not a controversy, the discussion is well argued. Another chapter covers analgesia post-section, hardly controversial as such but it does not mention intrathecal/epidural diamorphine as an option (although Chapter 14 does). This is a pity as it causes substantially less nausea and vomiting than mor- phine and is in widespread use outside of North America. Indeed, a controversial point is whether morphine should be used at all in this situation. In summary, this book is easy to read and on the whole contains good information, but is a bit of a mixed bag, being somewhat limited by the differences in clinical practice on the two sides of the Atlantic. This aspect is not good for those new to the eld and it is for this group for whom the book is primarily intended. For the in- formation this book does contain, and at this price, it would be a useful addition to a departmental bookshelf, but may need guidance from senior staff in its interpretation. S. Coley Leicester, UK E-mail: coley.sue@gmail.com doi:10.1093/bja/aes190 Anesthesia Outside of the Operating Room. R. D. Urman, W. L. Gross and B. K. Philip (editors). Pub- lished by Oxford University Press, Oxford, UK. Pp. 360; indexed; illustrated. Price 70.00. ISBN 978-0-19- 539667-6. A senior theatre nurse who enjoyed hunting and shing once said that if you want to know what the local weather is going to be like, you should check the weather 2 weeks previously in the USA. Much the same can be said of medical matters. There is an increasing demand to provide anaesthesia for patients undergoing procedures outside the operating theatre. Technological advances and an ageing population have increased the demand for complex diagnostic procedures and minimally invasive sur- gical interventions. This book deals with the topic from a North American perspective but does give insight into the challenges that are being presented to anaesthetists on this side of the Atlantic. The 360 pages of this A4 size hardback textbook are divided into 33 chapters and three appendices. The rst eight chapters deal with general topics such as the chal- lenges of anaesthesia outside the operating theatre, pre- operative evaluation, monitoring, anaesthetic techniques, and recovery. Management of stafng and scheduling, sedation by non-anaesthetists and issues relating to outcome, regulation, and quality improvement are discussed. The remaining chapters deal, in a detailed and informative way, with anaesthetic requirements in specic, familiar envir- onments such as interventional radiology, magnetic reson- ance imaging, gastrointestinal endoscopy, urology, and electroconvulsive therapy. Somewhat less familiar areas that are discussed include Anesthesia for Interventional Pul- monology, In Vitro Fertilization, and Natural Orice Trans- luminal Endoscopic Surgery. It is interesting that anaesthesia in the cardiac catheterization laboratory is dealt with in a chapter entitled New Challenges for Anaes- thesiologists Outside the Operating Room. The increasing demands for an anaesthetic presence during percutaneous coronary interventions are dealt with in detail. The debate exists in many hospitals in the UK as to whether cardiac anaesthetists or non-cardiac anaesthetists should be involved during invasive interventions by cardiologists. This book gives sound advice regarding the maximization of patient safety as a result of collaboration and planning between cardiologists and anaesthetists. A common knowl- edge base and mutual respect for each contributing discip- line is essential. Some chapters do have a denite North American avour, for example Ofce Based Anesthesia, Ultra-Rapid Opiate Detoxication, and Anesthetic Considerations in Homeland Disasters. While less relevant to UK practice, they do make interesting reading. The chapter on Anesthesia Considera- tions in Dental Practice describes administration of local anaesthesia that usually would be the province of the dentist. BJA Book reviews 132
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From a trainees point of view, this book will provide the answer to any examination questions that relate to non- operating theatre anaesthesia. However, all references are from North America and different guidelines will apply in Europe. This is a developing eld and there will be an increasing exposure of trainees to anaesthesia outside theatres. It will provide insight into what is to be expected during a fellowship year in North America. There is a concise chapter on anaesthe- sia in the emergency department that will be useful to trainees. We feel that this book would have been improved if illustra- tions were not in black and white. Images from the radiation oncology suite, for example, would be more informative if they were in colour. The multiple-contributor format has resulted in repetition of topics such as pharmacology of seda- tive agents and pre-assessment. Anaesthetists, who are trying to cope with the increasing demands of anaesthesia outside the operating theatre, will nd this a useful resource that will assist in proving the need for adequate resources. It could be waved at hospital managers and clinical colleagues whose practice will benet from anaesthetic support. P. A. Farling and R. Haughey Belfast, UK E-mail: peter.farling@dnet.co.uk doi:10.1093/bja/aes191 Book reviews BJA 133
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