Editors: Rachel Freedman, Lara Herbert, Aidan O’Donnell, Nicola Ross

Publisher: Oxford University Press

ISBN (paperback) 978-0-19-885305-3

ISBN (epub) 978-0-19-259466-2

The Fifth edition of “Oxford Handbook of Anaesthesia”, published in 2022, is a practical, well written, useful, schematic and easy-to-understand handbook of anaesthesia. It is written by four principal editors coming from the United Kingdom and New Zealand. It focuses on perioperative optimisation, anaesthetic management of different types of surgery and patient safety. Nowadays, new challenges that impact patient safety continue to arise, such as the prevalence of medical error and burnout among anaesthetists. This handbook covers perioperative assessment and optimisation, intensive care medicine, pain medicine, obstetric anaesthesia and sedation which are fields that require specific and updated skills. With the growth and improvement of surgery, specialized skills are also necessary to provide high-quality anaesthesia and analgesia for patients undergoing different types of operations. Perioperative medicine is a multidisciplinary and integrated medical care of patients, that includes understanding and optimization of both lifestyle and medical comorbidities during recovery from surgery with the aim to increase patient satisfaction and to improve outcomes.

This book is divided into 42 chapters, with a total of 1217 pages. Every chapter, full of references to the last guidelines, gives the reader a comprehensive overview of the topics and has a schematic view, with bulleted lists of important concepts. Colorful tables, figures and flowcharts attract the attention of the reader, helping him/her to memorize and summarise the most important concepts.

This book can be divided into three sections. The first section consists of 17 chapters which speak about the preoperative optimisation of the patient and the at-risk population, focusing on the attention to cardiovascular, respiratory, renal, hepatic, endocrine, neurological and psychiatric diseases, bone, joint and tissue disorders. The fundamental principles of physiology are analysed together with the risk stratification, the preoperative tests and the goals of the patients’ optimisation. The last five chapters of this section deal with anaesthetic gases and machines, ventilation, airways assessment and management, conduction of sedation and general anaesthesia, in particular focusing on fluid therapy, neuromuscular function, depth of anaesthesia monitoring and temperature control. Nowadays, airways management, as well as neuromuscular monitoring, are specific fields which are becoming more and more current, attracting a lot of interest.

Chapter 18 called “Specific Circumstances” analyses the impact of oncological surgery and other specific surgeries such as robotic, laser and day surgery on anaesthesia management. The principles of conduction of anaesthesia for robotic surgery are specific skills that an anaesthesiologist must have. We can consider this chapter a sort of link between the first and the second section.

The second part of this book (from chapters 19 to 36) is concentrated on the different approaches to various types of surgery. The most important and common operations are described for each surgical branch, giving information about preoperative, intraoperative and postoperative management, blood loss, pain, position, time and procedures. Specific approaches or considerations are analyzed, for example intraoperative transoesophageal echocardiography for cardiac anaesthesia.

The third and final part of this book (from chapters 37 to 42) covers many different topics. Chapters 37, 38 and 39 deal with the major trauma and the emergency patient, anaesthetic emergencies, regional anaesthesia and acute pain. Emergency situations are described, from different types of trauma to anaphylaxis, laryngospasm, pulmonary oedema and septic shock.

Analgesic drugs, regional and multimodal analgesia are discussed in the last two chapters. Chapter 42, “Acute Pain”, is particularly interesting as it explains how to provide subjective comfort after surgery. Inadequate postoperative pain control and stress response to surgery can lead to increased postoperative morbidity and mortality. A personalized and multimodal postoperative pain prevention and treatment are paramount. According to ERAS principles, a combination of opioid-sparing general anaesthesia with neuraxial or regional local anaesthesia are strongly recommended, particularly in the elderly. Generic benefits of regional anaesthesia usually include lower pain, fewer opioids and earlier mobilization.

Compared to the fourth edition, some sections have been completely revised or expanded, including preoperative considerations, major trauma and regional anaesthesia. Different nerve blocks are described, from the central neuraxial to the upper and lower limbs and how peripheral nerve stimulation can improve success in a wide range of blocks. The use of ultrasound machines is established practice in many countries with improvements in block quality and reduced complication rates. Compared to the fourth edition, new sections have been added, including sensible advice when things are going wrong, ECG rhythm strips, concepts on obesity surgery, anticoagulants and intraoperative fluid management.

In conclusion, “Oxford Handbook of Anaesthesia” is a quick and manageable handbook with a didactic approach to basic principles and to the latest updates in perioperative medicine, patient safety and anaesthetic management for elective surgical procedures and emergency situations. This book is a useful resource not only for resident anesthesiologists but also for trainees. Each chapter is schematic, full of concepts and references, and enables the readers to learn new concepts that can then be applied with greater ease to their practice.

Chiara Cambise, MD

Department of Anaesthesiology and Intensive Care Medicine

Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy