Anaesthesia for Medical Students (2024)

July 3, 2019

Don't get me wrong, this book has a lot of things going for it. I really, really enjoyed the descriptive and yet deceivingly simple anatomy drawings displayed all over the book. I also enjoyed some parts of the text regarding intubation techniques.

Now, this book is supposedly aimed at medical students doing a brief 8 week anesthesiology rotation and I am fully conscious that is very little time to truly cover a lot of ground regarding this niche medical specialty. I think the book got half things right. On one hand, it talks a little bit about everything a newbie might need to know such as the kinds of questions aiming to search for a difficult intubation airway or contradictions for regional anesthesia. It also displays nice diagrams on the airway difficulty scores that are very easy to understand.

Other chapters are a bit more of a miss in regard to the varying subspecialty chapters. I personally found the book to be too simplistic for a senior anesthesiology resident and at the same time, too advanced for a medical student. The anesthesiology machine chapter is too complicated for a med student. Instead of taking things slowly to avoid scaring the reader, it automatically assumes the students knows the difference between an E and an F gas canister and automatically understands why the dpi of an E oxygen canister must be at least 2200.

It mentions the security checks of the anesthesia machine, but it doesn't do it with a user friendly table and it doesn't explain why each step is important either. No mention made of the little inherent quirks of different popular machine models and why companies developed specific little upgrades to the machines. What is a rotamer made out of and why are those chambers perfectly hermetically sealed? What is the difference between a digital and analog flowmeter?

Insufficient information is given regarding the huge difference between regular vaporizers and the digital vaporizer exclusively used for Desflurane. Furthermore, it skips things a med student would probably be curious as hell to know such as what would happen if someone dumped Isoflurane into a Sevoflurane vaporizer by accident. Would the machine blow up? No explanation regarding what an APL valve is either.

While I enjoyed how the book talks about drug chemistry, the dosages are way off. Believe me, if you chugged 1 mg of fentanyl into a patient in one blow, you are going to kill that person. And no, I am not worried about the respiratory depression because the book states this insane dosage is for a planned 4 hour general surgery procedure, so you could simply connect the patient to the anesthesia machine and sigh in relief. No, I mean you will kill your patient by chugging over 4-5 times the regular anesthesia induction dose by causing wooden chest syndrome. If a patient ever suffers from that, no amount of naloxone and aggressive ventilation with 15 PEEP is going to relax it. Maybe 50 mg of Rocuronium in one blow might help a little, but you will still be left with a nice little malpractice lawsuit.

Furthermore, the book is proud to present Remifentanyl as a great general anesthesia inductor. No... just... no. Remifentanyl is out of the patient's system within 5 minutes and you inject the opioid before you use the hypnotic and muscle relaxant. By the time the muscles are fully relaxed, it has already been 4-5 minutes and your patient's blood pressure is going to jut through the roof during laryngoscopy, and that is if the procedure could be achieved on the first attempt perfectly flawlessly, which many times is not the case. Don't get me wrong, Remifentanyl is the opioid of choice for TIVA, but you need to use something a tad bit longer acting for the induction of an intubation. Choose any of the other phenylpiperidine derivatives; they are all perfectly good for this task.

Oh, and any book that believes a drug that is no longer in use in the majority of the developed world such as Halothane is a great choice for sedation anesthesia over Sevoflurane probably should not be taken too seriously. I will only let this one slide because I presume the book is over 25 years old.

With my previous grievances already addressed, use the book for its intubation techniques and illustrations, reserve the book for first year anesthesia residents and staunchly warn them to take any of the drug dosages displayed with a grain of salt. Some of the dosages are right such as Ketamine and Propofol, the opioids ones are infested with errors.

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Anaesthesia for Medical Students (2024)

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