Field of medicine: Critical care medicine.

Format: Hardcover book.

Audience: Anesthesiologists and trainees and practitioners of critical care medicine.

Purpose: To provide an overview of perioperative critical care from the perspective of the anesthesiologist and the intensivist.

Content: The book is divided into 10 sections. Chapters on perioperative assessment and acute interventions are followed by organ-specific discussions of perioperative critical care issues. Neurologic, cardiopulmonary, gastrointestinal, renal, hematologic, and infectious considerations are highlighted. The final section is devoted to miscellaneous concerns, including pediatrics and obstetric issues, trauma, and burns.

Highlights: The greatest strength of this work is its description of the anesthesiologist's approach to organ-specific operative risk and acute perioperative intervention for cardiopulmonary problems. This is consistent with the traditional strengths of the anesthesia literature on perioperative management.

Limitations: As the authors move beyond topics that are traditionally part of anesthesia practice, the power of the presentations decreases. Discussion of such issues as the organization of the intensive care unit and the biology of surgical or medical conditions (not covered in traditional anesthesia training) would be better addressed by senior authors from these disciplines. Despite the importance of pain management and the significance of the anesthesiologist's contribution to it, the use of sedating and analgesic medications receives little discussion; this is surprising in a text written by anesthesiologists. In addition, pulmonary critical care, a key component of perioperative support provided by the anesthesia-based intensivist, is given an inappropriate lack of emphasis.

Context: Critical care medicine is important because it focuses the attention of the anesthesia-trained intensivist on the needs of the critically ill patient during the perioperative period. However, this book must be supplemented by at least one of several recently published texts describing care of the patient at the time of surgery. These texts include Textbook of Critical Care, edited by Shoemaker, Ayres, Grenvick, and Holbrook; Textbook of Pediatric Intensive Care, edited by Rogers; and the two-volume set, Care of the Surgical Patient, with quarterly updates, published by the American College of Surgeons.

Reviewer: David J. Dries, MD, Loyola University Stritch School of Medicine, Maywood, Illinois.

Commentary: In their introduction, the editors highlight the political differences among the specialties that participate in the practice of critical care medicine. These differences are unfortunate because the optimal care of the critically ill patient requires an approach that integrates input from anesthesiologists, internists, pediatricians, surgeons, respiratory therapists, nurses, pharmacists, laboratory technicians, and others. The hospital-based perioperative physician-the modern anesthesiologist-intensivist-may prove to be a key player in the provision of cost-effective perioperative critical care. Nevertheless, this work highlights the importance of an integrated approach to training in critical care medicine. Until the specialties providing critical care support can agree on a unified curriculum and the role of each specialty, the practitioner will have to choose from a smorgasbord of specialists when developing his or her practice.