Laryngeal Mask Anesthesia: Principles and Practice. 2nd ed.

Laryngeal Mask Anesthesia: Principles and Practice. 2nd ed. Brimacombe JR. Philadelphia: Elsevier-Saunders, 2005. ISBN 0-7020-2700-6. 699 pages, $110.00. The author's goal of providing a complete summary of all that is known about the LMA and competing devices plus offering practical guidelines to their use is admirably accomplished. While one could quibble about a 699-page letter-size format monographic book being concise, the many innovative features of the text help to make it so. Like many monographs, the author begins with a historically oriented chapter, including an interesting brief biography of the inventor and developer, Archie Brain, who was born in Japan during WWII while his father was British Consul in Kobe. Much like how Thomas Edison described his technique for invention, the development of the LMA was 1% inspiration in 1981 plus later insights and 99% perspiration over the next 10 plus years. Unlike Edison who had many coworkers, the LMA was initially developed by one working anesthesiologist developing several hundred prototypes in a small workshop and initially testing them on his own patients. Comparing the situation 25 years ago with today's highly regulated research environment, one comes to the same conclusion as Dr. Brain in the foreword: it would be much harder today! The remaining 21 chapters cover a wide variety of issues pertaining to the LMA. The second chapter reviews the variations of the classic LMA and the multitude of adjuvant devises used with them. Chapters 3–6 review the anatomy, pathophysiology, and use of the LMA as a conduit to both the airway and gastrointestinal tracts. Chapters 7–10 review the clinical application in anesthesia practice from pre-anesthesia, insertion, maintenance, to the emergence phase of anesthesia. Chapters 11–15 cover special aspects of use in resuscitation, intensive care, difficult airway management, pediatrics, and patients with coexisting diseases. The pediatric chapter recapitulates the chapters of the book regarding the pediatric patient. Chapter 16 discusses specifics for the use of the LMA in procedures for different surgical subspecialties. Chapters 17–19 review the use of the special variations of the standard LMA, the flexible LMA for shared airway use, the intubating LMA and the ProSeal LMA. Chapter 20 provides information for the educational aspects of LMA use, and Chapter 21 includes highly useful information on the problems that may be encountered during LMA use. With an estimated clinical usage in 150 million procedures resulting in a plethora of similar devices to tap into the large market, the final chapter reviews a myriad of literature regarding other extraglottic airway devices, including clinical comparisons with the LMA. Throughout the chapters are a great number of diagrams, pictures, and tables, both original and referenced, that are of uniformly excellent quality and large in size. The chapters regarding insertion, maintenance, difficult airway management, specialty surgical considerations, and problems in use are particularly pertinent for the clinical anesthesia user of the LMA. Information requiring hours of Web searching can be found in minutes in these chapters. In addition to creating the definitive book regarding the LMA with 5,891 references from 4,299 researchers, the author may have produced a prototype for print media textbooks in the computer age. The author describes the computer aided methods used for its creation in the introduction. Meta-analysis of all available data was performed whenever more than three studies relevant to a particular issue were available. Unlike most published meta-analysis evaluations in peer-reviewed journals, the author chose to also include data from all sources, including abstracts of scientific meetings and letters to the editor. The meta-analytical findings for each chapter, placed after the text of the chapter summary in a lavender table format, are a compact summary of pertinent clinical research. For the busy clinician, several useful features are available to speed-finding information without resorting to searching an index at the end of the book. Each chapter begins with a table of contents. The author's conclusions of the information in most subheadings are included in bold print at the end of the subheading, allowing rapid reading of the pertinent information. At the end of each chapter are quick references in blue table format summarizing the chapter even more concisely. Whenever there are more than five studies regarding an issue, the information is presented in a tan-colored table rather than in text. Within the headings or text are “links” pointing to other locations where the bulk of information about a subject is logically placed (much like pointers in computer texts that would allow the book to be easily converted to computer-readable format) to reduce the redundancy found in many texts, especially those by multiple authors. Two appendices were added after going to press with the latest references arranged according to chapter and headings, making the book as current as possible. In summary, the dogged effort involved in creating this book (estimated by the author at 13,000 hours) rivals that of Dr. Archie Brain in inventing and developing its subject, the LMA. The effort shows in the results. Kenneth A. Haselby, MD Associate Professor Director of Anesthesia, Wishard Hospital Indiana University School of Medicine Indianapolis, IN [email protected]