Book Review

The Airway: Emergency Management

N Engl J Med 1993; 329:286July 22, 1993

Article

The Airway: Emergency Management
Edited by Robert H. Dailey, Barry Simon, Gary P. Young, and Ronald D. Stewart. 397 pp., illustrated. St. Louis, Mosby-Year Book, 1992. $62. ISBN: 0-8016-1270-5

Airway management in the acute care setting is an important skill to have no matter what the cause of the actual or potential respiratory compromise. Intubation is an acquired skill, and there is clearly a need for a sound knowledge of the basics of securing the airway in patients with compromised airways. Unfortunately, this book does not meet this requirement, in part because it is not clear who would benefit from it.

The book has three major subdivisions. The first section briefly reviews anatomy and physiology and includes a chapter on aspiration. The second discusses methods of controlling the airway, and the third provides examples of specific problems. All are rather superficial.

There are a number of factual errors, misinterpretations, or editing errors. For example, in the section on aspiration, the comment is made that compliance is increased after aspiration rather than decreased. The illustrations of intubation show laryngoscopes for left-handed practitioners. This is not a major issue except that such equipment is not commonly available. There is missing text in the first column on page 187. Unfortunately, many of the chapters suffer from a problem present in all multiauthored textbooks -- repetition.

Many of the drugs and therapeutic interventions suggested are inappropriate in the acute care setting or are not approved, such as the use of dimethyl sulfoxide as a free-radical scavenger for the treatment of adult respiratory distress syndrome. Although the author states that this therapy has not been approved in humans, the reason for its inclusion is unclear. Other techniques that may be useful for emergency intubations are omitted.

Determining how best to manage an airway and which technique to use for intubating the trachea in an emergency involves a great many important decisions. The best outcomes are probably achieved by asking an experienced anesthesiologist to assist in managing airway problems.

Gary W. Welch, M.D.
Texas Tech Regional Academic Health Center at El Paso, El Paso, TX 79905

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