Surgical and Perioperative Management of Patients with Anatomic Anomalies

Citation

Narayan, D., Kapadia, S. E., Kodumudi, G., & Vadivelu, N. (Eds.). (2020). Surgical and Perioperative Management of Patients with Anatomic Anomalies. Springer International Publishing. https://doi.org/10.1007/978-3-030-55658-7

Chapter Summary

The book has 20 chapters on about 500 pages, each written by its own contributors and arranged by anatomical area, from the head and neck through the thorax, abdomen, spine and limbs to vascular access. The publisher describes it as an evidence-based guide, the first of its kind, to the surgical and perioperative management of patients with anatomical anomalies. Its stated aim is to let trainees and practitioners assess a patient quickly, recognize an anatomic anomaly, judge whether the planned operation and anesthetic are feasible and safe, and arrange advanced consultation when needed. The publisher also highlights recent ultrasound techniques and images and case studies.

Chapters 1–3: Head and Neck Anatomy, Dental and Maxillofacial Surgery, and the Airway

Anatomy of the Head and Neck (Chapter 1); Challenges of Dental Surgery and Oral and Maxillofacial Surgery in Patients with Anatomical Anomalies (Chapter 2); and Airway Management (Chapter 3). The opening group starts with normal anatomy, then applies it to oral and maxillofacial surgery and to securing the airway. Chapters 2 and 3 run to roughly 20 to 25 pages each.

Chapters 4–7: Head and Neck Variations, Congenital Syndromes and the Thoracic Aorta

Head and Neck Variations: Vessels (4); Head and Neck Variations: Soft Tissue, Nerves, and Bones (5); Common Congenital Syndromes and Disease States Impacting Regional Anesthesiology Techniques (6); and Thoracic Aorta and Its Variants (7). Two chapters catalogue variants of the head and neck, one covers syndromes that affect regional anesthesia, and one covers the thoracic aorta and its variants.

Chapters 8–11: Gastrointestinal, Hepatobiliary and Pancreatic Anatomy

Anatomy of the Gastrointestinal System (8); Anomalies of the Gastrointestinal Tract (9); Surgical Anatomy of the Hepatobiliary System (10); and Surgical Anatomy, Anomalies, and Normal Variants of the Pancreas (11). The pattern here is anatomy followed by anomalies for the gut, with the liver, biliary tree and pancreas treated as separate organs.

Chapters 12–14: Genitourinary System and Duodenal Fossae

Anatomy of the Genitourinary System (12); Urologic Anomalies and Surgical Implications (13); and Duodenal Fossae (14). Chapter 13 is the longest in the book at about 75 pages; Chapter 14 is a short, focused chapter.

Chapters 15–16: Spine and Block Placement

Anatomy of Acquired Spinal Disorders (15) and Neuraxial and Peripheral Nerve Block Placement in Patients with Anatomical Anomalies (16). These bring the anesthetic perspective: how acquired spinal disease and anatomical variation affect neuraxial and peripheral nerve blocks.

Chapters 17–19: Upper and Lower Limbs

Upper Extremity Variations (17); Anatomical Anomalies of the Foot and Ankle (18); and Upper and Lower Extremity Vascular Variations (19). Chapter 17 alone takes about 45 pages, and the group deals with variation in the limbs and their blood vessels.

Chapter 20: Vascular Access and Anesthesia for Patients with Cardiac Anatomic Anomalies

The final chapter, about 35 pages, turns to vascular access and anesthetic management for patients whose heart or great vessels are anatomically unusual.

Key Concepts

Chapters 1–7: Head, Neck and Thorax

• Anatomic variant versus anomaly: normal variation in vessels, nerves and bones, which the book treats alongside true congenital anomalies.
• Airway management: securing the airway when the head and neck anatomy is unusual.
• Congenital syndromes and regional anesthesia: how syndromic anatomy changes the choice and conduct of regional techniques.
• Thoracic aortic variants: variation in the aorta as a planning issue.

Chapters 8–14: Abdomen and Pelvis

• Gastrointestinal, hepatobiliary and pancreatic variants: anatomy and common anomalies of each organ system.
• Urologic anomalies and surgical implications: how genitourinary variation affects operations.
• Duodenal fossae: peritoneal recesses of the duodenum, given a chapter of their own.

Chapters 15–20: Spine, Limbs and Vascular Access

• Acquired spinal disorders and neuraxial block: how spinal anatomy bears on epidural and spinal technique.
• Nerve block placement in anomalous anatomy: block placement when anatomy differs from the standard picture; the publisher highlights ultrasound techniques.
• Vascular variations of the limbs: variants affecting surgery and access.
• Cardiac anatomic anomalies and vascular access: planning access and anesthesia when cardiac anatomy is atypical.

Critical Analysis

Strengths

• Organized by anatomical area. The publisher's framing and the chapter order let a reader go straight to the region of the planned operation, and most regions have a normal-anatomy chapter before the anomaly chapters.
• Written for perioperative decisions. The stated purpose is to help a clinician judge whether a planned surgical and anesthetic course is feasible and safe, and several chapters (airway, block placement, vascular access) are explicitly about technique.
• Imaging and cases. The publisher says the chapters include ultrasound techniques and images and case studies, which suits anatomy that is hard to picture from text alone.
• Mixed audience. The book is intended for physicians, nurses and trainees in surgical, anesthetic, perioperative and critical care, so surgeons and anesthetists can read the same chapters.

Limitations

• Uneven chapter size. Chapter lengths range from about 5 pages (Duodenal Fossae) to about 75 (Urologic Anomalies), so some regions are covered much more fully than others.
• No chapters on some areas. The contents have no separate chapter on the brain and nervous system beyond the spine, or on the female reproductive system; readers needing those must look elsewhere.
• Reference rather than teaching text. Aimed at practitioners and trainees who need answers quickly, it presumes familiarity with standard anatomy, standard operations and basic anesthetic technique.
• Evidence varies. For rare anomalies the published evidence is generally limited, so recommendations should be checked against local policy and specialist advice.

Where It Fits in the Course

In the surgery and anesthesia list, this is a specialist reference for readers who already understand standard surgical care. The introductory books cover different ground: Browse's Introduction to the Symptoms & Signs of Surgical Disease teaches surgical history and examination, Crash Course Surgery is a concise introduction to surgical care for students, and Principles and Practice of Surgery is an undergraduate surgical textbook. Read one of those first.

Quick Hits in Obstetric Anesthesia is the other specialist title. It is organized around situations on the labor ward, whereas this book is organized by anatomical region, so the two complement each other: use this one when unusual anatomy affects a planned operation or block, and the obstetric book for obstetric emergencies and neuraxial technique.

How to Use This Book

The book is aimed at surgeons, anesthetists, nurses and trainees who meet patients whose anatomy departs from the textbook. Knowledge of standard surgical and regional anatomy and of basic anesthetic technique is assumed.

A practical plan: read the chapters for the region of interest rather than the book front to back. For anesthetic trainees, Chapters 3, 6, 15, 16 and 20 (airway, syndromes and regional anesthesia, the spine, block placement and vascular access) give the most direct technique; for surgical trainees, the anatomy chapters in each region (1, 8, 10, 12, 15) are the places to start before reading the anomaly chapters. Keep an anatomical atlas or imaging at hand, compare each variant with the standard picture, and use the case studies and ultrasound images to rehearse how a variant would be recognized before surgery. Treat the book as a prompt for pre-operative imaging and consultation, not as a substitute for them.