Multiple Choice Questions in Regional Anaesthesia, 2nd ed

Abstract

e2 www.anesthesia-analgesia.org July 2020 • Volume 131 • Number 1 DOI: 10.1213/ANE.0000000000004791 B with multiple-choice questions can be convenient when preparing for examinations or just refreshing knowledge. The second edition of the book, Multiple Choice Questions in Regional Anaesthesia, is reviewed to determine whether that’s the case. Dr Rajesh Gupta is a consultant in anesthesia and pain management at Frimley Park Hospital in London, and Honorary Lecturer at the University of East Anglia, and has previously written 3 books on regional anesthesia and pain medicine; his coauthor, Dr Dilip Patel is a consultant in the Department of Anaesthesia at the Royal Free Hospital in London. The authors have now undertaken the significant effort of revising their question book, first published by Springer in 2013. The recent expanded edition, also accessible online, now includes 644 questions and new chapters on anatomy, physiology, and assessment of acute pain. However, the authors have surprisingly removed the chapters on regional anesthesia in obstetrics and pediatrics. Both topics are now mainly included in the chapter “Anaesthesia in Patients With Special Considerations.” The number of questions in each chapter vary from 10 to 144, and in the longer chapters, checking the answers at the end of the chapter becomes tiresome. Questions are not in the usual multiple-choice format, with a stem question followed by several possible answers. Here, every question has a title, followed by 5 pertinent statements, often unconnected. Not all answers are supported by a comment or a reference, and there are great variations between the chapters in this respect. The references are often dated and if they were of outstanding value, this could be acceptable, but one can question the relevance of a reference from 1990 cited to support “Sitting epigastric pressure test” for diagnosis of postdural puncture headache (PDPH) (Chapter 11, Question 72), or a reference from 1942 that informs us that the headache resolves after the reconstitution of the cerebro spinal fluid (CSF) volume. Another outdated reference from 1981 is provided for iatrogenic meningitis, and Pseudomonas aeruginosa is supposedly the most common infectious agent in complications to epidural blockade (Chapter 4, Questions 7 and 8). The previous edition was hampered with several misspellings, and fortunately the “medium nerve” is no longer mentioned. However, this edition features the “Guillain Barry syndrome” (Chapter 11, Question 31) and one can also read that “Pancoasts tumor presents in radial aspect of hand and forearm” due to “brachial carcinoma” (Chapter 7, Question 10). There are several nonsense affirmations like “Tibial nerve is innervated by deep fibular nerve” (Chapter 8, Question 18). These frequent errors are distracting and annoying. In other instances, the same question is provided with contradictory answers: “Intrathecal catheter promotes better sealing of breach in the dura and promotes healing” (Chapter 4, Question 23), whereas the opposite statement can be found in Chapter 12, Question 58. In Chapter 11, high body mass index (BMI) is claimed to be a risk factor for PDPH, but elsewhere to be associated with decreased risk of PDPH. A major concern regards obvious medical errors: “High acetaminophen usage is associated with decrease in renal function though it is not seen with high NSAID usage” (Chapter 3, Question 4) or “Ropivacaine causes more motor block than l-bupivacaine” (Chapter 7, Question 32). Other equally disconcerting flaws are the incorrectly cited references: The answer in Chapter 12, Question 14 states that “Regional anesthesia has been shown to decrease cancer recurrence”; however, the provided reference concludes that “there is no hard evidence to support altering anesthetic technique.” In the answer to Chapter 11, Question 12 regarding complications to neuraxial blockades, a review by Brull is cited as showing a “high incidence of complications” but the conclusion in this paper reads “permanent neurologic injury is rare in contemporary anesthetic practice.” The authors let us know that “Ondansetron is known to mimic PDPH” while in fact the cited reference describes how intrathecal air may cause the confusion (Chapter 11, Question 72). I could go on and on, but the above-mentioned inconsistencies are just some of several other examples. If you should wish to buy the book, this will set you back some $100, whereas the eBook sells at $80. However, the real cost could be unlearning carefully acquired medical knowledge.