A Textbook of Anaesthesia, 4th Edition

Abstract

When I picked up this book, it was clearly an introductory textbook, which would normally necessitate cover-to-cover reading. What an onerous task. This is a large, soft-cover book of more than 800 pages, and the print is small. However, what a surprise I had. This book is an absolute gem, providing a readable, extremely comprehensive text that is heavily founded on basic scientific concepts, especially anatomy, physiology, and pharmacology. It is well written, clear, and concise. The text is especially strong in basic pharmacology—as up-to-date and accurate as almost any pharmacology text that I have recently read. There are also new chapters (from the last edition) on statistics and cellular physiology, additional chapters on the cardiovascular, nervous, and gastrointestinal systems, and chapters that cover immunology, metabolism, and endocrinology. The addition of updated material has led the authors to include new contributions “to ensure fresh minds are applied to the subject matter.” As such, there are now more than 60 contributors. This book is divided into 2 main sections: Principles of Anesthesia and Practice of Anesthesia. The first section consists of 32 chapters, which cover the major body systems and background subsections on such topics as physics, statistics, pharmacology, and the physiology of nearly every body system. The second section discusses actual clinical practice from monitoring to anesthesia for virtually every situation imaginable, such as the intensive care unit, preoperative assessment, intercurrent disease, complications of anesthesia, and pain management, to name only a few. Interestingly, it includes chapters on local anesthetic techniques and dental anesthesia. This book contains 10 appendices, which include formulae, infusion set-ups, normal hematologic values, fluid balance, and pulmonary function tests, to, once again, name only a few. The book concludes with an index. This text is not referenced in the body of the text, but each chapter concludes with a section titled “Further Reading.” The last chapter of this book is a review of cardiopulmonary resuscitation and includes most of the recent advanced cardiac life support algorithms. This text is full of information. In the chapter on dental anesthesia, for example, a 1997 study by Paris et al showed that most parameters with respect to induction and recovery times for halothane and sevoflurane were NOT significantly different. Once again, the importance of the simple concept of exercise tolerance is emphasized in each chapter that deals with patient evaluation before anesthesia. This book is well illustrated, with hundreds of line drawings. Important points and concepts—and there are many—are summarized in tables. The only point of contention that I had with this book was the statement that “amide-type local anesthetics trigger this syndrome [malignant hyperthermia] in susceptible individuals.” This, of course, we know not to be true. Once again, this is an absolutely outstanding text for not only the new resident but also the experienced practitioner. It contains an enormous amount of factual information, which is nicely explained on the basis of basic scientific principles and studies. One small nuance that some readers may find is the use of English (United Kingdom) units, such as kilopascals, and terms. This presents little problem, however, because the appendices cover all possible conversions. This would be an excellent addition to the library of anyone practicing anesthesia, pharmacology, and physiology.