Anesthesia: a Comprehensive Review

Abstract

First published more than 20 yr ago in 1992, Anesthesia: a Comprehensive Review is in its fifth edition, attesting to its usefulness to the anaesthesia community, particularly to those studying for certifying or recertifying examinations. The editors and contributors are faculty or former faculty members of the Mayo College of Medicine in Rochester, MN, USA. The present book is an update from the fourth edition published in 2010. It is published in both paperback and electronic (Kindle) formats. The Kindle version is less expensive, but the reader has access to an electronic version of the textbook through Expert Consult at no extra cost after purchasing the paperback version. The Kindle version is merely a flat copy of the paperback version, but the electronic version has added functionality that is very useful (see below). I reviewed the electronic version of the book. The fifth edition mimics the organization of previous editions. The book contains 1001 single best-answer questions divided into two parts, Basic Sciences and Clinical Sciences, and 11 chapters. The Basic Science section contains chapters on anaesthesia equipment and physics, respiratory (including critical care medicine questions), and pharmacology of i.v. and inhaled anesthetics (the chapter is entitled ‘Pharmacology and Pharmacokinetics of Volatile Anesthetics’, but there are a few questions about nitrous oxide). The Clinical Science section contains chapters on fluid management, general anaesthesia, and subspecialty anaesthesia (paediatrics, obstetrics, neuroanaesthesia, regional/pain, and cardiac). There is a fair bit of overlap, in that clinical questions appear in Part 1 and basic physiology questions appear in Part 2. In general, however, the chapter divisions make sense. Each chapter in the printed version starts with a section of questions, followed by a section with answers and explanations. Thus, one has to flip back and forth in the book (and the Kindle version) if one wants to check out the answer immediately after answering the question. The electronic version has this standard formatting, but also includes a fun, interactive, and immediate gratification functionality (new to the fifth edition), in which one can read each question, click on the answer, immediately check the answer (and revise the answer if wrong), and read the explanation. Thus, no page turning is required, and feedback is immediate. The book covers an extensive amount of clinical anaesthesia. Its strongest feature, and one that differentiates it from other review books, is the detailed explanation that accompanies each question, along with the source. Sources include major general and subspecialty anaesthesia textbooks or practice guidelines, and the exact page range is listed. This is very helpful to the reader looking for further information. Primary sources (except for practice guidelines) are not cited, although the primary sources could probably be found by consulting the cited textbook. A few of the cited textbooks are fairly old and unlikely to be accessible easily; for example, Eger’s classic Anesthetic Uptake and Action was published in 1974, and even ‘seasoned’ anaesthetists such as me are unlikely to have this book on their bookshelf. Occasionally, outdated editions of textbooks have been cited (e.g. Cousins and Bridenbaugh’s Neural Blockade in Clinical Anesthesia and Management of Pain, third edition, 1999; the fourth edition was published in 2008). In general, however, most of the sources cited in the book have been updated to the latest editions of the textbooks, even those published as recently as the autumn of 2014. An additional feature is that many answer explanations cite two, or sometimes even three, source textbooks. For example, Miller’s Anesthesia and Clinical Anesthesia (Barash and colleagues) are often both cited as sources. Thus, readers who have only one major anaesthesia textbook on their bookshelves or e-readers should be able to find the source material easily. The book contains a lot of text, with some figures and tables embedded in a small number of questions and answers. This profusion of text without figures is distracting when using the printed version, but is not at all bothersome when using the Interactive Assessment, because the reader views only one question and one answer on the screen at a time. The fifth edition has been updated from the fourth edition, and the material is clinically relevant for the modern anaesthetist. However, a large proportion of the questions are drawn from the fourth edition. Whether the new questions and removal of some dated material justifies the purchase of the new edition may depend on the reader and the reason for using the book. The questions are generally well written and the answers are correct. I completed all of the questions and answers in the ‘Obstetric physiology and anesthesia’ chapter because obstetric anaesthesia is my area of expertise and I thought I should know all of the answers! Indeed, I did answer most of the questions correctly, and I agreed with the explanation of the answers. The few I got wrong were generally because I did not read the question carefully, not because the questions were ambiguous. The questions vary in difficulty from basic, entry-level questions to more advanced clinical questions. This is both a strength and a weakness of the book. It is likely to be a strength for the practitioner studying for recertification; however, for the American trainee studying for the American Board of Anesthesiology Basic or Advanced examination or for the UK trainee studying for the Royal College primary or final fellow examination, the mixing of basic and advanced clinical questions will make use of the book more cumbersome. It would be helpful to label the questions as basic or advanced. The bibliography in the front of the book is inaccurate. For example, editions 6 and 7 of Miller’s Anesthesia (2004 and 2009) are both listed, but the eighth edition, which is cited extensively throughout the text, is not. Williams Obstetrics, edition 22 (2005) is listed in the bibliography, but the 24th edition is currently in print (2014) and I found no citations to Williams in the textbook. Yao and Artusio’s Anesthesiology: Problem-Oriented Patient Management is cited multiple times throughout the text, but is not listed in the bibliography. Finally, the book was written by Americans, using American source textbooks and the practice guidelines of American professional organizations. Thus, the book is likely to be less useful for UK than for American trainees and anaesthetists. Nevertheless, many of the basic and clinical questions are common to the practice of anaesthesia on both sides of the Atlantic. The detailed explanations of the answers allow the reader to absorb more knowledge than is typical for a review book, without having to consult the source textbook. Thus, I think the book is likely to be very useful to Americans studying for a written anaesthesia examination and may be useful, but perhaps less so, to those outside the USA.