P. Foex, G. G. Harrison and L. H. OpieLippincott – Raven Publishers, 1999. 391 pp. £35.50. A large proportion of patients presenting for surgery, cardiac and noncardiac, have coexisting cardiac disease. These patients often present with polypharmacy prescriptions attempting to control the symptoms of cardiovascular dysfunction, thus posing the anaesthetist with the challenge of deciding how best to manage these patients peri-operatively. When looking at this book I hoped this would go someway to helping me. The first thing that strikes you about this book is its unusual size and shape. Presumably the book is designed to be carried in the pocket of a white coat for constant reference, advice and enlightenment. Why then include large sections on detailed cellular physiology and pharmacology? This is probably better left to formal textbooks rather than a book such as this, which has a different agenda. This ‘handbook’ is aimed at all grades of anaesthetists but more specifically trainees progressing through postgraduate examinations. It is designed as a portable compendium and reference book. The book aims to tackle an enormous field encompassing the physiology of myocardial cells, the autonomic nervous system and the cardiovascular system in general. In addition to this, the subjects of clinical cardiovascular pharmacology and the influence of anaesthetic agents upon all aspects of the cardiovascular system are included. All this is brought together in the later chapters by the application of these principles in the clinical setting of everyday encountered cardiac morbidity. The book attempts to be a ‘jack of all trades’ in covering such a large scope in a handbook. The organisation of the book is good with a clear table of contents enabling easy access to a specific topic. The eminent editors have collated chapters from a variety of authors. Each chapter is extensively referenced and provides an excellent source for detailed reading on the aspects included in the chapter. However, as is often the case with multi-author books, the chapters are increasingly repetitive. The editors cite this issue and explain it as preparing stand-alone chapters, but the repetitive nature is irritating. Failings of the chapters are somewhat rectified by the clear concise summaries at the end of each section. The sections involved in the pharmacokinetics and pharmacodynamics of the various drugs are detailed synopses. The figures included attempt to summarise the detailed prose. The result, however, is too complex to follow the principles involved clearly and this is exacerbated by the size of the book. The second half of the book conversely is more of interest to the practising clinician. This section provides current evidence-based reviews on the optimal methods of maximising cardiac function in various states of cardiac morbidity. The quality of these reviews is generally very good but the important issue of institution of peri-operative beta-blockade is only touched upon, but the references are provided for further investigation. The last two chapters involving ICU and resuscitation provide little new information and are much better covered elsewhere. All faults considered, in my opinion, this book provides a generally good quality evaluation of the evidence to support treatment regimens in cardiovascular disease. It includes details on more of the newer drugs available and how they fit into the current armamentarium of the clinician. Did it fulfil what I wanted? Well, yes, but after ploughing through two-thirds of the book. In the role as a reference book for cardiovascular pharmacology for anaesthetists generally, it does attain its goal. I would certainly recommend this book for inclusion in any anaesthetic library, more than for the individual though. Change the shape and size, and stop pretending that people will actually carry it around with them.