This fifth edition claims to remain true to its original purpose in providing ‘an easily accessible, practical reference designed to help the practitioner prepare for and manage cardiac anaesthetics’. To that end, it is presented in five sections covering Cardiovascular Physiology and Pharmacology; Anaesthetic Management for Cardiac Surgery; Anaesthetic Management of Specific Cardiac Disorders; Circulatory Support; and Thoracic Anaesthesia and Pain Management. Each section is divided into separate chapters and each chapter is structured as a series of headings and subheadings providing an outline and referenced to the specific page where it is discussed. This allows for easy identification of each topic within the chapter. In addition, there is a list of up to 19 (but usually between 6 and 10) key points presented at the beginning of each chapter as a list of the major learning topics to be addressed. Where these topics are discussed in the body of the chapter they are highlighted by the appearance of the relevant learning point number in the margin. The use of the heading and subheading technique has been reasonably well adapted by most authors to provide a short but practical discussion of relevant topics. Illustrations, diagrams and echocardiographic images are used sparingly throughout the text but are of good quality and relevant when employed. Allowing for the lead time to textbook publication, most chapters include up to date information with references dating up to and including 2011. The book certainly provides an introduction and practical approach to the practice of cardiac anaesthesia. The chapter headings have been well chosen to provide a broad spectrum of relevant information. Integrating a large number of authors and topics can be difficult and repetition of topics has been minimised. However, this is at the cost of making some relevant, and reasonably common, issues for those starting out in cardiac anaesthesia difficult to find; for example, the approach to the patient scheduled for redo cardiac surgery, where a practical discussion would prove useful. A discussion on repeat sternotomy can be found in the chapters on myocardial revascularisation, congenital heart disease and also transplantation. It must be noted that only four of the 55 authors are from outside the United States and only two from outside North America, and none of the authors are European. There are a small number of typographical errors, but these are of little significance other than to those who read things meticulously. In terms of the target audience for the book, the information contained is certainly more than that required for the FRCA examination. Although presenting a heavily North American approach it does offer a very good, broad introduction to the specialty of cardiac anaesthesia. With this in mind it would be a reasonable addition to a hospital library, or for the trainee interested in pursuing a career in cardiothoracic anaesthesia.