Anesthesia, Fifth Edition. By Ronald D. Miller. Philadelphia, Churchill Livingstone, 2000. Pages: 2,877. Price: $250.00.

Joseph R. Tobin, M.D., Wake Forest University School of Medicine, Winston-Salem, North Carolina.

The fifth edition of Anesthesia  is a welcome addition for the anesthesiologist, resident, and student alike. This impressive two-volume set, with its accompanying CD-ROM, provides a comprehensive overview of contemporary anesthesia practice.

Anesthesia  is organized in six sections as previous editions, with a splendid, albeit short, synopsis of the history of anesthesia in the first section. The second section, Scientific Principles, is well-organized and amply illustrated. The figures are larger than those in most texts and have easy readability. Illustrations are of higher quality than those in previous editions, and the effort to improve illustration with color is noted widely throughout. This section and the third, Anesthetic Management, are the core of the text. These sections are well-updated and have introduced recent research in our field, including ischemic preconditioning, development of stereoisomer pharmacology, and molecular biology of receptor and enzymatic variants. I appreciate the extensive chapters about metabolism and toxicity of inhaled anesthetics and opioid pharmacology, but they may seem a bit long to the casual reader. The chapters on research design and statistics and transesophageal echocardiography are presented well and should be useful to clinicians and investigators. Although mentioned, the section on office-based anesthesia should be highlighted and developed, possibly as a separate chapter, because more procedures are being performed in nontraditional settings.

Section IV is entitled Subspecialty Management. The chapters in this section reintroduce the general principles and management strategies presented for specific procedures or situations. These authors discuss a wide spectrum of patients and procedures and include contemporary concepts in the care of patients at the extremes of age, management of the different lasers used in surgical care, and a thorough discussion of postanesthesia care unit issues and perioperative and chronic pain. Section V, devoted to critical care medicine, is nicely updated and similar in its organization to the previous edition. Unfortunately, because of the latency involved in publishing any major work of this size, certain sections will become outdated more quickly than others. One example includes the changing advanced cardiac life support guidelines. Newer concepts in the determination of brain death are presented and are valuable to the critical care specialist.

In the final section, Ancillary Responsibilities and Problems, the authors have energetically updated their contributions, including new research about human performance, simulators, and education, as well as operating room management, legal and ethical aspects, and environmental safety. Future work on safety, injury, and other healthcare concerns of anesthesiologists will become an even more important contribution to future editions.

Anesthesia  is complemented with appendices, which include the American Society of Anesthesiologists Practice Guidelines. This is a welcome addition because texts are more easily located in a busy operating room or cluttered office than were the individual practice guidelines when published. The CD-ROM accompanying the text could not be opened in the Windows NT environment but worked splendidly on my nonnetworked personal computer. It is a great complement to the text.

In summary, I have very high regard for Anesthesia . I am happy to replace my well-worn previous editions for this one. I still enjoy using a hard-bound textbook and do not solely use electronic publishing as my resources. This is a text I will enjoy for years and is a great core text for students, residents, faculty, and practitioners alike. It should be available in most anesthetizing locations and is a dependable resource for academic and practice questions.