HEAL: Harvard Electronic Anesthesia Library: CD-ROM for Windows and Macintosh. Edited by Michael Bailin, M.D. Philadelphia, Lippincott Williams & Williams, 2001. ISBN: 0781714087. Price: $395.

Welcome to the twenty-first century! It is a world in which textbooks are electronic, lightweight, and virtually coffee-stain–proof. The Harvard Electronic Anesthesia Library is an electronic textbook that encompasses the breadth and depth of the field of anesthesia by utilizing text format combined with hyperlinked reference material and video-clip illustrations. Compiled from Harvard Medical School’s four teaching hospitals, the topics begin with coverage of the fundamental concepts and current research within the field of anesthesia. The clinical subspecialties, including ambulatory, pediatric, cardiac, vascular, regional, obstetric, and neuroanesthesia, are then reviewed. The Library concludes with an overview of pain management.

A useful format for the modern practitioner in practice or in training, the information is easy to download and review quickly. For every medical student or resident who has carried a few textbooks in a backpack, this CD-ROM is delightfully lightweight. The search engine allows searching by author, chapter, key word, topic, phrase, or section. References are hyperlinked via  PubMed and are accessed with the click of a button. Web site addresses are provided and hyperlinked also. These revolutions enable a time-efficient review of the literature surrounding various practices in anesthesia. Evidenced-based medicine is now available literally at the touch of a button.

The Library offers one the ability to assemble a slide or video presentation in just minutes. For example, if one were asked to give a lecture to residents about regional anesthesia techniques, one could simply click on the slide illustrations of interest and the slide show manager  compiles the slides, an audience handout, and presenter notes in just seconds. This function, however, renders the excuse, “I left my slides at home; therefore, the lecture is canceled,” null and void. Therefore, beware before mastering this skill!

HEAL begins with a chapter entitled General Considerations, in which acknowledged experts review fundamental concepts of anesthesiology. These topics range from how general anesthetics work to the kinetics of inhaled and intravenous drugs. Authors who have devoted their life’s work to these subjects cover allergic reactions, malignant hyperthermia, and electrical hazards in the operating room. However, the malignant hyperthermia chapter says very little about the actual management of a malignant hyperthermia crisis, which is perhaps the major concern of most clinicians. The management of critical events in general is covered at length with accompanying video clips of simulator vignettes of both good and poor decision making and team management. There are numerous Web site references (although at the risk of the URLs becoming out of date).

The Library provides coverage of ambulatory anesthesia with current standards of care and its particular intricacies of the outpatient setting. The modern practitioner will enjoy discussions on cost-effective care, techniques of clinically oriented practices, and the ever-expanding role of the anesthesiologist as a manager of a staff and a facility.

Highlights from the clinical chapters include video clips and anatomic figures. The cardiac chapter features 18 transesophageal electrocardiography examinations with each view accompanied by the multiplane angle range, the anatomy imaged, and its clinical utility. The enlightened authors recognize that especially when it comes to transesophageal electrocardiography, a picture is worth a thousand words. These are most useful for novices, but they do not substitute for more detailed video clips for those intending to become certified in transesophageal electrocardiography use. In the same chapter, six cardiac assist devices approved by the U.S. Food and Drug Administration are compared and contrasted along with the management of patients dependent on these devices. An introduction to orthopedic and regional anesthesia again demonstrates the strength of the multimodality CD-ROM with the downloaded visual movies of the various blocks.

Obstetric anesthesia is covered comprehensively yet succinctly. Fundamental concepts of obstetric and fetal physiology and anesthetic management are reviewed to ensure that the reader is provided the basics. A case discussion on postpartum hemorrhage engages the reader in a crisis situation. More senior anesthesiologists will enjoy the discussion of the controversies surrounding anesthetic effects on the progress of labor.

The pediatric anesthetic chapter provides particular psychological insight to this highly demanding subspecialty. In the words of Drs. Holzman and Mancuso, providing “knowledge, confidence and diplomacy” to the patient’s caregivers compounds the challenges of this field. The science behind the anesthetic management of the developing human body is intertwined with the art of management of the youngsters’ minds along with those of their concerned family members.

Residency training programs vary in access to hands-on expertise in trauma anesthesia. The chapter’s editor, Richard Dutton, recognizes that “most anesthesiologists learn to care for trauma patients in a piecemeal fashion, in the dark of the night and the heat of the moment, without any sort of organized exposure to the mechanisms of traumatic injury or the body’s physiologic response.” In light of this, emergency airway management and the pathophysiology of shock are reviewed in detail. The chapter then provides clinically relevant solutions to the anesthetic management of some traumatic injuries, including spinal cord injury, acetabular reconstructions, carbon monoxide poisoning, burns, flail chest, and traumatic brain injury.

The Library’s chapters conclude with an exploration of pain management. The contents provide an overview suited to the resident or anesthesiologist in general practice. Again, the fundamental concepts are reviewed, and clinically relevant subjects surrounding acute and chronic pain are discussed. Epidural steroids, management of cancer pain, and treatment of postdural puncture headaches provide a welcome and easy-to-use resource of such a comprehensive subject. Video clips and fluoroscopic images accompany the text, allowing the subject matter to be retained painlessly.

HEAL encourages readers to solidify the information they have ingested by providing two opportunities to answer questions. Each chapter ends with a set of questions covering the material presented within. Another section compiles 100 randomized questions in the form of an examination that can be taken at multiple sittings for further review of the subject material.

Overall, the Harvard Electronic Anesthesia Library provides an enjoyable learning experience. With its interactive media choices and hyperlinked reference material, it would surely find a welcome place on an anesthesiologist’s hard disk drive (and the trees that are allowed to remain standing will be grateful). On the other hand, its price of $395 may deter many who would otherwise be interested.