The Manual of Anesthesia Practice, version 1.1.0.  Edited by Manuel Pardo, M.D., and James Sonner, M.D. Price: $50.00.

What is the “killer app” for an anesthesiologist with a handheld computer? Sadly, the answer is too often “the calendar.” Rabid technophiles often find common ground with casual users of handheld computers on one topic: there is a paucity of high-quality, context-specific, appropriately priced, medical references for personal digital assistants (PDAs). Rare exceptions to this observation include drug references like ePocrates and Tarascon’s, which share a widely installed base among physicians owing to their ease of use and tailored point-of-care format. When one narrows the field of entrants to a particular specialty (e.g. , anesthesiology), the quality curve drops off steeply. One does not have to look very hard on the web to find folks selling their old medical school notes in PDA format as “definitive medical references.” Alternatively, established texts have also found their way onto PDAs’ 2.5-square-inch screens as outlines of the original or as massive unabridged copies. Each format has its share of drawbacks. Outlines, while useful in guiding study, are too brief and vague to provide significant benefit in a working environment; whereas unabridged editions are too lengthy and unnavigable to be useful at the point of care. In addition, the costs of creating an electronic version of a preexisting text are added to the cost of the original, often making the price (sometimes 2–3 times the paper version) unappealing to the buyer.

Enter The Manual Of Anesthesia Practice , a welcome and refreshing addition to PDA literature in that it falls into neither of the above two categories, as it was written specifically to be a PDA-based reference. I reviewed the PalmOS format (PocketPC and WinCE versions are also available), version 1.1.0, edited by Manuel Pardo, M.D., and James Sonner, M.D. All of the content contributors were members of the University of California, San Francisco Department of Anesthesia and Perioperative Care at the time of contribution. The interface was largely designed and implemented by the publisher,, inc. I will attempt to evaluate interface and content separately.


Installation of the full version of The Manual of Anesthesia Practice  was a more cumbersome task than your average HotSync install, involving slightly more than 10 user steps between Palm, Personal Computer, and logging information to and from the Web site. Although I appreciate the need to protect intellectual property from piracy, the lengthy registration process might intimidate new PDA users and might irritate those users who are moderately impatient. Another potential pitfall related to this specific form of copy protection is the fact that this process locks the software to the individual PDA ID rather than to the user. This becomes a problem when the user replaces and/or upgrades to another PDA. Because the device ID on the new PDA will be different from the original (even if it is the same make and model), the software will only run in demo mode on the new PDA.

The installed application contains five sections, each containing 85–190 topics. The application is easily navigated in a manner similar to the PalmOS address book, in that topics within each book are listed alphabetically, and writing in the first letters of a topic of interest prompts the application to display the closest match. There are a number of additional navigation tools to allow you to click through subtopics serially, or specifically, to find the information you want. Unlike several other texts, the interface of The Manual of Anesthesia Practice  fully supports high-resolution screens, providing sharp icons and text. Although great attention was obviously paid to assuring the ease of navigation through the outlined format of each section, my biggest interface criticism is that there is no text-searching tool or global find function to search across, or even within, all five books. This omission poses a problem for trainees; because the user is constrained to search for details within the conceptual framework of the text outline, the success of queries for small details is tied to the depth of the user’s own knowledge base. That is, the more you know, the easier it is to find the desired information, but the less likely you are to actually need that information.


The beauty of this electronic text is not in its scope of coverage, but rather in its succinct and relevant coverage of the topics that are included. Information is categorized into five aforementioned sections: “Coexisting Disease,”“(Surgical) Procedures,”“Critical Events,”“Techniques,” and “Drugs.” The topics within each section are well-written “quick-fact,” and “how-to” bullets that avoid being overly general or vague. The authors do an excellent job of maintaining focus on issues of immediate clinical interest and rightly avoid more lofty academic narratives that are better suited for printed textbooks and leisurely study outside of the operating room. Although the content is not referenced to any other texts or journal articles, each topic is specifically referenced to its author(s).

A representative example of the fine writings for each topic can be found in the (likely to be highly popular with readers) topic of “CABG with Cardiopulmonary Bypass.” The fluidly navigable outline for this (and other procedural topics) is broken down into preoperative considerations, intraoperative care, postoperative care, and a summary of the surgical procedure. When reminders to administer adequate anxiolysis and antibiotic prophylaxis are provided in the text, specific drug choices and doses immediately follow. Individual and/or institutional differences in practice are clearly self-identified, as in the case of pulmonary artery catheter use for coronary artery bypass grafting; the author furnishes perspective on general indications and scope of alternatives without sacrificing brevity, applicability, or respect for varied clinical practice.

There were a few topical omissions that might subjectively be considered to be basic topics. There is no mention at all of aprotinin or oxymorphone. There are references to oxytocin and methergonovine under “C-section,” but these same drugs are not specifically listed in the “Drugs” section. In all fairness, these are minor issues, especially in light of how easy it will be to add content (as updates) to an already structurally robust application like The Manual of Anesthesia Practice .


So, who is this manual written for? I believe that the largest audience will be those who are in training. However, there are still a number of more obscure topics within this volume that more seasoned practitioners will certainly find useful at the point of care, particularly when they find themselves doing cases that are outside of their particular specialty or typical geography. Finally, from an educational standpoint, this application provides an excellent, portable, written supplement to operating table teaching.

Despite a few minute issues, The Manual of Anesthesia Practice  stands out among a bevy of currently available medical PDA references. Whether you are a PDA novice or a pro who is leery of the mixed bag of electronic reference offerings past, I can enthusiastically recommend The Manual of Anesthesia Practice  as a quality addition to your virtual library.

Mayo Clinic, Rochester, Minnesota.