Gerry's Real World Guide to Pharmacokinetics and Other Things. By Gerald M. Woerlee, M.B.B.S., F.R.C.A. Leicester, United Kingdom, Matador Publishing, 2005. Pages: 142. Price: £9.95 ($17.50).
As the text on the back cover of this little volume asserts: “many anesthetists secretly regard pharmacokinetic and pharmacodynamics as arcane and devilishly difficult mathematical sciences.” There is some truth in the assertion, and with this slim book, Dr. Woerlee has attempted to educate these reluctant individuals. He tries to show how enlightening it can be to have clinical phenomena explained using the tools provided by pharmacokinetic and pharmacodynamic science.
Despite the title, the book is not really comprehensive enough to be considered a guide, nor is it a text or even a primer. It is not a novel but perhaps a collection of short stories, in each of which a training anesthesiologist and his mentor encounter clinical problems. The mentor uses the clinical problem to enlighten the trainee through the application of pharmacokinetic and pharmacodynamic techniques. The book is an easy read; it is 80% short story and (perhaps) 20% science. The storytelling depicts scenarios that will seem slightly unfamiliar to both North American and United Kingdom anesthesiologists but they are easily “translated” into the operating room culture of either. The stories contain detail that can, at times, become annoyingly repetitive—one can be left with the impression that coffee drinking is the highest priority in the operating room.
The book is quite effective at showing how pharmacokinetic concepts can be effective at explaining the time course of drug effects when they are nonintuitive. The explanations offered are mainly at the level of verbal logic. The mathematics are given just the briefest mention and are far from comprehensive. For the stated purpose of the book, I think the balance between verbal logic and math is about right. The concepts involved in choosing a model and determining its parameters are not covered. The book is mainly devoted to pharmacokinetics, and just one chapter is given to pharmacodynamics. The pharmacodynamic chapter introduces the concept of link compartment models, whereas concentration–response curves are not covered. Another neglected area that Dr. Woerlee could usefully have covered is that of the interaction between duration of drug administration and pharmacokinetics (e.g. , in the concept of a context-sensitive half-time).
When considering the question of who should buy the book, it is easier to say who should not buy it. The book will not appeal to those with an interest in or expertise in pharmacokinetics, because they will learn nothing from it. It also will not be of interest to those who wish to study or learn pharmacokinetics, because it skims over the surface of the science. Perhaps the book will be most useful in the library, from where it can be borrowed by anesthetic neophytes, perhaps on the recommendation of their mentors.
University of California, San Francisco, California. firstname.lastname@example.org