Yao & Artusio’s Anesthesiology: Problem-oriented Patient Management, 5th Edition for PDA. By Fun-Sun Yao, M.D. Baltimore, LWW Mobile, 2004. Price: $99.00.

Anesthesia-oriented personal digital assistant (PDA) resources are becoming increasingly available. This program is based on the case-based, problem-oriented teaching textbook of the same name.

The software is available for use on either a Windows Pocket-PC or Palm OS-based PDA, and installation versions are provided for both Windows and Macintosh systems. The software was purchased from the Internet*and tested using Windows XP and a Palm Zire 71 PDA with Palm OS 4.5.

The product is supplied as a 6.7-Mb downloadable application, and installation was straightforward. Once installed, the product consists of 6 application-specific files totaling 4.3 Mb and 11 generic Skyscape applications requiring an additional 623 kb of memory. Although the 11 Skyscape applications are required to be stored in your PDA’s main memory, only the main Yao and Artusio’s Anesthesiology .PRC application totaling 270 kb is required to be in the PDA’s main memory, whereas the additional 4 Mb of .PDB databases may be stored on an external memory card. The end result is that without an external memory card, this resource will consume 4.9 Mb of a PDA’s memory, whereas if an external memory card is present, 4 Mb of this may be stored on it using only 900 kb of internal memory. The generic Skyscape applications are required to run any of the many Skyscape medical resources that are available, and only a single copy is needed on each PDA; thus, if other Skyscape resources are already present, the required program footprint will be smaller.

Similar to most Skyscape applications, after launching the PDA program, one is presented with a screen titled “Main Index,” with subjects listed in alphabetical order. These topics are user searchable in the usual manner by writing in the first few letters of a topic of interest, and the program narrows the list of displayed subjects. Subjects may also be viewed on a “Table of Contents” menu, where subjects are subdivided by organ system. Finally, there is a medication index, which serves to direct the user to areas in the text where that particular drug is mentioned.

This application is a word-for-word duplication of the original hard-copy textbook. It consists of 60 cases on a variety of common surgical procedures, anesthetic situations, and coexisting disease states relevant to anesthetic practice. Each topic consists of a short case presentation followed by questions based on four subheadings, including medical disease and differential diagnosis, preoperative evaluation and preparation, intraoperative management, and postoperative management. The number of questions varies by topic but ranges from a low of 15 questions for “Low Back Pain and Sciatica” to a maximum of 93 questions for “Ischemic Heart Disease and Coronary Artery Bypass Grafting,” with a grand total of slightly more than 2,000 questions in the entire resource. Each question is answered in detail, in some cases with figures and tables. All answers have the relevant literature or textbook references from which the answer was derived.

The only modifications in the PDA version from the hard-copy version is an insignificant change in a single chapter title and the addition of two algorithms, one a systemic approach to emergence and extubation and the second an algorithm for the management of difficult intubation.

I believe that the target audience for this resource is primarily for certified registered nurse anesthetists in training and anesthesia residents because the majority of information is likely known by experienced anesthesiologists.

Interestingly, while the word-for-word conversion of textbooks such as Miller or Barash to PDA format would fail miserably because of their large volume of content, it works surprisingly well in this case. In fact, I believe Anesthesiology: Problem-oriented Patient Management  is improved by conversion to a PDA version because the questions and answers are now separated from each other by a hyperlink so one does not accidentally see the answer before reading the relevant question. In addition, whereas the “Table of Contents” view simply shows the 60 topic headings, the “Main Index” view allows one to search within all topic headings; thus, a search for mitral stenosis returns information not only from the chapter on valvular heart disease but also from the chapter on intraoperative management of obstetric situations. However, one flaw, which this resource shares in common with most PDA resources, is its handling of images. Figures are included but do not appear automatically in the text; instead, one must select a hyperlink and have the image open in a new window, and of course, viewing images on a small PDA is no match for the textbook version.

For those seeking a case-based, problem-oriented approach to a broad range of anesthesia topics, this resource would be a valuable addition to their PDA library. I highly recommend this text in particular to both those starting out in their anesthesia training and those looking for reviews in preparation for written and oral examinations. However, for those seeking a quick review of pertinent points on an upcoming anesthetic procedure or disease process, I recommend The Manual of Anesthetic Practice .1 

McGill University, Montreal, Quebec, Canada. trevor_hennessey@yahoo.com

Husser Casey S: The manual of anesthesia practice, version 1.1.0. Anesthesiology 2004; 101:1490