Clinical Anesthesia, 5th Edition. By Paul G. Barash, M.D., Bruce F. Cullen, M.D., and Robert K. Stoelting, M.D. Philadelphia, Lippincott Williams & Wilkins, 2006. Pages: 1,595. Price: $179.00.

Since its initial publication in 1989, Clinical Anesthesia , edited by Paul Barash, Bruce Cullen, and Robert Stoelting, has remained one of the mainstays of reference for the practitioner of anesthesiology. It has served as a comprehensive text instrumental to the study of anesthesiology for generations of practitioners, residents, and students. The fourth edition was published in 2001, and the fifth edition has been eagerly anticipated.

The latest edition truly represents a leap forward from the already outstanding fourth version. You do not have to look beyond the cover to notice many of the new features contained in this improved version. Previous editions were bound in canvas; now, the latest is presented in laminated hardback, with full-color graphics and more contemporary typesetting. It is hardly recognizable from the traditional Barash. The fifth edition has improved organization, with each chapter introduced in outline form on a blue background with black bold and blue font. On the first page of each chapter, key points are numbered, again in blue type, and identified later in the text in the margin when the topic is presented. These features aid the reader when scanning material to help identify the “lay of the land” and decrease page flipping. Many tables have been redesigned using bullet format with blue background so that vital information jumps out at the reader versus  blending into the page. Overall, the new format maintains the serious appearance of previous editions while being more reader-friendly and attractive.

What about content? The fifth edition is organized along the lines of the fourth, with six sections and 59 chapters. This is 2 more chapters than the previous edition. Some of the authors have changed, and this transition has been seamless. Chapters written by the authors of the previous version have been appropriately updated and, in some cases, reorganized to improve clarity of presentation. Several new chapters have been added, reflecting the changing field of anesthesiology and expanding scope of practice. Chapter 7 is titled “Genomic Basis of Perioperative Medicine” and carries the reader through interesting and relevant topics such as genetic susceptibility to adverse perioperative cardiovascular, neurologic, renal, and pulmonary outcomes. Also included is a section on genetic variability and response to anesthetic agents, which includes a helpful table showing genetic polymorphisms involved in variable responses to common perioperative drugs. Chapter 52 is new and titled “Office Based Anesthesia.” In the fourth edition, this topic was discussed in the chapter titled “Anesthesia Provided at Alternative Sites.” Dedicating an entire chapter to this subject reflects the contemporary growth in office-based anesthesia and the subsequent issues raised. Procedure and office selection, requirements for safe delivery, anesthetic techniques, and emergencies that may require contingency plans are covered in detail. Issues regarding accreditation, regulations, legal aspects, and information adapted from the American Society of Anesthesiologists Task Force on Office Based Anesthesia are included, among other subjects.

The political and social climate in the United States has been reshaped since the events of September 11, 2001. The final chapter in the fifth edition is new and titled “Disaster Preparedness and Weapons of Mass Destruction.” This is intended to highlight key topics ranging from potential terrorist threats of biologic, nuclear, or chemical nature to other scenarios of mass casualties, whether intentional, accidental, or a result of natural phenomenon. The Joint Commission on Accreditation of Healthcare Organizations 2004 Emergency Management Standards are presented in clear and concise format, and the role of the anesthesiologist in managing mass casualties is discussed. This chapter is an outstanding summary of important information relevant for healthcare providers at many levels.

Obesity has emerged as a growing epidemic in the United States and other Western societies. The anesthetic implications are obvious from a multisystem standpoint, and Barash recognizes this by allotting an independent chapter to the topic. Previously, obesity was lumped with other gastrointestinal disorders in a single chapter. The current coverage has been expanded to include not only a complete section on relevant physiology and pharmacology, but also an inclusive discussion of bariatric surgery, complete with helpful schematics of the various surgical techniques and patient positioning. As clinicians, we are clearly seeing a striking increase in morbidly obese patients for all types of surgical procedures, and the proliferation of bariatric surgery is affecting many in community and tertiary care settings.

Overall, the fifth edition of Clinical Anesthesia  continues the tradition of excellence seen in previous versions. This text is attractive, reader-friendly, and updated to reflect the changing science and practice of anesthesiology. There is no doubt Barash will continue to hold its place as one of the premier references of anesthesiology, and it is recommended as a core resource for the library of every anesthesiologist.

Mayo Clinic–Arizona, Phoenix, Arizona.