Anesthesia Unplugged: A Step-by-step Guide to Techniques and Procedures. By Christopher Gallagher, M.D., Ricardo Martinez-Ruiz, M.D., and David Lubarsky, M.D. New York, McGraw-Hill Medical, 2007. Pages: 462. Price: $89.95.

I have spent much of my academic life explaining to medical students and nonanesthesiologists that procedures are not all that anesthesia is about. Therefore, when I started to read this book I had a natural antithesis to it. That having been said, it is a very good book. It is exactly as the title suggests, a step-by-step guide to any procedure you might want to perform in the course of anesthetic management. It starts out with simple things such as placement of intravenous catheters and explains how to perform this technique in the same way any of us would explain to students and residents. Subsequent chapters include helpful guides to placement of internal jugular, brachial, subclavian, and femoral venous catheters and how to pass pulmonary artery catheters. The book then progresses to techniques for placing arterial catheters, obtaining and managing airways, and handling many other techniques, such as performance of spinals and epidurals, regional blocks, lung isolation, transesophageal echocardiology, and transvenous pacing. There are even chapters on operating room efficiency and positioning.

The style of writing is breezy, irreverent, and unaffected. This makes reading quite entertaining and not at all difficult. These characteristics are important advantages for a clinical textbook. I had both a resident and a student nurse anesthetist each read selected chapters, and they thought the teaching points were excellent and useful. Importantly, they wanted to know where to buy the book.

There are some excellent features of this book. Each chapter clearly gives indications, contraindications, complications, and helpful hints for problems that may occur. There are photographs that follow the explanations, and they are clear and helpful. One of the more interesting features is the reference section at the end of each chapter. It is annotated, with a short synopsis describing each reference. I have never seen this summary approach used in a text before, and it makes it easy to decide which references to go to for more information. There were other helpful features. For example, in the airway chapter there was a great suggestion on how to preoxygenate the claustrophobic patient: Simply remove the mask from the circuit and let the patient breathe through the tubing like a straw. The pacemaker and transesophageal echocardiology chapters do not pretend to be authoritative texts, but they do give good basic information on how these technologies work.

There are a few weak points to consider. I think regional blocks are better covered in regional textbooks, although this book is a reasonable introduction. The authors mention “external Zoll® pads,” which is a great plug for that particular company (ZOLL Medical Corporation, Chelmsford, MA), but leaves out everyone else who makes external pacers. Some of the irreverence is completely unnecessary and may be offensive to some readers. For example, in the airway chapter there is a column about masks worn by Batman, Superman, and the Lone Ranger. Why? In a reference to lack of preoxygenation, there are several nonsensical comments such as “you’ll be hip deep in caca” and “you’ve already screwed the pooch.” In the regional chapter, there is a series of photographs that keep referring to the model “looking dead.” These types of statements are completely unnecessary and if edited out would add to a better professional approach to teaching procedures.

All in all, I think this book is a useful addition to the teaching armamentarium in anesthesia. Learners will enjoy learning from it, and teachers will find it a useful guide and reference. If subsequent editions seriously edit out the less professional statements, it will be even better.

Columbia University College of Physicians and Surgeons, New York, New York.