Principles of Physiology for the Anaesthetist, Second Edition. By Ian Power, M.D., and Peter Kam, M.D. London, United Kingdom, Hodder Education, 2008. Pages: 472. Price: $65.00.

Attuned to subtleties, the anesthesia provider is accustomed to observing a twitch of the hand or a quickening of the pulse and perceiving through such a detail several important implications about the body's dynamics. The submicroscopic saturation of receptors, the complex equilibration of the body's fluid, a glitch in the heart's circuitry—all of these are germane to our practice. Anesthesia as a specialty has earned respect in the House of Medicine for its ability to perceive and respond to such subtle trends. It is thus a fitting reception for the anesthetic field to welcome the second edition of Principles of Physiology for the Anesthetist,  by Drs. Ian Power and Peter Kam. In this conveniently sized, soft-back textbook, the authors offer a concise and targeted resource for the anesthesia provider to refine or refresh an understanding of pertinent physiology.

First published in Britain in 2001, the second edition adds over 70 pages of material and marks several updates and improvements. Students of anesthesia preparing for certifying exams will be pleased to find that the book has retained its earlier helpful figures and illustrations, and has added a valuable Reflections  section to each chapter. These summaries are helpful as overviews in prereading chapters and, combined with the new Key Equations and Tables  glossary, form a useful resource for students seeking a quick review for test preparation.

The scope and depth of the text are excellent—it touches on the broad canvas of human physiology, but most of the content is dedicated to topics of most pertinence to anesthesia. Cardiac, respiratory, renal, and neurophysiologic issues take the forefront, but other topics important to anesthesia such as immune, liver, and metabolic physiology are also handled in depth. The authors have included helpful chapters on the physiology of pain and the physiology of aging, as well as a compelling Special Environments  chapter that discusses the physiology of diving, altitude, and even space travel. The Learning Point  and Reflections  sections help the book to maintain a comprehensive focus without miring the reader in minutiae. However, the discussions are detailed enough to satisfy even a veteran seeking a refresher on the cell-level functioning of N -methyl-d-aspartate receptors or the formulation of the Nernst equation.

Principles of Physiology for the Anesthetist  has few drawbacks and favors well in comparison to similar texts. It provides even more figures and reader-friendly summaries than Stoelting and Hillier's Pharmacology & Physiology in Anesthetic Practice,  and is more focused and concise than general texts such as Guyton and Hall's superb Textbook of Medical Physiology .1,2If the book has a drawback, it is the extent to which the principles of physiology are discussed in the context of clinical anesthesia. For instance, a detailed and graceful description of the determinants of venous return to the heart deals with standard physiology but would benefit from a discussion of how positive pressure ventilation, anesthetic agents, and surgical positioning affect the venous return (pp. 157 and 158). The discussion of normal renal physiology is comprehensive and helpful, but particular concerns for an anesthesia provider such as renal failure and the effects of vasopressors or volatile agents on the kidneys are not discussed. Elsewhere, neuromuscular blockade is described with memorable references to snake toxins and antiquated pharmacology but with only general reference to drugs current in clinical practice (pp. 19 and 24). While not always overtly treating anesthetic issues in physiology, the selected content of the book never strays too far from topics central to anesthesia, and does so with a reader-friendly format.

Drs. Power and Kam have produced an excellent text that will help perpetuate the expertise in physiology that belongs to the field of anesthesia. Whether the reader is a student of anesthetic practice or a veteran looking for a reference to refresh the fundamentals, Principles of Physiology for the Anesthetist  offers a concise and authoritative resource.

*Mayo Clinic Rochester, Rochester, Minnesota.

Stoelting RK, Hillier SC: Pharmacology & Physiology in Anesthetic Practice, 4th edition, Philadelphia, Lippincott Williams & Wilkins, 2006
Lippincott Williams & Wilkins
Guyton AC, Hall JE: Textbook of Medical Physiology, 11th edition, Philadelphia, Elsevier, 2006