A Practical Approach to Obstetric Anesthesia. Edited by Brenda A. Bucklin, M.D., David R. Gambling, M.D., and David Wlody, M.D. Philadelphia, Lippincott Williams & Wilkins, 2009. Pages: 546. Price: $85.00.

Obstetric anesthesiology entails all of the usual general anesthetic concerns, plus an array of unique physiologic changes and disease entities that can be quite challenging to manage. With this text, there is a portable and current reference that provides a thorough, yet succinct, presentation of the salient information. A Practical Approach to Obstetric Anesthesia  outlines the essential information for sound practice of evidence-based obstetric anesthesiology in an easy-to-read and well-referenced manner.

Initially, the perspective that this book is part of the familiar series of “A Practical Approach to…” somehow eluded me. As I began to read it though, I felt a likable familiarity to its style and readability that led to my “aha” moment. Being a recent residency graduate, I have relied on the cardiac book in this series a number of times. In that vein, this book is also on the mark.

An estimated two percent of parturients will have nonobstetric surgery during their pregnancy. For anesthesiologists who practice general anesthesia (outside of the obstetric suite) this book has a nice review of nonobstetric surgery during pregnancy that addresses not only intraoperative management, monitoring, and teratogenicity issues, but also pre- and postoperative management concerns.

In the obstetric suite, there is both labor analgesia and surgical anesthesia to consider. This not-so-subtle, yet often misunderstood distinction demands an understanding of the pharmacodynamics of local anesthetics and opioids, as well as the altered pharmacokinetics of the parturient. Here you will find an outline of local anesthetic properties and their implications in the parturient, as well as uteroplacental drug transfer considerations.

The general principles of labor, delivery, and postpartum issues, plus a multitude of disease states and disorders are described as they apply to both the mother and the fetus. One important entity that is not addressed is the impact of illicit drug use on obstetric anesthetic practice. This “great pretender” must be considered in one’s differential diagnosis for hypertension, and its life-threatening complications kept in mind when preparing for and administering anesthesia.

The onerous task of newborn resuscitation, usually provided by pediatricians, occasionally becomes the concern of obstetric anesthesiologists. Those in residency or who have recently finished training can also expect to see this material on the board exams. The algorithm, guidelines, and useful tables highlight a well-written chapter on this subject.

Anyone who has had the pleasure of reading any of the other “Practical Approach” books will understand my endorsement of this book as well. For those who have not, it is time for you to discover its value in your library. A Practical Approach to Obstetric Anesthesia  is a certain asset and addition to the other helpful books in this series. Although the larger texts cannot be replaced by it, as an obstetric anesthesiology attending at a tertiary care teaching institution I will be endorsing this book to our residents to supplement their study of obstetric anesthesiology.

University of Miami School of Medicine, Miami, Florida. dbrauer@med.miami.edu