Chestnut's Obstetric Anesthesia: Principals and Practice, 4th Edition.  Edited by David H. Chestnut, M.D., Linda S. Polley, M.D., Lawrence C. Tsen, M.D., Cynthia A. Wong, M.D. Philadelphia, Mosby Elsevier, 2009. Pages: 1,222. Price: $199.00.

The practice of obstetric anesthesiology requires a robust knowledge of anesthesiology, obstetrics, medicine, and neonatology. These fields are advancing daily, and our population of parturients is only getting more complex. An up-to-date comprehensive reference book available in hard copy and electronic form can help the obstetric anesthesiologist navigate his or her daily practice with excellence. The newly updated Chestnut's Obstetric Anesthesia: Principals and Practice , 4th edition expertly provides us with this vital resource.

The previous editions of this book were solely edited by David Chestnut, one of the premier authorities in the specialty, and were considered among the best obstetric anesthesia textbook resources, competing only with Shnider and Levinson's Anesthesia for Obstetrics . However, this book adds three new editors, all of whom are highly respected within the obstetric anesthesiology community: Linda Polley from the University of Michigan, Ann Arbor, Michigan; Lawrence Tsen from the Brigham and Women's Hospital in Boston, Massachusetts; and Cynthia Wong from Northwestern University in Chicago, Illinois. Their lifelong dedication to the field of obstetric anesthesia and the depth and breadth of their research in obstetric anesthesiology shine through in this new edition. With 72 other contributors, 32 of whom are new to the 4th edition, this acclaimed team produces a text that is truly a work of art. It is precise in its language, comprehensive in its content, and up to date and well referenced in nearly every subject matter.

The cover of the book is remarkable in its artistry, simplicity, and class—a black background with an artistic rendition of a mother embracing her fetus, which is visible within her gravid uterus. A third color, teal, has also been added to the pages, providing additional contrast to the excellent tables and figures throughout. The “Key Points” box at the end of each chapter remains a concise recap that provides a multitude of pearls for the anesthesia learner. Finally, when a reader purchases the book, the front cover contains directions to activate an account on at no further cost, such that the entire book can be accessed online and searched electronically.

Two new chapters have been added since the prior edition, making this edition truly progressive among anesthesia texts. David Birnbach, M.D., M.P.H., University of Miami, Miami, Florida, another highly respected member of the academic obstetric anesthesia community, and Eduardo Salas, Ph.D., University of Central Florida, Orlando, Florida, a professor of psychology and world leader in human systems integration research, wrote a superb chapter on “Patient Safety and Team Training.” Here, medical errors, near misses, and sentinal events are defined, the “swiss cheese model” of organizational errors is discussed, and the ways to create a healthcare culture that builds a safer system is outlined. Further, the authors provide an excellent discussion of the characteristics of effective teams and the ways in which simulation and drills can be used in the labor and delivery setting for both training and performance assessment. Jill Mhyre, M.D., University of Michigan Health System, Ann Arbor, Michigan, yet another respected obstetric anesthesia colleague, wrote the chapter on “Maternal Mortality,” which contains a refreshingly inclusive section on global maternal mortality and a disquieting table with data on maternal mortality in various developed and developing regions of the world.

Multiple chapters have been rewritten in their entirety. Other subjects, such as “Anesthesia for Cesarean Section” and “Anesthesia for Fetal Distress,” which were previously covered in two chapters, have been condensed into a single chapter, “Anesthesia for Cesarean Delivery.” The chapter “Epidural and Spinal Analgesia/Anesthesia for Labor and Vaginal Delivery,” which had been broken down into three sections and each written by different authors in the prior edition, has been reorganized and partially rewritten by Cynthia Wong. I believe it to be the most concise, yet thorough, review of this subject available. It covers informed consent through pelvic floor injury and everything in between. It would be excellent required reading for new trainees working on labor floors. Overall, all chapters seem to have undergone at least some revision for the better, even the chapter on “The History of Obstetric Anesthesia.”

Beginning with this first chapter, “The History of Obstetric Anesthesia,” through the final Appendix, “Online Resources for Obstetric Anesthesia Providers,” this book covers every aspect of the practice of obstetric anesthesia: old and new. It maintains a healthy depth of basic clinical knowledge while incorporating the latest evidence, guidelines, and trends. As a result, it remains a comprehensive resource for the novice, the experienced obstetric anesthesiologist, and anesthesiologists who only occasionally practice obstetric anesthesia. This book is no longer one of the best obstetric anesthesiology textbooks; it is the best obstetric anesthesiology textbook available and a necessity for the library of all anesthesia providers who care for pregnant women.

Katherine W. Arendt, M.D.

Mayo Clinic College of Medicine, Rochester, Minnesota.