Carol A. Hirshman, M.D., Editor

Anaesthesia. Two Volumes. Second Edition. By W. S. Nimmo, D.J. Rowbotham, and G. Smith. Oxford, Blackwell Scientific Publications, 1994. Pages: 1,937. Price:$250.00.

The preface to this second edition of Anaesthesia harbors a highly pertinent comment:“It may not be possible to provide within a single text all the knowledge for the anaesthetist but we see a clear need for modern anaesthetic practice to be summarized in one text….” With this concept, your reviewer agrees, and indeed, the authors have assembled a large, predominately British cast of coauthors with wide knowledge and experience. The two-volume set is divided into five sections totalling 92 chapters spreading over 1,937 pages. The first section undertakes a review of the pharmacology, physiology, physics, and statistics pertaining to anesthesia. Section 2 covers the complete gamut of subspecialty anesthesia. Section 3 embraces local anesthetic pharmacology, then local and regional anesthesia. Section 4 offers a spectrum of topics on acute and chronic pain. Section 5 deals with those few specific topics of intensive care that have significant bearing upon anesthesiologists' concerns in that realm.

Common to all attempts to compose texts of anesthesia to cover all aspects of the practice, there is always a quandary as to where to end. Nimmo et al. clearly designate the target audience as those individuals sitting for Board or Fellowship examinations, and I commend their choice. However, they also offer the book as a “current readable and authorititative work for anaesthetists.” In both regards, I believe they have succeeded. The obvious current transatlantic competition is Anesthesia, edited by Professor Ronald D. Miller. I believe they are comparable texts.

The authors have collected a fine coherent amalgam of topics in anesthesia, pain, and intensive care that have been well edited. There is considerable breadth in subject matter, and few instances of omission exist. For the most part, chapter quality is very high, yet some chapters disappoint, usually because of superficial coverage of rather complex problems. I sensed that the descriptions of the physiology and pathophysiology of the coronary and cerebral circulation were too superficial even for such a general text. Despite the inclusion of a chapter “Crystalloid Fluid Therapy,” the complex and frequently debated crystalloid-colloid controversy that plagues anesthetic practice was dealt with in only two pages. A singular disappointment is the absence of a cogent discussion of right ventricular failure and pulmonary hypertension along with its therapy. Concomitantly, pulmonary vasodilators are poorly dealt with. The chapter on artificial ventilation disappointingly fails to discuss permissive hypercapnia or ventilation with helium/oxygen mixtures. The chapter on breathing circuits and vaporizers still includes low-resistance in-circuit vaporizers, which should be, by now, no longer a facet of practice. Other chapters that suffer from supertificiality are those on liver disease and plastic surgery. Inevitably, there is the occasion for repetition when many authors collaborate in one text, yet with a few exceptions there is little redundancy in this text, the only notable examples being assessment of myocardial risk and preoperative assessment. I would like to commend the editors for including a brief supplemental reading list for each chapter in addition to the extensive reference lists.

Despite this seemingly lengthy discussion of individual criticisms, the text is a highly sound compendium of knowledge with a justifiable strong, didactic clinical emphasis. Moreover, some specific chapters impressed. I mention them, not to denigrate the other chapters in an excellent text, but because they impressed greatly. These included chapters on anesthesia and cardiac disease, ventilatory failure, monitoring, and opioids. I was gratified by the inclusion of chapters about operating room/postanesthesia care unit management and design, as well as a comprehensive chapter on audit of anesthetic practice. These reflect sound, modern progress in the development of our specialty beyond the hackneyed phrase “passing gas” sometimes invoked by our detractors.

Often, the topics poorly dealt with in anesthesia texts are those on statistics and epidemiology. These are superbly discussed here in a sound, concise chapter. Additionally, so often sections on intensive care and pain are poorly thought-out addendums to texts. This is not the case in this reference work. They are well collated topics applicable to the general practice of anesthesia.

In summary, this is a fine text and a solid, well thought-out compendium of the practice of anesthesia as envisioned on both sides of the Atlantic. It befits its stated target audience well and should prove to be a sound preparatory text for anesthesiologists-in-training as well as a reference for graduates.

Simon Body, M.B., Ch.B., Instructor in Anesthesia, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115.