Essentials of Anesthesiology, Third Edition. By David C. Chung and Arthur M. Lam. Philadelphia, W. B. Saunders Company, 1997. Pages: 351. Price:$30.00.
Essentials of Anesthesiology, written by David Chung of the University of British Columbia and Arthur Lam of the University of Washington, is now in its third edition. The book continues to be aimed at the clinical clerk, and in that task it clearly succeeds. As a third-year clerk, I remember asking one of my attending physicians which book I should read as an introduction to anesthesiology. I was directed to Dripps, Eckenhoff, and Vandam, which probably is too long and bulky for a harried, mobile clerk. Chung most likely would have fulfilled my needs perfectly at that stage of my career.
This introductory text has been modified to deemphasize subspecialty areas with a return to basic principles and practice. Updated areas include checkout procedures, pharmacology, and airway assessment. New chapters include airway management and acute postoperative pain. Chapters are divided into classical areas such as inhalational agents and opioids, allowing for quick assimilation of related materials. The book is clearly written, with many well-designed tables and diagrams. Some sections, although, include information that appears anecdotal, and because the book is not referenced, it is difficult to delve deeper. A “Further Reading” appendix refers mostly to other standard textbooks of anesthesia and a few classical references. I am not sure that this section easily leads to further efficient study.
The introductory chapters are succinct and well written. The chapter on “Inhalation Anesthetics” includes much information, but it may have been more clear if tables including blood-gas coefficients, and so on, were included. Diagrams of agent structures I believe would help to integrate information relating to the effects of the volatile agents and should have been included.
The “Opioids” chapter is superb with a good table on receptors and generous information on each of available drugs. I took notice of a few statements: e.g., cardiac dosing of fentanyl 50–150 micro gram/kg, which is relatively old thinking. Again, a summary table would help to summarize much of the data presented.
"Muscle Relaxants" is complete and a stand-out chapter. In contrast, “Local Anesthetics” has a good introduction but includes very little information on each drug. Perhaps more depth is warranted because these agents are used by essentially all physicians, and a good background source from an anesthesia rotation might be helpful.
"Anesthetic Circuits" and “Mechanical Ventilators” also are very well-written chapters with clear charts and diagrams. I wish that I would have had access to such a compact source of information on equipment when I began my career in anesthesia.
The “Airway Management in Anesthetized Patients” chapter is billed as complete on the back cover but misses newer techniques such as the Bullard laryngoscope. The LMA is appropriately discussed, as is fiberoptic intubation (without diagrams). Again, more detail is warranted because for some clerks, this may be their only exposure to airway management, i.e., it should at least mention all available modalities.
The “Pain” chapter serves as a solid introduction to this evolving subject. “Blood Transfusion in Surgical Patients” is clearly the best, concise treatise on the subject that I have read. The index is above average for a book of this type.
In summary, Chung performs well in introducing many of the most important concepts in anesthesiology today. It is a logical choice for clerks and also as the first read for beginning residents. At $30, the book is a good value, and its size allows placement in the back pocket of scrub pants. Its weaknesses are few and will be soon forgotten when the student of anesthesia moves up to one of the larger introductory texts.
Mark F. Trankina, M.D.
Assistant Professor of Anesthesiology; Cardiovascular Division; University of Florida College of Medicine; 1600 SW Archer Road; Gainesville, FL 32610–0254
