James C. Eisenach, M.D., Editor.
Anesthesia Drug Manual. Edited by Paul F. White. Philadelphia, W.B. Saunders, 1996. Pages: 378. Price:$35.00.
This manual is an honorable and courageous attempt by these authors to produce a comprehensive, user-friendly outline of commonly and not so commonly used pharmacologic agents. This treatise is directed at anesthesia health care providers, both in practice and in training and critical care and pain management specialists. Intensive care unit nurses might find many portions of this text useful.
The drugs are grouped according to the pharmacologic classification system used by the Physicians Desk Reference and the United States Pharmacopeia. Within each specific drug group, the drugs are listed alphabetically according to their generic names. The authors classify each drug into 1 of 34 chapters from “Adrenergic Agonists and Antagonists” to “Vitamins and Nutritional Supplements.” Each drug is examined according to the following parameters: indications, pharmacokinetics, pharmacodynamics, dosages/concentrations, contraindications, and drug interactions/allergy. The editor also includes an additional section on “Immunizing Agents.”
In the “Indications” sections, we find an effort by each author to briefly describe the clinical situations in which a particular drug is most likely to be used. This is generally done in 10 words or less, and for the majority of drugs this suffices. However, several notable exceptions exist, and for the novice anesthesiologist or nurse anesthetist some of these indications could be misunderstood and thought to be the only indications where the particular agent might be used. As written, this section is primarily useful to those already familiar with the proper use of each pharmacologic agent. Lacking are a few lines on appropriate alternate therapies, if for example, the reader's first choice is contraindicated in a particular patient.
The “Pharmacokinetics” section will not prove as useful to many readers because this section assumes that all readers are familiar and comfortable with terms such as; Cmax, Vd, clearance, protein binding, and T 1/2, alpha, beta and gamma. There appears to be no set format to this section as the presented information varies between and within chapters, from molecular weights to oil and water solubilities and pKa for some agents (calcium channel blockers). Additionally, descriptions of many of the drugs lack any words on metabolism, active metabolic byproducts, or routes of elimination.
The “Pharmacodynamics” section was most informative, well outlined, and easy to read and understand. This section uses a systems approach and covers the side effects and systems interactions of each described agent. The outline format allows the reader to identify key words necessary to the understanding of the proper uses of each drug.
The “Dosage/Concentrations” section offered information on the concentrations of the drugs available but does not always inform the reader as to how these agents are supplied, and many inconsistencies are evident in this section. The most obvious occurred with those drugs described in more than one section (scopolamine and cimetidine). Although the authors made some attempt to include pediatric dosages, there are many sections where these dosages are omitted when considering drugs well known in the pediatric arena. Additionally, many doses were not described in the routine, pediatric mg/kg format. A few pediatric doses were incorrect; phenobarbital and dilantin being among the most obvious examples. Finally, the most obvious of dosage errors occurred where the authors neglected to mention the minimum pediatric dose for atropine.
The sections on “Contraindications” and “Drug Interactions/Allergy” elegantly display the author's goal of offering a manual that would assist in the evaluation of patients on the day of surgery. This is perhaps the most useful section (along with the Indications section). This section outlines possible contraindications or adverse reactions that a particular drug could provoke in pointed and easily readable terms.
Finally, the section on “Immunizing Agents” could have been augmented by using the authors' previous format of “Dosage/Concentrations,”“Contraindications,” and “Drug Interactions/Allergy.” As written, it adds little to the text.
The sections on antimicrobial agents, antineoplastics, bronchodilators and antiasthmatics, hormones, and psychotropic drugs are put together well and worth a read, especially as a quick, fairly comprehensive guide to patients admitted for same day surgery.
The editor skillfully identified many well-respected authors for each chapter. In addition, the outline of the text was fairly easy to digest. The laminated paperback format and price make this text portable, durable, and affordable. Although an excellent idea, this treatment falls somewhat short of the mark of its stated goals and projected target audiences. Expectedly, such a large task produced several inconsistencies. Overall, there is not enough practical information presented in a fashion that will allow most readers to find this a valuable addition to their libraries. It will prove useful to the seasoned health care provider as a pocket reference for drugs not commonly encountered in our daily practices.
Dolores B. Njoku, M.D.
Jackie L. Martin, Jr., M.D.
Department of Anesthesiology and Critical Care Medicine; The Johns Hopkins University; Baltimore, Maryland