James C. Eisenach, M.D., Editor

Ocular Anesthesia. Edited by S. Greenbaum. Philadelphia, W.B. Saunders Company, 1997. Pages: 237. Price:$70.00.

Anesthesiologists may find it difficult to believe that a 237-page textbook can be written on the subject of ophthalmic anesthesia. This relative verbosity is paradoxically the strength and weakness of Ocular Anesthesia, a new textbook edited by Scott Greenbaum. Each subspecialty becomes the subject of a comprehensive commentary on the ideal ophthalmic anesthetic. For instance, the chapter on “Anesthesia for Cataract Surgery” contains all of the information one would ever desire on the history, anatomy, procedures, and complications of anesthesia for this common operation. Unfortunately, the editing of this book allows for similar detail to be found in the chapters on vitreoretinal surgery, refractive surgery, and so on.

The reader who is willing to wade through pages of redundant information is rewarded with wonderful snippets of information. The history of ocular anesthesia, clear descriptions of eye and adnexa anatomy accompanied by remarkable illustrations, detailed technical narrations of the major ocular and facial nerve blocks, and comprehensive discussions of anesthetic complications are otherwise obscured by yet another version of retrobulbar block. Some specific commentary is excellent, such as the pertinent relationship of intraocular pressure and general anesthesia. The sole contributing anesthesiologist offers practical wisdom on special patient situations, such as preoperative hypertension, anticoagulation, coughing, or claustrophobia.

The publisher identifies ophthalmologists as this book's primary audience, with anesthesiologists constituting a secondary market. One suspects most ophthalmologists will gain little from specific descriptions of anesthetic induction agents, although the section on sedating patients for oculoplastic procedures is reasonably well done. Although explicit discussions about malignant hyperthermia and masseter muscle spasm may on first glance seem irrelevant, they do serve to educate ophthalmologists about anesthetic complications. Anesthesiologists will no doubt find much of this new book curiously outdated. For example, it warns against the potential for ventricular dysrhythmia when epinephrine is used in conjunction with cyclopropane, advises preoperative chest radio-graphs in patients aged more than 60 yr, and suggests liver enzymes may be indicated if the patient is to undergo general anesthesia.

Because this book is relatively inexpensive ($70.00), Ocular Anesthesia may be a suitable reference text in centers where anesthesiologists actually perform eye blocks as part of their practice. However, most practicing anesthesiologists and residents can procure the essentials of ocular anesthesia from standard textbooks such as Miller's Anesthesia or Brown's Atlas of Regional Anesthesia.

Joseph M. Neal, M.D.

Department of Anesthesiology; The Mason Clinic; Seattle, Washington 98101