James C. Eisenach, M.D., Editor

Introduction to Anesthesia. Edited by D. E. Longnecker F. L. Murphy. Philadelphia, WB Saunders, 1997. Pages: 518. Price:$47.50.

I well remember my first rotation in anesthesia, with my copy of the sixth edition of Introduction to Anesthesia as my guide. It was part of the critical mass that sparked my interest and fascination with our specialty. Now comes the ninth edition, with the expected improvements and advancements, but still as fundamental as ever.

The book is divided into seven sections, which include, among others, “Preparing to Administer Anesthesia,”“Administering Anesthesia,”“Drugs Used in Anesthesia,” and “Patients with Special Requirements.” The order of the chapters flows logically, and reading the book cover-to-cover will not leave the reader confused, a result of the logical buildup of knowledge. However, there are a few bumps along the way. “Hazards of Anesthesia,” which deals with intraoperative problems, is in the section on “Care Outside the Operating Room.” The figures and tables nicely complement the text, although a few of the figures were of marginal quality.

In general, I found the writing superb, and rarely were explanations confusing. But, I am not a third-year medical student anymore! What might seem logical to me might not be logical to a beginning student. In any case, there were some gems, which might not be appreciated by the novice, but would be by those of us who have had our share of challenges in the operating room. For example, in a wonderful chapter entitled “Conduct of General Anesthesia,” the reader is taken step-by-step through a general anesthetic. The author writes “Target planning requires that the anesthesiologist imagine the state to be achieved for the patient at the end of the case and work back in time to plan the needed steps to achieve that state.” A very basic tenet, one that I wish my residents would learn sooner rather than later. I also found the chapters dealing with patient diseases to be generally excellent. These chapters leave no doubt as to the anesthetic implications of preexisting disease.

There is little for me to disagree with in this book. But one example is in the chapter on premeditation. The author writes “Diazepam is unsuited for parental use because of inconsistent absorption from intramuscular sites and pain and phlebitis after intravenous injection.” In a perfect world, we would all use midazolam, but we live in a managed-care era, and believe me, intravenous diazepam is back! Also, in the chapter on patients with renal disease, the author writes that sevoflurane can be used in patients with renal disease. Considering the potential problems with Compound A, this is a controversial statement. My final complaint regards the reference sections. Generally, there were few references, which I found incongruous, especially in a book that took the time, effort, and space to include a chapter on developing personal learning habits. But more bothersome, was that the references were not specifically cited in the text, but were “general references,” which leave the reader struggling to find which specific reference is being cited-never a good thing as far as I am concerned. Lastly, a random check of 20 references revealed five errors, based on the citations in Medline. None of these errors were serious enough, however, to make it difficult for the reader to retrieve the references.

There are a few glaring errors in the text. In the chapter on obstetric anesthesia, the reader is told that hypotension after a spinal block can be managed with 20–40 mg of phenylephrine. This could easily confuse a novice. On the next page, subarachnoid injection of fentanyl, 25–30 mg, is recommended. Even a novice will think something is amiss when he or she tries to inject 500 ml of fentanyl into the subarachnoid space. There are several errors of this type in this chapter, and hopefully these will be removed from the next edition. Another error occurs in the discussion of malignant hyperthermia (Chapter 36), as we are told that MH is triggered by potent inhaled anesthetics and nondepolarizing muscle relaxants. Further, the phone numbers and addresses for MHAUS and the North American MH Registry are out of date.

In general, I found this book easy to read and enjoyable as well. Despite the minor drawbacks, I still highly recommend it, and it will no doubt continue to inspire (and be part of the critical mass of) many future students to come.

Joseph F. Antognini, M.D.

Department of Anesthesiology; University of California, Davis; Davis, California 95616