Clinical Neuroanesthesia, 2nd edition. Edited by Roy F. Cucchiara, Susan Black, and John D. Michenfelder. Philadelphia, Churchill Livingstone, 1998. Pages: 701 (including index). Cost:$125.00.

The second edition of Clinical Neuroanesthesia is an accomplishment of substantial progress from the first edition, which was published in 1990. This text is composed of 21 chapters written by 31 authorities in the perioperative management of neurosurgical patients. There are five new chapters within this text, and many recurring chapters from the first edition have been appropriately expanded and revised. Clinical Neuroanesthesia, 2nd edition is neither a handbook nor a comprehensive authority for the neuroanesthesiologist. It does however provide a framework for the clinical application of scientific concepts for the advanced resident and anesthesiologist who wish to be proficient in the care of patients for neurologic surgery.

Although technically the authors represent eight different institutions, the predominate contributions to this edition are from the Mayo Clinic and the University of Florida. In the “Preface,” not only is this influence acknowledged, but a strong link between these two institutions is also admitted. Accordingly, the reader should take caution in the interpretation of areas in which an institutional bias might be injected. However, with a reference list averaging 143 entries for each chapter, the authors have provided solid support for the concepts presented within this text.

Clinical Neuroanesthesia, 2nd edition is 701 pages, and, with an average text length of 26 pages, most chapters can be read and assimilated in a single setting. This edition is noteworthy for the many invaluable figures and tables that greatly facilitate the reading and understanding of the material provided therein. Clinical Neuroanesthesia, 2nd edition is divided into two sections-"Scientific Foundations" and “Clinical Applications.” In general, the “Scientific Foundations” section provides the appropriate data and theory necessary for the “Clinical Applications” section. However, a major disappointment to this reviewer was the chapter entitled “Cerebral Blood Flow and Metabolism.” This chapter was inadequately updated from the excellent chapter in the first edition. As an example, of 253 references cited in this chapter, only 19 were dated after 1990. Even more astonishing was the failure to even cite “the molecule of the 90s”-nitric oxide-in this chapter. The other chapters in the “Scientific Foundations” section were sufficiently up to date and provided a solid base of understanding for the proper execution of a neuroanesthetic.

There were several chapters in this text that were singularly “worth the price of admission.” Of note, Dr. Mahla's chapter, “Neurologic Monitoring,” was as well a written discourse on the subject as I have read. Dr.'s Black, Sulek, and Day's chapter, “Cerebral Aneurysm and Arteriovenous Malformation,” would be the first 47 pages I would recommend for reading on the subject. Other chapters of exceptional note include Dr.'s Mahla and Horlocker's chapter, “Vertebral Column and Spinal Cord Surgery”; Dr.'s Pollard and Mickle's chapter, “Pediatric Neuroanesthesia”; and Dr.'s Layon, Stachniak, and Day's chapter, “Neurointensive Care.”

In summary, Clinical Neuroanesthesia, 2nd edition is clearly written in a practical manner, and overall provides an excellent foundation of knowledge and understanding for the management of patients who present for neurologic surgery. The A+ components far outweigh the deficiencies, and I recommend this book as a fundamental resource for those training in neuroanesthesia and for those anesthesiologists who wish to update their foundation of neuroanesthesia knowledge and practice. The potential enrichment to the reader from Clinical Neuroanesthesia, 2nd edition is worth its $125.00 price; however, with limited resources, residents have expressed “sticker shock” at its price for a 1- or 2-month neuroanesthesia rotation-for which it is highly recommended.

Daniel J. Cole, M.D.

Professor of Anesthesiology; Loma Linda University; Loma Linda, California;

(Accepted for publication September 23, 1998.)