James C. Eisenach, M.D., Editor
Principles and Practice of Anesthesiology, 2nd Edition. Edited by David E. Longnecker, John H. Tinker, and G. Edward Morgan, Jr. St. Louis, Mosby-Year Book, 1998. Pages: 2,529. Price:$247.50.
The second edition of this two-volume text is an excellent and complete anesthesiology textbook. It is both a thorough review for residents and a concise reference for practicing anesthesiologists. As the editors point out in their introduction, the outline of Principles and Practice of Anesthesiology focuses on the disease processes of patients rather than on the procedures and techniques of anesthesiology. The intention of this unique approach is to emphasize the role of the anesthesiologist as a perioperative physician rather than as a technician. In meeting this goal, the text's outline is somewhat unconventional, but after a review of the Table ofcontents I found its 2,500 pages easier to read than anticipated.
The chapters are outlined for quick reference and end with bulleted “key points.” Throughout the text there are boldfaced items and summarizing tables, included for emphasis and review. The “key references” are current and thorough. The text is divided into five parts. The first, titled “Approach to the Patient,” starts with preoperative evaluation of the healthy patient and moves through premedication, monitoring, anesthetic planning, and common intraoperative and postoperative complications. It continues with the approach to particular disease processes. Individual chapters are devoted to an inclusive variety of medical problems, ranging from neonates to the elderly and from dermatologic conditions to trauma patients. Chapters deserving special mention for particular clinical usefulness include Drs. Ross and Tinker's chapter on adult cardiac disease and Drs. Kopp and Boysen's evaluation of pulmonary problems.
The second part is entitled “Anesthetic Care” and is divided into patient safety, monitoring, inhalation anesthesia, intravenous sedation and analgesia, regional anesthesia/analgesia, and pain and concurrent drugs. Oddly, a chapter on the physiology and pharmacology of the autonomic nervous system and two chapters on the physiology and pharmacology of neuromuscular blockers are included under patient safety. Although it is perhaps misplaced, Pino and Basta's summary of the pharmacokinetics and pharmacodynamics of neurmuscular blockers is very complete.
Monitoring is covered thoroughly with current and extensive descriptions of the use of transesophageal echocardiography and hemodynamic monitoring and neurologic and respiratory monitors. The chapter on neurologic monitoring provides a particularly useful review by Robert McPherson of the application of intraoperative electroencephalography and evoked potentials. Included in the monitoring section is a chapter addressing the management of electrolyte abnormalities and acid-base disorders and the replacement of fluids. This is an extensive list of important topics for one chapter, but Dr. Sendak provides a useful guide to management of these common perioperative issues. This chapter provides practical summaries for board review. The next two sections under “Anesthetic Care” discuss inhalational and intravenous anesthetic pharmacology very thoroughly. Dr. Eisenkraft's chapter discussing anesthesia delivery systems and Drs. Ovassapian and Meyer's summary of airway management are excellent references for junior residents. Somewhat randomly intermixed within this second part labeled anesthetic care is a section discussing regional anesthesia and pain. The final section addresses concurrent drugs, including cardiovascular agents, antibiotics, and corticosteroids.
The third part of Principles and Practice of Anesthesiology covers “Specialty Areas of Anesthetic Practice.” There are 21 chapters that detail anesthetic management for different surgical subspecialties. In my opinion, this is that most useful part of the book. It provides a comprehensive resource for the practicing clinician and a starting point for residents. There is surprisingly little redundancy when one compares these chapters with the previously mentioned chapters relating anesthetic approach to the patient with medical problems.
Postoperative recovery and complications are discussed in the fourth part of this textbook. There is a description of the normal recovery process and a chapter dealing with acute postoperative pain management in which Dr. Ferrante reviews the pathways of pain transmission with clear and simplified diagrams. I found the six chapters that detail common postoperative complications to be comprehensive. Drs. Todd and Warner's chapter explaining central nervous system protection during anesthesia is oddly placed under postoperative complications.
The final and perhaps most currently relevant section of Principles and Practice of Anesthesiology addresses the social and ethical issues pertinent to the anesthesiologist. Drs. Tinker and Hesson summarize legal situations involving malpractice and contracts and government rules and regulations. Substance abuse is another crucial issue that is well addressed. Quality improvement and cost-effectiveness as they relate to anesthesia are discussed in the last two chapters. There is an excellent formulary of drugs commonly used in anesthesia practice, including the doses and estimated costs, which is found on the last pages of this second edition.
This book has been available to me for the past 3 months, and I have read it not only to write this review but also as a study adjunct for board preparation and as a daily reference for case management. Drs. Longnecker, Tinker, and Morgan acknowledge that critical care medicine is too large a subspecialty to be adequately covered in this text, and I would add that pain management is also not thoroughly reviewed. Regional techniques for pain management and acute postoperative pain are addressed separately, but there is no discussion of common pain syndromes. As noted previously, pharmacology is somewhat divided throughout the text in various parts and chapters. Overall, Principles and Practice of Anesthesiology is a well-written, well-referenced, and easily understood textbook of anesthesiology. Despite its 2,500 pages and $250 price tag, I would highly recommend it as a comprehensive and succinct resource for anesthesia care providers at all levels of training and beyond.
Laura S. Dean, M.D.
Assistant Professor; Department of Anesthesiology; Wake Forest University School of Medicine; Winston-Salem, North Carolina 27157
(Accepted for publication October 3, 1998.)
