Interactive Anesthesia Library on CD-ROM (Version 2.0). Editorial Consultant, PG Barash. Philadelphia, Lippincott-Raven, 1997. Price:$395.

With the explosion in medical information coinciding with the development of technology capable of storing massive quantities of data, medical publishers are releasing popular texts on CD-ROM. The Interactive Anesthesia Library combines seven textbooks (more than 7,900 pages of text and 2,900 images), an anesthesia simulator program, and short videos of anesthetic and monitoring procedures on a single CD-ROM and integrates the information using a search engine for key works and hypertext links. Included in this product are Clinical Anesthesia (3rd edition) edited by Barash PG, Cullen BF, and Stoelting RK; Handbook of Clinical Anesthesia (3rd edition), edited by Barash PG, Cullen BF, and Stoelting RK: Review of Clinical Anesthesia (2nd edition), edited by Silverman DG, and Connelly NR; Neural Blockade in Clinical Anesthesia and Management of Pain (2nd edition), edited by Cousins MJ, and Bridenbaugh PO; Pharmacology and Physiology in Anesthesia Practice (2nd edition), authored by Stoelting RK; Anesthesiology: Problem-Oriented Patient Management (3rd edition), edited by Yao FS and Artusio JF; and Textbook of Internal Medicine (3rd edition), edited by Kelley WN. The anesthesia simulator software was developed by Anesoft Corporation (Issaquah, WA) and appears to be a modified version of a larger program. The cost of the CD-ROM is significantly less than the cost of the seven textbooks purchased separately. Although this would suggest an economic advantage for the CD-ROM, newer editions of three of the texts have now been published. Also, the Library does not contain “subspecialty” books with more detailed information about pediatric, cardiac, neurologic, or obstetric anesthesia or treatment of patients in the intensive care unit.

The CD-ROM is compatible for use in either the personal computer or the Macintosh (Apple, Cupertino, CA) environment and requires at least 4 MB RAM and 3 MB hard disk space. A small but clearly written instruction manual is provided, along with on-screen help buttons. The program was easy to install on my personal computer and consistently ran smoothly without system errors. Navigating through the program was quite simple and, when use of the on-screen function buttons was not intuitive, the instructions were helpful. People with little computer experience should be able to take full advantage of the features of this program without great difficulty.

To evaluate this product, I installed the program on my computer at home and in the office. By carrying the CD-ROM between the two locations, I was able to consult the textbooks, both for my practice and my academic needs. For several weeks, I used the CD-ROM as my initial source for textbook information, in addition to exploring the other functions that would be of interest to residents or graduates preparing for specialty examinations.

The main menu, which initially comes on screen, permits access to each of the texts or the anesthesia simulator. From there, the user can go directly to a specific chapter within a book to read the material, as with a printed text. At the beginning of each chapter, there are function buttons that allow an outline of the chapter, a list of figures, a list of tables, or a chapter review to be accessed. From the outline or list of figures or tables, the reader can go directly to the specific material of interest. Because only a small portion of the text is in view at any time, a reference window is present at the top of the screen, which provides the location of the material by book name and chapter number. Buttons on a toolbelt or toolbar at the top of the screen allow specific places in the text to be marked, creating a bookmark for returning at a later time, or a note can be appended to incorporate information for future use. Additionally, the reader can access a highlighter to call attention to specific portions of the material. Selected text, figures, or tables can be printed, allowing for a hard copy of pertinent information.

The most powerful features made possible by this technology are the search functions and links between the seven textbooks, the videotapes, and the anesthesia simulator. Throughout the text, there are active links to the other books, the videotapes, the clinical simulator, or other relevant material, so the reader can integrate the multiple sources of material. A backtrack button on the toolbelt permits the user to return to previous portions of the text. A query function is available through a button on the toolbelt to search all of the textbooks for specific topics or key words. The search returns a listing of the books and chapters in which the information could be found, along with the number of times that the key word is located within the text. By clicking directly on the listing of the text and the chapter, the user moves to the beginning of the selected chapter, and the specific “hit” for the key word is accessed by clicking on a button on the toolbelt. It was quite easy to progress from general medical information in the internal medicine text to the anesthetic implications and management in the other textbooks.

The simulator program provides scenarios to anesthetize one of four patients and allows for a routine anesthetic or permits inclusion of a critical incident. Pharmacologic and physiologic models are used to determine the patient response and permits realistic case management. The documentation provides only a brief description of the simulator and minimal instructions for its operation, and there is no on-screen help for people who are unfamiliar with running this portion of the program. More detailed instructions for this section would be useful.

For trainees or others studying for written examinations, a series of interactive quizzes of several topics is available. The number of questions in each test can be selected and at completion, scores are tabulated. For individual questions, answers are provided and links to related material in the textbooks allows the user to obtain more detailed information regarding the topic.

There are some limitations of the material and the design of the product. When I compared several chapters from the printed books with their electronic equivalents, all of the text, figures, and tables from the original text were included, but there were some instances in which the tables or figures were listed at the beginning of the chapter but were not linked directly to their references in the text. This requires the reader to go back to the beginning of the chapter to locate the pertinent material. The figures on the CD-ROM appear to be scanned in the text and, therefore, the quality of some small details was not as good as the original. The program permitted selected portions of a Figure orTable tobe magnified, but when this was performed, the reader could not move around the larger image to see other portions of the material or to obtain the overall perspective of what was being viewed. For figures with multiple portions, the program permitted the user to enlarge one part at a time, but after doing this, it was not possible to return to the larger Figure withoutclosing and then reopening it. For tables that were too large to be viewed in their entirety on one screen, scrolling in all directions was possible, but it was difficult to follow rows across columns to integrate the information. Subtitles in the text, which are listed in bold in the printed books to permit the reader to skim through the information to search for a specific topic, are not bolded in the electronic version. Therefore, the subtitles are less visible, and the transitions between portions of the text are hard to delineate. Finally, I was unable to locate information concerning the CD-ROM regarding the dates of publication of any of the books, and, for the multiauthored texts, the titles and affiliation of the contributing authors were not provided for those who would like to know more about the chapter authors.

Overall, the Interactive Anesthesia Library is recommended for anesthesiologists who have access to a computer at work or in a study location. There are some limitations associated with the electronic format, and an occasional user may find it difficult to make the transition to reading material from the screen rather than from a printed page. But, there are tremendous advantages, such as the search functions and text linkages between the books. I believe it would be a worthwhile tool for people studying for examinations because it collates information from multiple sources and provides practice tests. Inclusion of subspecialty texts in subsequent versions of the CD-ROM would be quite useful for anesthesiologists requiring more detailed information for patient treatment.

Arnold J. Berry, M.D., M.P.H.

Professor of Anesthesiology; Emory University School of Medicine; Department of Anesthesiology; Emory University Hospital; Atlanta, Georgia 30322;

(Accepted for publication December 5, 1998.)