Pharmacology & Physiology in Anesthesia Practice, 3rd edition. By Robert K. Stoelting. Philadelphia, Lippincott Williams & Wilkins, 1999. Pages: 822 (including indexes). Price:$95.00.
The long-awaited third edition of the classic text Pharmacology & Physiology in Anesthetic Practice has some large shoes to fill. The second edition of this text has been a favorite among anesthesia residents, nurse anesthetists, and staff anesthesiologists for several years. But two things about my copy of the former edition bothered me:(1) It had grown outdated, especially in the rapidly changing area of pharmacology, and (2) frankly, the book's cover was unattractive. The new version has received a face-lift and is virtually unrecognizable from the outside. The drab gray circa 1970s cover is replaced with navy, red, and gold. It is sleeker, slimmer, and definitely looks great. But the important question was whether the third edition could measure up to its predecessor in content.
The new text follows the old outline closely as it is divided into two major sections that address physiology and pharmacology as it relates to the practice of anesthesia. There are still 58 chapters that are each subdivided into several smaller topics. In section I, the author takes readers through an extensive review of pharmacology, covering 37 major classes of pharmacological agents, and provides a chapter that reviews pharmacokinetics, pharmacodynamics, and stereochemistry. This is followed in section II by a brief discussion of physiology, including 20 chapters that review every major organ system and cover several important and related topics (i.e., pain, nutrition, and fluid management). New information about the latest drugs and some recent advances in physiology are included. Each chapter is enhanced by extensive updates to the tables, figures, and contents. The new version is easy to read, with many great figures and tables that should improve the reader's comprehension. The book makes an excellent review text for residents and nurse anesthesia students. In addition, it is an outstanding standing reference for all anesthesia care providers.
Section I covers the area of pharmacology and has undergone the most extensive changes from the second edition. It includes many new additions. The chapter on pharmacokinetics and pharmacodynamics provides a good discussion of stereochemistry and potential drug-receptor interactions. The author has updated the information on potential mechanisms of action for both intravenous and inhalational agents. I especially liked the addition of several new figures in this section, which improved my overall understanding of the material. The chapters on specific drug classes contain the latest information, and the figures have been revised for easier access to information. I was pleased to find very current information on important items such as sevoflurane, remifentanil, ropivacaine, and opioid receptors. It is to the author's credit that recent topics such as low molecular weight heparin and transient radicular irritation were also addressed. I found the chapters on local anesthetics, opioids, neuromuscular-blocking drugs, and receptors to be well written and arranged. The Drug Index makes material very easy to access. The pharmacology section is this book's best aspect and is a wonderful reference for the busy practitioner.
Section II of the text covers all of physiology in less then 200 pages. It is concise and, of course, incomplete. If an in-depth discussion of cutting-edge research in physiology is needed, it is best to look elsewhere. The author has updated and expanded some topics but has definitely retained the original plan of keeping it light. I was a little disappointed in the pain chapter, which contains very little new information. However, I must admit that the best chapters are the ones that are probably most popular with readers. For instance, the chapters on central nervous system, cardiac, and lung physiology are excellent. The addition of several figures to these sections again should improve reader comprehension. Overall, if a quick review of physiology (with a few missing details) is sufficient, this text cannot be beat.
Pharmacology & Physiology in Anesthesia Practice is a well-written text and fits the bill if a no-frills review and reference is needed. The amount of material covered in this slim volume is generous. At $95.00 it is expensive, but it has a lot to offer. The third edition has been updated with the latest drug information, many new figures, and significant improvements in content. It does an outstanding job in the section on pharmacology, but it remains weak in addressing physiology. This classic is definitely new and improved, and it also looks great on the bookshelf.
John A. Thomas, M.D.
Assistant Professor; Department of Anesthesiology; Wake Forest University School of Medicine; Medical Center Boulevard; Winston-Salem, North Carolina 27157–1009;jthomas@wfubmc.edu
(Accepted for publication April 29, 1999.)
