Obstetric Anesthesia Principle and Practice, Second Edition. Edited by David H. Chestnut. St. Louis, Mosby-Yearbook, 1999. Pages: 1112. List Price: $125.00.

Five years have elapsed since the publication of the first edition of this textbook in obstetric anesthesia. Dr. Chestnut has again brought together a variety of distinguished authors from different institutions to achieve a well-balanced textbook that elucidates the fundamental principles of obstetric anesthesia.

It is fitting that the textbook starts with a contribution to the history of obstetric anesthesia. As in the first edition, the second edition is divided into 10 parts. Each part comprehensively covers a specific area of interest. The format in which the text is arranged makes this book very easy to read. However, the line diagrams are in black and white but they contribute significantly to the flow of the narrative. The textbook has a good cross-referencing system that allows the reader rapid access to a specific query, and serves as an exceptional reference book.

New concepts have been incorporated into many of the chapters in this edition. Chapters describing the physiologic changes during pregnancy, fetal physiology, uteroplacental flow, and placental transfer of drugs are thorough and well documented. Each chapter is succinctly summarized with key points.

One of the greatest strengths of this textbook is the chapter on regional analgesia and anesthesia. In the last 5 yr, several studies have implicated epidural analgesia to increase the incidence of assisted delivery. Dr. Chestnut writes a thorough review of the pathophysiology and pharmacology of assisted delivery. He highlights some of the inadequacies of studies and presents a logical and balanced argument that helps the reader understand the complexity of assisted delivery.

The second addition also reviews newer clinical techniques. For example, the combined spinal-epidural technique has regained popularity in obstetric anesthesia and this is referenced in many of the chapters. There is a review of anesthesia-related complications in obstetrics, which is exceptionally well done. Clinical relevance is supported by evidence from recent reports on the confidential inquiry into perioperative deaths in England and American Society of Anesthesiologists’ closed claims project database.

The text also includes significant chapters on preterm labor, abnormal presentation, multiple gestation, fever, and infection. Postpartum hemorrhage is thoroughly covered. There is a good summary of the parturient with systemic disease. I enjoyed reading the chapter on neurologic and neuromuscular disorders.

There are a few minor deficiencies of this book. Some chapters did not contain significantly new information from the first edition. This may reflect a lack of suitable new material or the opinions of the chapter author. A paperback edition may be more affordable for some students of anesthesia and easier to carry.

Overall, the second edition has some commendable improvements on an already outstanding reference. This textbook will be an invaluable addition to the library of any anesthesia practitioner, neonatologist, obstetrician, or midwife. It deals with the fundamentals of obstetric anesthesia in a balanced manner with emphasis on evidence-based data. I would recommend this textbook of obstetric anesthesia to all who participate in the care of parturients.