Understanding Anesthesia Equipment, 4th edition. By Jerry A. Dorsch, M.D., and Susan E. Dorsch, M.D. Philadelphia,Lippincott Williams & Wilkins, 1999. Pages: 1,066. Price: $99.00

From a clinical and academic perspective, it was interesting to review a group of topics that remain in a state of continual evolution and development. In the preface to Understanding Anesthesia Equipment, 4th edition  by Drs. Jerry and Susan Dorsch, the authors acknowledge this dynamic process:

Our goals in producing this book were to update subjects found in previous editions and to cover new topics important to anesthesia care providers by bringing together as much of the relevant literature as possible… . It is our sincere hope that this book will be especially helpful to the anesthesia resident or student nurse anesthetist who faces the daunting task of absorbing new knowledge and applying it in practice. It should also be useful to the seasoned practitioner who finds the machine that was a familiar friend has been replaced by one with unfamiliar sounds and computer menus.

Except for one omission, I believe that the authors have accomplished their goals.

This single volume is divided into five sections:“Gas Supply and Distribution Systems,”“Anesthesia Machines and Breathing Systems,”“Airway Equipment,”“Monitoring Devices,” and “Equipment Care and Planning.” In section 1, the reader is introduced to many apparatuses and components. Fortunately, this section is rich with clear definitions. The reader can learn the definition and function of items, such as a rupture disc, a fusible plug, and a manifold changeover device, while also noting the subtle, yet important, differences between a container and a cylinder. Furthermore, this section goes beyond simple definition of apparatuses and components through its in-depth discussion of the intended use of the devices, methods of operation, applications, and associated safety issues.

In section 2, through the use of copious definitions and descriptions and the review of physical principles, the reader can gain a thorough understanding of the anesthesia machine and breathing systems. This section is supported effectively with pictures and diagrams. However, color contrast for the various gases, in addition to the black and white shading found in the schematics, would have made for easier viewing and better understanding.

Section 3 focuses on airway equipment. Consistent with the marked increase in the use of the laryngeal mask airway (LMA) since the third edition of this text was published, the authors devoted an entire chapter to the description, use, and care of this device. Drs. Dorsch offer detailed information about LMA insertion, clinical situations in which the LMA may be of particular benefit, and complications and potential disadvantages of the use of the LMA. I was particularly pleased to see information about the role of the LMA for neonatal resuscitation because many practitioners do not appreciate or consider the use of the LMA for this clinical situation.

Section 4, replete with illustrations, evaluates monitoring devices. Again, the use of color would have made for more readily followed schematics. The inclusion of electronic recordkeeping and perioperative information management systems was a worthwhile addition to this edition.

The final section, which includes a new and important chapter titled “Operating Room Design and Equipment Selection,” nicely concludes this book—a text that may be used by those planning and developing operating room suites.

Another noteworthy feature found in this edition is the placement of board examination–type questions at the end of each chapter. The authors have included answers to all of the questions, along with some additional explanations to selected questions. These questions and answers are of use to all readers, not just those reviewing for the board examination.

This edition has one potentially significant omission. As is now well-recognized, inhaled nitric oxide is a selective pulmonary vasodilator gaining increased use in the treatment of pulmonary hypertension and hypoxemia. Delivery of nitric oxide can be accomplished by use of nasal cannulae, face mask, and critical care ventilators. Intraoperatively, nitric oxide may be administered by anesthesia machines. Nitric oxide delivery through the aforementioned devices is complicated because the inspired nitric oxide concentration depends on many variables, and its administration via  an anesthesia machine may result in rebreathing. Furthermore, there are toxicity issues to be addressed regarding the safe delivery of nitric oxide because of the production of nitrogen dioxide. Because many anesthesiologists will deliver nitric oxide, it would have been useful to discuss methods of nitric oxide delivery and the associated monitoring and safety considerations.

In summary, clinical anesthesiologists use anesthesia equipment every day in practice, and, as such, they should have an excellent working knowledge of these devices and the associated clinical techniques. Understanding Anesthesia Equipment, 4th edition , a comprehensive, clearly written, polished, and referenced text offers anesthesiologists and anesthesia technicians this essential knowledge and insight. I strongly recommend reading this text and including it in all anesthesia libraries.