Handbook of Neuroanesthesia, Third Edition. By Philippa Newfield and James E. Cottrell.Philadelphia, Lippincott Williams & Wilkins, 1999. Pages: 431. Cost: $39.95.

The third edition of the Handbook of Neuroanesthesia  has a new look compared with the second edition. First, the text has been reorganized in an outline manner and supplemented by graphs, figures, and tables, which is more efficient and easier to comprehend for the reader. Second, and more importantly, the authors have updated this book with the most advanced knowledge and techniques of neuroanesthesia, and they have included some new topics, such as preoperative evaluation, neuroradiodiagnostics, nutrition, and others. Finally, the smaller size of this new edition makes it fit more easily in one’s pocket.

This book is divided in three sections: General Considerations, Clinical Anesthesia Management, and Neuro-Intensive Care issues. Each section contains chapters that are written by different authors. In section 1, the authors start with advances in basic neuroscience and review neurophysiology and pharmacology, including, for example, evaluation of the effect of new volatile and intravenous anesthetics on cerebral blood flow/cerebral metabolic rate regulation. For perioperative monitoring, in addition to the traditional techniques, the author also briefly discusses some newer techniques (such as transcranial Doppler ultrasonography, jugular mixture venous oxygen saturation, cerebral oximetry, and others), providing a useful introduction to the reader. The chapter on cerebral protection and resuscitation contains a diagram that illustrates the relations among primary injury, neurotransmitters, and secondary injury, and it discusses some of the interventions to prevent or decrease secondary injury. This includes an emphasis on things that are a focus in the operating room every day (maintaining global/cerebral oxygenation, avoiding hypoperfusion and hyperglycemia, decreasing temperature, and others). In part 2, each chapter clearly discusses some of the key points for different neurosurgical procedures (e.g. , patient positioning, induction, maintenance, and emergency anesthesia). Each chapter also contains a list of pitfalls and clinical scenarios. The authors updated this handbook with some of the newest practice guidelines (e.g. , preoperative evaluation for patients undergoing carotid endarterectomy, and so forth) and the most advanced techniques, including neurodiagnostic and interventional neuroradiologic procedures, which are areas of increasing involvement for anesthesiologists. In addition to routine postoperative intensive care unit treatment, part 3 discusses new protocols for initiating and weaning patients from ventilatory support and for nutritional management as examples of anesthesiologists’ expansion out of the operating room and into perioperative medicine.

Because each chapter is written by independent authors, with each chapter trying to stand on its own, there are some duplicated graphs, figures, and even text in this book. Overall, this is an excellent handbook. As a newly trained neuroanesthesiologist, I still remember the days of running between the operating room and different sites, including the magnetic resonance imaging building and interventional radiology suites. A pocket-size handbook of neuroanesthesia (which could fit easily into a scrub pocket) would be helpful as a quick reference to start some of the uncommon procedures in these settings. At $39.95, it is worth the cost. I recommend this book to anesthesia residents, neuroanesthesia fellows, and practitioners who perform only occasional neuroanesthesia procedures in remote sites as a quick reference resource.