Decision Making in Anesthesiology: An Algorithmic Approach. By Lois L. Bready, Rhonda M. Mullins, Susan Helene Noorily, R. Brian Smith. St. Louis, Mosby, 2000. Pages: 688. Price: $79.00.

Philippe E. Gautier, M.D.,* Bernard Vanderick, M.D. *Clinique Ste Anne-St Remi, Brussels, Belgium.

Despite its austere title, interestingly pointing to the Arabic origin of our numeration system, this is already the third edition of a homogeneous collective work written by more than 140 authors. The book is divided into seven sections: principles of anesthesia, resuscitation, preoperative problems, specialty anesthesia, postoperative management, chronic pain management, and hyperbaric oxygenation. The ensuing 223 chapters address most of the clinical dilemmas of our daily work. The answers are not exhaustive because this is not the aim of the book, but they are clear and precise. Each chapter is introduced by a short theoretical paragraph explaining key steps in the decision-making process followed by a list of suggested references.

The didactic aspect is emphasized in the algorithm joined to each chapter. This step-by-step approach compels the reader to use all his or her knowledge in a thoughtful, systematic, and logical way. This is a good introduction for the one who wants to learn and an interesting review for the one who thinks that he or she knows it all.

Clearly, the possibilities are so numerous that it is impossible to find the answers to every single one of our daily problems, but as an anesthesiologist involved in regional and obstetric anesthesia, I would have liked to have been able to find an approach to failed epidural analgesia during labor or to the controversy regarding test doses. I believe that continuous femoral nerve block represents a first-line approach in postoperative pain management after total knee replacement and deserves a recent reference. Low-molecular-weight heparin and regional anesthesia might also have deserved special attention.

Some chapters are extremely useful, such as the management of dental injuries associated with general anesthesia or the management of a needlestick. Medicine, and in particular anesthesiology, is an art that requires a great deal of knowledge, excellent clinical sense, and a lot of experience. It takes years to acquire the last of these. This affordable and practical reference book will hopefully help us toward attaining our goal a little faster, and I would certainly recommend that it have a place in every anesthesiology library.