Handbook of Ambulatory Anesthesia, Second Edition. Edited by Rebecca S. Twersky, M.D., M.P.H., and Beverly K. Philip, M.D. New York, Springer, 2008. Pages: 484. Price: $79.95.

In the past 30 yr there has been a massive proliferation of ambulatory surgical centers as well as procedural and diagnostic sites, with a corresponding increase in the number of patients requiring ambulatory anesthetic services. Anesthesiologists are continually faced with one overwhelming question: Which patients should be cared for in these ambulatory settings, and which should be anesthetized in the traditional hospital setting?

The Handbook of Ambulatory Anesthesia, second edition, edited by Rebecca S. Twersky, M.D., M.P.H. and Beverly K. Philip, M.D. answers this question and provides comprehensive support for the answer(s) with a summary of clinical research, published guidelines and consensus, as well as individual expert opinion. The handbook emphasizes the relevant diseases and clinical entities facing the ambulatory anesthesiologist, and also addresses the administrative concerns associated with ambulatory surgery and anesthesia including recovery, discharge, quality management, accreditation, and business fundamentals.

This is a soft cover book of 484 pages with 16 chapters written by 30 expert authors. The editors have standardized each chapter, beginning with a brief outline, followed by text enhanced with illustrations and tables, and concluding with a summary and a listing of key references. Chapters 1 through 9 are a concise review of adult and pediatric clinical challenges, sedation, and regional and general anesthesia. The content is easy to read with a rapid flow of the most pertinent information. However, it provided no additional information beyond that available in other current anesthesiology handbooks.

After these early chapters the handbook starts to set itself apart from others and provides information unique to the ambulatory setting. Chapters 10 and 11 introduce the reader to anesthesia outside of the operating room, including space requirements, equipment and administrative considerations, and a brief summary of common procedures and recommendations on anesthetic technique. Chapters 12 and 13 discuss recovery, criteria for discharge, emergency transport issues, and common postoperative complications and how to handle them in light of the ambulatory setting. Chapter 14 introduces the reader to the accreditation and regulation of ambulatory surgical facilities and provides a nice list of “hot-button” issues of particular importance to the ambulatory anesthesiologist. This list includes intraoperative awareness, sedation by nonanesthesiologists, monitor and ventilator alarm systems, the definition of “immediate availability” of anesthesiologists when the anesthesia is being provided under the supervision of the anesthesiologist, informed consent, and medication security. Chapter 15 provides information about the financial stability and profitability of the ambulatory surgical center. The final chapter provides an overview of both the initial planning and development, and the daily management of the ambulatory surgical center. This chapter delineates the roles of ambulatory surgical center professionals and other personnel and their impact on creating a safe, smoothly functioning, and profitable center. The handbook also contains 20 appendices with important tables and figures which are likely to be referenced frequently by the practitioner. The index for these appendices is listed on both the inside front and back covers of the handbook.

This handbook provides an overview of the common clinical issues facing the ambulatory anesthesiologist as well as an introduction to the administrative items necessary for the successful development and performance of the ambulatory surgical center. As for this book’s limitations, I noticed several incorrect drug dosages and mislabeled information embedded in the text and appendices. The lack of font color (black text only) made the reading a bit monotonous.

Ambulatory anesthesiologists will likely refer to this handbook when faced with clinical dilemmas, with its scope, chapter organization and succinct clarity capable of addressing most concerns. Ambulatory surgical administrative personnel will find the handbook useful in gaining a perspective of the clinical challenges facing the ambulatory patient, anesthesiologist, and surgeon.

*Rush University Medical Center, Chicago, Illinois. rlembersky@pol.net