Obstetric Anesthesia: Principles and Practice, 3rd Edition. By David H. Chestnut, M.D., Ph.D. Philadelphia, Elsevier Mosby, 2004. Pages: 1,096. Price: $165.00.
Obstetric anesthesia has been recognized as a subspecialty for a relatively brief period of time, but its importance has steadily increased in recent years. In most Western countries, the majority of laboring women are cared for by a multidisciplinary team, which involves an anesthesiologist as the professional able to provide both adequate pain relief and efficient treatment of emergent conditions. From its first edition, the textbook Obstetric Anesthesia , edited by David H. Chestnut, has been one of the preferred references in the field. A new edition has been released every 5 yr, allowing practitioners to get timely information. All chapters have been thoroughly reviewed and updated, including references published as recently as 2004. This third edition is less heavy than the preceding one but contains more information. This has been made possible through editorial and presentation changes.
The book is divided into 10 parts and 53 chapters. For an encyclopedic textbook, it is surprisingly easy to use. Each chapter begins with a description of its contents, allowing the reader to rapidly know whether he or she will find what he or she is looking for. Each chapter ends with a gray box reminding the reader of the main information to “take home.” Several chapters may seem difficult to read at first glance because of the enormous amount of information contained. However, the paragraphs are short and well separated, and the writing style is clear. All of these editorial considerations make the book easy to read overall.
The first chapters, which are very well illustrated, are a reappraisal of maternal, fetal, and placental physiology. They also provide an overview of labor physiology and obstetric techniques, anatomy of the pregnant woman, and techniques used for regional anesthesia.
The next part of the book is dedicated to fetal complications and care of the newborn. As might be expected, a major part of the book details techniques used for anesthesia and analgesia in pregnant women. One chapter describes anesthetic techniques that are to be used in pregnant patients undergoing nonobstetric surgery, a chapter that nonobstetric anesthesiologists will find invaluable. Each chapter provides adequate and detailed information on pharmacologic and pharmacokinetic aspects of the drugs used, with special consideration to changes related to pregnancy. Despite the generous amount of information contained in these chapters, a few of the ideas presented are debatable. For example, the “pro ephedrine” position defended in the chapter related to spinal anesthesia for cesarean delivery does not reflect the current practice of many.
The largest section of the text describes symptoms and management of obstetric complications as well as considerations regarding patients presenting with a medical history unrelated to pregnancy that might be influenced by pregnancy. The need for better understanding the relations between pregnancy and preexisting medical conditions is highlighted by the increased number of women who now present with conditions that formerly were thought to be incompatible with pregnancy. Although incomplete (because it is impossible to describe all interactions), the chapters well describe a large number of these diseases. Regarding some controversial conditions, the editor (David H. Chestnut) has added in the text some personal notes based on his own experience. Of note, one chapter describes medicolegal features of anesthesiology and will be useful for most readers, given the litigious climate in which we currently live.
In summary, the third edition of Obstetric Anesthesia is no doubt the most complete and up-to-date textbook in the field. One should take the time to read each chapter. It is recommended not only to nonobstetric anesthesiologists who will find in a single book all the necessary recent information, but also to subspecialty experts, who can find additional information they probably had missed in some areas. This third edition should be found in every anesthesia department library.