Obstetric Anesthesia Handbook, 4th Edition. By Sanjay Datta, M.D. New York, Springer, 2006. Pages: 380. Price: $49.95.

The fourth edition of Sanjay Datta’s Obstetric Anesthesia Handbook  represents an update of a concise, single-authored text that many consider the best resource of its kind. During the past 15 yr, this text has been most popular among anesthesiology and obstetrics residents, fellows, and staff, both in the United States and in the international community. The text is authoritative, succinct, and highly practical. It is accompanied by more than 100 illustrations and tables, making the text a convenient reference to the busy practitioner.

In his handbook, Datta has capitalized on his long career as a teacher, mentor, and advisor to classes of residents, fellows, and faculty that came through the Division for Obstetric Anesthesia at Harvard’s Brigham and Women’s Hospital in Boston, Massachusetts, and condensed the wealth of information about obstetric anesthesiology into a succinct clinical resource. Professor Datta, a prolific clinical researcher and excellent teacher, is known for his interest in the concerns and questions posed by his students during lectures, teaching rounds, and bedside discussions. Over the years, he has taken volumes of handwritten notes that were primarily used to provide supportive feedback to his students, residents, fellows, and professional visitors from around the globe.

Datta’s experience as a teacher served as a background to compile a handbook that would provide practical answers to a wide variety of questions from within the field of obstetric anesthesia. Most would agree that this type of practice-oriented information is difficult to obtain from standard textbooks or electronic sources. An example of a highly relevant clinical topic of interest to the reader is the discussion about thrombocytopenia and regional anesthesia, which is clearly discussed on page 231 as part of the chapter about high-risk pregnancy.

Consider another topic, the question of fetal oxygen transport. Did you know that the umbilical arterial oxygen tension is only 20 mmHg and that there is a simple rule to remember the approximate oxygen tension in the umbilical artery and vein? The expert in obstetric anesthesia might answer, Of course I know. However, residents and fellows with less exposure to the field have difficulty organizing and remembering important scientific facts such as this. Datta provides the answer to the above question with his “20, 30, 40, 50 formula,” in the form of a simple table on page 305 of the fourth edition of his handbook. These are only two examples to illustrate how this text constitutes a resource that provides compact and useful answers where other sources fall short.

The contents of the book are organized in a traditional fashion. Chapters 1–5 introduce important physiologic and pharmacologic background information to the reader. They cover important topics such as the physiologic changes of pregnancy, maternal and perinatal pharmacology, a review of local anesthetics used in obstetrics, uteroplacental circulation, and the physiology of labor and delivery. Next, Datta covers important information about analgesic options for the pregnant woman. While focusing on the practical management of labor analgesia and its impact on fetal and maternal physiology, a comprehensive discussion is provided. The later chapters of the book offer essential information about selected clinical topics: obstetric anesthesia for cesarean delivery, tubal ligation and in vitro  fertilization procedures, high-risk pregnancy, and neonatal resuscitation. The last chapter discusses maternal morbidity and mortality and important practice guidelines.

The practice of obstetric anesthesia is constantly undergoing change. Examples of this are new recommendations about spinal anesthesia in severely preeclamptic patients or the use of phenylephrine as a vasopressor in obstetric patients. Datta has updated his text in this fourth edition to accommodate new techniques, guidelines, and therapeutic modalities. The fourth edition of Datta’s Obstetric Anesthesia Handbook  will certainly continue to enjoy interest from a broad medical audience just as the previous editions did.

University of Alabama at Birmingham, Birmingham, Alabama. froelich@uab.edu