Handbook of Neuroanesthesia, 4th Edition. Edited by Philippa Newfield, M.D., and James E. Cottrell, M.D. Philadelphia, Lippincott Williams & Wilkins, 2007. Pages: 466. Price: $49.95.

Most anesthesiologists initially acquire their knowledge base from the weighty, hardback-bound grand tomes of our profession. Yet, however much we may learn during residency and fellowship, the sheer volume of knowledge and the humbling realities of human memory mean that we need something to refer to when we are in need of a reminder, a clarification, or when we simply wish to review a topic to reinforce and consolidate our memory. For these purposes, the impressive volumes on our shelves are rarely optimal; what we seek is a “ready reference”—something that possesses crisp brevity but does not compromise depth, is current and accurate, and is structured and indexed in a way that makes rapid navigation easy. And, because we require our knowledge in operating rooms far removed from our bookshelves, portability is essential if any such work seeks to be more useful than the readily available Google searches that have become a staple of physician life in this iPod age.

What a pleasure it is then, as a neuroanesthesiologist, to read and review the fourth edition of the Handbook of Neuroanesthesia . Coming 7 yr after the previous edition, this volume is again edited by Phillipa Newfield and James Cottrell, with individual chapters written by a collection of outstanding authors from across the United States and Canada, and including several contributions from Europe and Asia. The appearance and structure of the book will be instantly recognizable to those familiar with other publications of the Lippincott Williams & Wilkins Handbook series, which notably includes Clinical Anesthesia Procedures of the Massachusetts General Hospital  and the Critical Care Handbook of the Massachusetts General Hospital . Each chapter is concise and focused, and is structured as a hierarchical outline with somewhere between a single sentence and two short paragraphs addressing each point. The text disposes of any unnecessary narrative but avoids regressing to the level of fragmentary sentences and bullets. The end result works very well; the reader is left with short sentences in plain English that are dense in information but easy to read. Because it is tacitly assumed that the reader already possesses a conceptual grounding, this is probably not an ideal first choice for students new to the principles and vocabulary of anesthesiology; on the other hand, by sparing narrative dedicated to the introduction of concepts, this little handbook that measures less than 5 × 8 inches contains more current factual information than primary texts of much greater size.

Chapters at the beginning of the book are dedicated to general considerations derived from neurophysiology and pharmacology, including excellent chapters on neurophysiologic monitoring and cerebral protection. There are then several chapters dedicated to the anesthetic management of specific neurosurgical procedures and patient populations. Some of these, such as those describing anesthesia for posterior fossa surgery, supratentorial tumors, and head trauma, are current versions of topics that have long been the staple of neuroanesthesia texts. Others, such as those dedicated to interventional neuroradiology, intraoperative magnetic resonance imaging, epilepsy surgery, and awake craniotomy, reflect recent trends in neurosurgery that have evolved tremendously since the previous edition; this section also contains excellent chapters on pediatric neuroanesthesia and neurosurgery in pregnant patients. Finally, several chapters are dedicated to postoperative issues; these include chapters covering postoperative cardiovascular, respiratory, and fluid management considerations related to specific neurosurgical procedures, as well as sections dedicated to issues more broadly encountered in neurointensive care units, such as nutritional support, stroke, and brain death. The book is weighted heavily to intracranial procedures, with far less emphasis on the spine; neuroanesthesiologists whose practice includes substantial exposure to spinal surgery will find an excellent chapter on the management of spinal cord injury, but only a relatively cursory discussion of the complex management of major spine procedures. Overall, the use of figures and tables is very good, with all the core material presented in a concise and readily understandable form. Unlike the Clinical Anesthesia Procedures  handbook, there is not an appendix dedicated to drug dosages; however, it is generally easy to find dosages and other quantitative values that are often sought in a hurry.

This book should be regarded as an essential purchase at the beginning of the year for anybody undertaking a neuroanesthesia fellowship, and should be carried at all times. It should make its way onto the bookshelf of general anesthesiologists who find themselves encountering neurosurgical cases, and who seek an accurate and current reference to help them optimally understand and manage these challenging cases when they arise. It should also be strongly considered by trained neuroanesthesiologists who recognize the need for a concise, up-to-date refresher and reference source. Although perhaps providing more detail than required by junior residents, it can be wholeheartedly recommended to senior residents looking to take their knowledge of neuroanesthesia up a level without engaging an enormous textbook. I have certainly found it to be both useful and enjoyable, and expect it shall remain in my coat pocket for quite some time.

Weill Medical College of Cornell University, New York, New York. kap9009@med.cornell.edu