Principles and Practice of Pharmacology for Anaesthetists, 5th Edition. By Norman Calvey, B.Sc., M.D., Ph.D., and Norton Williams, M.B., Ch.B., F.F.A.R.C.S. Hoboken, New Jersey; Wiley, John & Sons, Inc.; 2008. Pages: 352. Price: $200.00.

Peruse the bookshelf of any anesthesiologist and you are sure to find a selection or two on pharmacology. Few elements are more central to the practice of medicine than understanding the drugs we use. The administration of medication is the foundation of our specialty, and sets anesthesiology apart from other areas of medicine. The outside world, including some of our medical colleges, view our practice as something akin to a mysterious spell with a convenient “on and off” switch. However, refined knowledge of pharmacology, and specifically anesthetic agents, allows us to transform the event into a predictable experience.

Calvey and Williams have written a current, fifth edition of their previous work entitled, Principles and Practice of Pharmacology for Anesthetists.  The title is the first clue that these authors are colleagues from “across the pond,” specifically the University of Liverpool. In 352 pages, these gentlemen have created an updated text that provides a strong scientific base in pharmacology and a relevant guide for practicing clinicians.

As stated in the preface, each chapter has been overhauled to reflect the state of the art in pharmacology. Each section is divided into key word subsections that break up the tedious academia into manageable pods of digestible information. They have made liberal use of tables and diagrams. The table in Chapter 9 outlining local anesthetics is a noteworthy example. A complete summary of the pharmacologic characteristics of all commonly used agents is presented. Charts of this sort are perfect tools for learning these drugs and preparing for board examinations. Flow charts, such as the one outlining the receptor mechanism behind malignant hyperthermia, are also pertinent adjuncts for essential material. Unfortunately some drawings are a bit rudimentary, and the monochromatic green accent to the black and white illustrations is less than engaging. Given that this text is more expensive than other comparable tomes, higher-quality graphics and illustrations would be expected.

The authors do make an attempt to broaden the scope of this new edition. The important segment on adverse drug reactions briefly outlines the physiology of the more common hypersensitivity reactions we encounter. Unfortunately, the subject matter is overrun by British nomenclature that makes it conceptually challenging for those from outside the British Isles to absorb.

The first 6 of the 17 chapters cover the basic science of pharmacology. Topics include absorption and elimination, drug action, drug interactions, variable response, pharmacokinetics, and adverse reactions. Attention is then turned to specifics of anesthetic pharmaceuticals. Each major drug is given a separate heading and summary for convenient reference. The final chapters address drugs commonly used in the perioperative period such as antihypertensives, anticoagulants, and hypoglycemics. The initial chapters give a solid foundation of knowledge that is built upon in the chapters to follow. When read from cover to cover, one receives a cohesive overview of pharmacology relevant to anesthesia. Appropriate physiology is reviewed where needed to elucidate the mechanism of various drugs. Best of all, with only two authors there is little redundancy. The book is kept concise by referencing other chapters for further explanation, avoiding repetition. A ton of information is packed into this volume.

It should be noted that the European authors only refer to drugs currently available in Great Britain, some of which will be less familiar to the American audience. Further, generic drugs are referred to according to the recommendations of the International Nonproprietary Names. Although the reader may be aware of paracetamol, suxamethonium, dopexamine, and enoximone, their reference may be distracting for the average American practitioner and confusing for trainees.

Pharmacology is a highly complex subject that is made more accessible for common practice in this text. In a manageable length, the authors have created a complete knowledge base for the nubile anesthesiologist. For the practicing clinician, the detailed index and succinct summaries of specific topics make ready reference quick and convenient. This book will surely be welcome in the European community, an audience already familiar with previous editions. It will be interesting to see how well it is received in the competitive United States academic textbook market.

*Weill Cornell Medical College, New York, New York.