Analgesia, Anaesthesia and Pregnancy: A Practical Guide, 2nd Edition. Edited by Steve Yentis, M.B.B.S., B.Sc., M.D., F.R.C.A.; Anne May, F.R.C.A.; Surbhi Malhotra, M.B.B.S., F.R.C.A.; with David Bogod, F.R.C.A.; Diana Brighouse, B.M., F.R.C.A.; and Chris Elton, M.B., Ch.B., F.R.C.A. Cambridge, England, Cambridge University Press, 2007. Pages: 414. Price: $70.00.

An experienced team of British obstetric anesthesiologists has edited the second edition of this practical guide. It provides useful information for the anesthesiologist in training as well as for the anesthesiology specialist.

Frequently occurring problems are presented in brief mini-sections, a format that makes this work useful for quick and easy browsing. The chapters are well written and the information is concisely presented. The problems are outlined, the management options are discussed, and the key messages are presented at the end of each chapter in gray boxes. The authors make suggestions for further reading at the end of most chapters.

The first section deals with preconception and conception. Strategies for management of ovarian hyperstimulation syndrome as well as anesthesia for assisted reproduction technologies are presented.

There are many problems that can arise during pregnancy, and the second section in this book is remarkably comprehensive in their presentation. Pregnancy and pregnancy-related problems are discussed from anesthetic, obstetric, or nonobstetric perspectives. Common problems (e.g.,  aortocaval compression syndrome or pain of labor) as well as strategies for managing rare situations (e.g.,  intrauterine surgery) are described in detail. The spectrum of topics extends from spinal anesthesia for delivery to air embolism to awareness during general anesthesia for cesarean delivery. A number of the issues listed are more of a concern for the obstetrician than for the anesthesiologist. However, understanding the underlying obstetric pathology and therapeutic concepts will clearly help the anesthesiologist to provide better care for the patient. At the end of the second section an introduction into neonatal physiology, assessment, pharmacology, and resuscitation is given, as many anesthesiologists may be confronted with a newborn who is delivered and requires immediate resuscitation.

Section 3 discusses different aspects of the puerperium and the immediate time thereafter. Common and important issues such as the use of maternally administered drugs and their impact on breastfeeding are discussed. Further, the authors note factors that may influence maternal satisfaction.

The last section covers organizational issues, administrative and medicolegal problems, and minimum standards, guidelines, and protocols. It also includes up-to-date commentary on the most recent (2006) American Society of Anesthesiologists Practice Guidelines for Obstetric Anesthesia, although the reference cited (p. 362) is to the older 1999 version. Excellent practical advice is given in the medico-legal section, including a plea for legible handwriting and contemporaneous, complete written notes. A mention is even made of the frequent illegibility of physician’s signatures, with a suggestion to print one’s name in capital letters after each signature. This is truly excellent advice, which should be heeded by more physicians!

This book gives both practicing anesthesiologists and anesthesiologists in training an overview of recurring topics in obstetric anesthesia. Trainees will be provided with new knowledge, while specialists might use this book as a quick reference while on call on obstetric wards. While most management strategies are universally applicable, others are limited to the United Kingdom, although differences to the United States are usually, but not consistently, mentioned. For example, chloroprocaine is not available in the United Kingdom and most parts of continental Europe. Thus, it is not listed as an option for “topping up” an epidural catheter either during labor or for emergency cesarean delivery. The widespread use of chloroprocaine in the United States may make this omission seem rather curious to American practitioners. Similarly, although many anesthesiologists in the United Kingdom and Europe use alfentanil for transvaginal oocyte retrieval, its use for this procedure has not gained popularity in the United States.

Other controversial topics (e.g.,  cricoid pressure) are discussed using the perspective of current United Kingdom practices. A section on vaginal birth after cesarean is titled “Trial of Scar,” a uniquely British term which many American anesthesiologists will not recognize. The text does, however, mention the more common acronym of “VBAC.” While the American obstetric anesthesiologist may appreciate a comparative approach to practice, such as learning about inhalation analgesia (Entonox) for labor, midwifery training, and midwife-controlled epidural top-ups, the book is primarily aimed at a United Kingdom or European audience. With the aforementioned limitation in mind, this book makes a nice addition to the library of anesthesiologists who want a concise and yet comprehensive book covering a wide range of topics in obstetric anesthesia.

*Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.