Important Principles of Anesthesia

Important Principles of Anesthesia attempts to highlight and convey the key ideas that affect day-to-day anesthetic practice, with some useful and practical hints along the way. In this textbook, which feels more like a selection of notes when reading, Dr. Corbett has selected the topics he feels have the most practical application, and he explains the theory behind these topics with helpful diagrams and analogies. The 13 chapters cover a wide range of topics, from intubation all the way to chloride shift. In each chapter, Dr. Corbett starts with some simple background, often with a real-world example. He then delves deeper into the minutiae of the topics before offering up some pragmatic advice on how to apply this theory in day-to-day practice. Where possible, real examples are used to illustrate the theory, linking theory and practice together.

For the most part, Dr. Corbett achieves his aims. The chapters on endotracheal intubation and oxygen transport are particularly useful, giving a good overview of the topic before advising how to apply the topic to anesthetic practice. The analogies he uses help to clarify some of the more abstract topics. A good example of this is his explanation of blood:gas partition coefficient, which breaks down this abstruse idea into simple language and basic principles. For these topics, Dr. Corbett provides the easiest-to-understand explanations we have come across.

Unfortunately, this does not apply to all chapters. A particularly egregious chapter is “Awareness in Anesthesia.” Here the author puts great trust into the pupillary reflex and its reliability for predicting lack of awareness. This is not usual practice and does not have a strong evidence base behind it. Indeed, a recent review article published in Anesthesiology suggested that pupillary response to light should not be used to judge awareness. The author also states that he has conducted awareness and pupillary light reflex experiments on more than 1,200 patients, with some patients giving a verbal response on the operating table. The ethical implications of this are significant.

The book is easy and pleasant to read, with a conversational tone maintained throughout. The language and structure lend themselves easily to sitting down and reading a few chapters at a time. Indeed, the author encourages skim reading on the first read, and the text certainly lends itself to this. This does lead to sections of text that are difficult to follow, with one memorable passage discussing the differences in anatomy between predator and prey animals. Its relevance to the topic at hand was lost on us, even after multiple readings! Similar passages throughout the text make it a sometimes difficult read, with the author’s point obscured behind strained analogies. The structure of the book is also slightly haphazard, with each chapter best viewed in isolation, rather than as a continuation of a topic.

While there are useful and educational passages, we struggle to recommend this book. While some of the explanations are extremely good at outlining the basic principles, the practical applications come across as one person’s slightly outdated perspective on anesthetic practice. The chapters that explore topics with less grounding in peer-reviewed evidence are of concern, with some suggestions that would definitely not be recommended. The book appears to be aimed at those new to anesthesia; however, there are many sections that would confuse a novice. With further editing, this has the potential to be a useful resource, and we hope the next edition has significant changes made.