Carol A. Hirshman, M.D., Editor

Obstetric Anesthesia: Principles and Practice. Edited by David H. Chestnut. St. Louis, Mosby, 1994. Pages: 1,040. Price: $125.00.

During the last 20 yr, the practice of obstetric anesthesia has undergone a noticeable metamorphosis. The main reason for this is the development of maternal-fetal medicine as a distinct discipline, which has enabled women with serious medical illnesses to have children. Anesthesiologists have become increasingly involved in the intrapartum medical as well as the anesthetic management of these women. In addition, several new techniques and drugs, notably neuraxial opioids, have been introduced for the routine management of labor pain and postoperative pain. Thus, the modern-day obstetric anesthesiologist is expected to possess a wide range of skills and knowledge for managing routine and high-risk situations in the labor ward. This book will serve as a source of accurate and dependable information relating to obstetric anesthesia.

Chestnut is an experienced obstetric anesthesiologist who also is fully trained in obstetrics. It is, therefore, not surprising that many chapters contain authoritative information on relevant obstetric issues. There are approximately 62 contributors, which include anesthesiologists and obstetricians, primarily from North America. The book consists of 53 chapters grouped into 10 parts. Each part contains a set of related topics, such as anesthesia for labor and delivery, anesthesia for cesarean section, and anesthesia for obstetric complications. The chapters are extremely well organized. Each provides the reader with basic science background, relevant obstetric information, rationale for the approach suggested, and the techniques available, as well as their pros and cons. Several practical and clinical considerations are discussed, and key summary points are listed at the end of each chapter. This prevents the reader from becoming lost in the voluminous information and supporting experimental data offered. Several text boxes are included in many chapters, providing a quick review of the essential points. This feature is most valuable to busy clinicians. The book is amply illustrated with excellent diagrams. The bibliography is extensive and comprehensive, although somewhat overwhelming: It includes vintage citations from as far back as 1938 as well as more recent contributions.

In a multi-authored text book such as this, it is not unusual to find contradictions between authors. However, I was hard-pressed to find any major contradictions in this work. This again reflects the editorial skill of Chestnut. These chapters dealing with clinical aspects of obstetric anesthesia (17-28) were particularly helpful and enjoyable to read. As a practicing obstetric anesthesiologist, I was pleased to see timely chapters on human immunodeficiency virus, substance abuse, and medicolegal issues in the parturient. The chapter on the difficult airway (31) is well written, but the management algorithm is presented in two parts on pages 578 and 594. The average reader may find that navigating through the algorithms is more difficult than the actual management of the difficult airway. Although the sheer size (and price) of this book may intimidate a reader at first glance, he or she will soon notice that the information provided in each chapter is clinically relevant, useful, and very well organized.

Obstetric Anesthesia: Principles and Practice is recommended both as a basic book and as a reference text to anesthesiologists, certified registered nurse anesthetists, medical students, nursing students, and obstetricians at all levels of training.

Sivam Ramanathan, M.D.; Chief of Anesthesiology; Magee-Women's Hospital; University of Pittsburgh School of Medicine; 300 Halket Street; Pittsburgh, Pennsylvania 15213-3180.