James C. Eisenach, M.D., Editor.

Interactive Anesthesia Library on CD-ROM, 1995 Edition, Residents Version. Philadelphia, Lippincott-Raven Publishers, 1995. Price:$125.00.

With a distinct sense of adventure, I donned my computer spectacles, cracked my knuckles, and, while gazing rapturously at the monitor, said to myself “Let's see what's out there!” My mission was to review the Interactive Anesthesia Library on CD-ROM, 1995 Edition, Resident Version published by Lippincott-Raven Publishers. This educational tool comprises the full text and graphics of seven (virtual) textbooks: Clinical Anesthesia, edited by Barash, Cullen, and Stoelting, with 98 contributors (2nd ed), Handbook of Clinical Anesthesia, by Barash, Cullen, and Stoelting (2nd ed), Review of Clinical Anesthesia, edited by Silverman and Connelly, Neural Blockade, edited by Cousins and Bridenbaugh (2nd ed), Pharmacology and Physiology, by Stoelting (2nd ed), Anesthesiology: Problem Oriented Patient Management, edited by Yao and Artusio (3rd ed), and the Textbook of Internal Medicine, editor-in-chief Kelly, edited by DeVita et al. (two volumes, 2nd ed).

I will preface my comments with an insight into the level of my computer literacy. Neither a novice nor a hacker, I have used CD-ROMs to balance my checkbook, prepare my Federal Tax statement, plan family vacations, and play computer games. My home computer already met the equipment requirements. These are for a PC: 80386 33 MHZ with 4 Mb RAM (80486 with 8 Mb RAM recommended), 6 Mb hard disk space available, MS-DOS 5.0 and Windows 3.1 or later, CD-ROM drive (double speed recommended), 256 color graphics card and monitor (graphics card that provides thousands of color recommended), and for a MAC: 68030 computer with 4 Mb RAM (68040 with 8 Mb RAM recommended), 256 color graphics display (high-resolution graphics display with thousands of colors recommended), 6 Mb hard disk space available, CD-ROM drive (double speed recommended), system 6.8 or higher.

The package insert includes clear, concise directions for installation and operation for both Windows and Macintosh, a process that takes less than 5 min to execute. The font type and size are easy on the eyes, even for long intervals. There are some minor glitches in formatting, such as errors in spacing and indenting. On activation of the main menu, access to the individual textbooks is rapid and simple. I was able to move among different chapters and textbooks with ease. Occasionally, I found myself back at the main menu without intending to be there, but this was no more inconvenient than losing one's page in a real (as opposed to virtual) book. A useful feature is the consolidated Subject Index for all texts.

Another navigational tool is the “Hypertext Link,” which permits viewing of chapter outlines, lists of figures and tables within each chapter, and so forth. The “Query” function is essentially a search engine within the program that works like a sophisticated interactive index. The toolbelt buttons are especially fun to use; e.g., I could highlight text (in a color of my choice), make notes in the margin, or place a bookmark.

In general, I found this CD-ROM useful and enjoyable to use. The novelty of learning in the virtual world seemed to open my memory banks, while the interactive nature of the program (a.k.a., playing with toys) maintained my interest. The ability to look up a topic in the internal medicine textbook (e.g., thyrotoxicosis) was conducive to an in-depth survey of a perioperative management problem. Without doubt, the major advantage of this format is the power of data storage compression. When I compare the size and weight of this CD-ROM to the seven textbooks they replace, no further discussion seems necessary. However, there are some caveats. To use this tool effectively, one requires access to appropriate computer equipment at home, at work, and in remote locations. As more anesthesiologists (and perioperative physicians) buy laptop computers with attached CD-ROM, this issue will become moot.

A significant and worrisome obstacle to widespread adoption of this technology is the cost. The CD-ROM is $125 on initial purchase. Twelve months after installation of the program, it can no longer be used, requiring purchase of an update for-you guessed it, $125. The initial cost seems justified in comparison with the purchase of seven individual textbooks. However, the mandate for a complete update every year seems excessive. Most anesthesia textbooks are revised every 3–5 yr. When I called the customer service line at Lippincott-Raven, the courteous staff member was unable to tell me how the update would differ from the current iteration. The regular version costs $395, and does not have a lockout of any kind.

In closing, I reflect on the watershed we face as we cross into a fully technologic age. I was raised in an era when men were sent to the moon using slide-rules for mathematical calculations, when telling the time involved checking the big hand and the little hand, and when hit songs could be purchased on singles, EP, or LP records. For me, the printed book, with its delicious smell, crackly spine, and smooth, silky paper, remains the gold standard. However, social and professional competence now dictate mastery of electronic multimedia, with ease and speed of data acquisition and storage. The Lippincott-Raven Interactive Anesthesia Library on CD-ROM provides both in a ready-to-use format. Good browsing. Meanwhile, I'm off to see my doctor for a severe case of “mouse” finger.

Anne T. Rogers, M.B.Ch.B., F.R.C.P.(C.), Associate Professor, Department of Anesthesia, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157–1009.