Drugs, Diseases & Anesthesia. Ronald J. Stern, M.D. Philadelphia, Lippincott-Raven Publishers, 1996. ISBN: 0–397–58758–9 (softcover); 0–397–58764–3 (network version). Prices: softcover, $99.00; network version, $395.00.
Drugs, Diseases & Anesthesia is one of a growing number of texts available on interactive software. This critique will focus exclusively on the Lippincott-Raven interactive software package and its usefulness for practicing anesthesiologists and residents. The information also comes in a softcover textbook. I probably represent most practicing anesthesiologists who rely on multiple software packages to accomplish daily administrative duties but have neither the time nor the interest to become a computer expert. Computers to me are useful if they make my task "easier to accomplish" or make me more "efficient."
Following the user-guided instructions, I found the installation process to be straightforward and easy. The software came on four computer disks. For window-based personal computers, the minimum system configuration needed to use the software is an IBM (or compatible) 486 or a Pentium (Intel) processor, 4 MB RAM, 8 MB free hard disk space, Microsoft 3.1 (Redmond, WA), or higher. No Macintosh (Apple, Cupertino, CA) version was described.
After the program is loaded, the program opens to a screen that lists Patient Drugs (drugs that a patient may be taking), Diseases (coexisting diseases that a patient may have), and Anesthetics (drugs or anesthetic agents that the anesthesiologist may administer to a patient during the course of an anesthetic). To use the program, one would select an item from one of these three categories. After selection, a description of the item will appear in a text window. To see interactions among the three items, one would click on the "see interaction" button and a window will appear over the main screen with a description of the specific interaction.
Although only 63 disease states are listed, the interaction of the disease state, drug, and anesthetic can be very helpful. Confronted with patients prescribed various new drugs, it is often difficult to keep up with all the possible interactions. This software is an example of "computer decision support." This program enables the anesthesiologist to quickly select anesthetics best suited for patients and their diseases, while lessening the chance for an adverse drug interaction, therefore making a significant contribution to patient safety.
Negatives: The copyright on the most recent version is 1996, hence, some of the material is out of date. For example, there were no descriptions of more recent drugs, such as cisatracurium, remifentanyl, and milrinone. The text reads like the Physicians Desk Reference, [1] there are no literature citations, most of the information is derived from textbook information: Anesthesia, [2] Anesthesia and Coexisting Disease, [3] and The Pharmacological Basis of Therapeutics. [4] The diseases discussed are not extensive; for example, no information regarding mitral regurgitation, anemia, amyloidosis, or epiglottis was found. There was no "search" or "find" mode, which would make it easier to find information. The installation required four computer disks; I hope future editions will come out on CD-ROM. Customer service to this product was lacking: calls placed on multiple occasions provided only an answering machine. This is clearly not the prompt customer service that I have experienced with other software vendors.
The software version provides several advantages over the textbook version. First, the software version provides easy point and click access to listed information rather than going through the Table ofcontents or the index in the back of the text. However, the softcover version is very portable and does not require a computer to access.
This program represents exciting change in the practice of anesthesiology. It is a tool for facilitating and improving the anesthesiology practitioner's performance. Our challenge as users is to use this tool to the advantage of our patients. It is an "operational" teacher, one that could be used in the operating room, at the bedside, or in the preoperative clinic when one is formulating an anesthetic plan or is confronted with an unfamiliar drug or unusual disease.
Is it worth purchasing? This product is one of several interactive software products that are intended to assist the clinician to provide a safer anesthetic. It's aim is to get the right information in the hands of the clinician when needed. However, because of the rapid advance in our specialty and the dated information, I would consider waiting for the next edition before purchasing this product. Also, poor customer service limits it's potential appeal, especially to the computer novice.
Frank J. Villamaria, M.D.
Vice Chairman; Department of Anesthesiology; Associate Medical Director for Quality; Texas A&M University HSC; Scott & White Memorial Hospital; Temple, Texas 76508
(Accepted for publication January 7, 1999.)
