Clinical Anesthesia, 3rd Edition. By Paul G. Barash, Bruce F. Cullen, and Robert K. Stoelting. Philadelphia–New York, Lippincott-Raven, 1997. Pages: 1,483. Price:$165.00.
This is the third edition of a multiauthored textbook of anesthesiology edited by three well-known anesthesiologists and experienced editors. In the preface of this edition, the editors state their goal for this text: to “supply both residents and experienced anesthesiologists with a contemporary textbook of anesthesiology, emphasizing rapid acquisition of information pertinent for patient management in a comprehensive, up-to-date, single volume book.” With this edition, new chapters have been added as well as new authors for previous chapters. This effort does help to keep the text fresh and up to date. In addition, it provides emphasis to some new or expanding areas of the anesthesiologist's practice, such as anesthesia for laparoscopic surgery and anesthesia in nonoperative locations. It is indeed a comprehensive text, covering all major areas of an anesthesiologist's practice. The list of authors for this text contains many of the recognized experts in the field.
The first section of the book is entitled “Introduction to Anesthesia Practice.” This section contains chapters on history, research design, practice management, and risk management. The next section, “Basic Principles of Anesthesia Practice,” contains chapters on electrical safety, mechanisms of anesthesia, and basic physiology. The third section is devoted to pharmacology and contains seven chapters on basic pharmacology as well as pharmacology of drugs used in anesthetic practice. The section entitled “Preparation for Anesthesia” consists of eight chapters that deal with all areas of preoperative evaluation and anesthetic planning, including patient evaluation, premedication, positioning, monitoring, and anesthetic delivery systems. The fifth section is the largest and consists of 27 chapters covering all types of anesthetics (regional, general, and monitored anesthesia care) as well as anesthetic management for all types of surgical procedures. The final section consists of five chapters dedicated to postoperative management and the anesthesiologist's consultant role.
In the section entitled “Introduction to Anesthesia Practice,” there are several excellent chapters. In the past, anesthesia textbooks have tended not to address some of these topics, such as practice management, risk management, and quality assurance. However, it is critical that anesthesiology residents understand these topics and that practicing anesthesiologists have a source of information on these subjects. The chapters entitled “Practice Management” and “Professional Liability, Risk Management, and Quality Improvement” both provide well-written, organized introductions to these complex subjects. Equally important, they provide an excellent list of resources available to the anesthesiologist dealing with these areas. “Experimental Design and Statistics” is detailed enough to serve as an initial guide to residents interested in research. The chapter entitled “Value-Based Anesthesia Management” is notable for defining terms and goals as well as a thorough discussion of available data. A particularly good chapter in this section is “Hazards of Working in the Operating Room,” which covers not only physical hazards, but also stress management and substance abuse. Overall, this is an excellent section and provides increased emphasis on important issues in anesthesiology today.
The second two sections are also well done and address basic physiology and pharmacology. The chapters are all well organized and well written. Each presents both basic information and the clinical applications. The chapter entitled “Hemostasis and Hemotherapy” contains an excellent review of available data on transfusion practice followed by well-founded recommendations. The “Muscle Relaxants” chapter provides a thorough review of pharmacology of these agents followed by sound clinical evaluation and implications. The fourth section, dealing with preparation for anesthesia, contains a number of excellent chapters. “Preoperative Evaluation” first addresses each organ system and then reviews available testing and its efficacy. It is an excellent and succinct chapter.
The chapters in Section V, “Management of Anesthesia,” are organized to provide first a review of relevant physiology, pharmacology, and pathology dealing with either the type of anesthesia or surgical area. Then, specific procedures are reviewed addressing anesthetic options, specific concerns for that procedure, and potential complications. This format allows the reader to gain not only information regarding clinical care, but also provides a good review of relevant physiologic or pharmacologic principles. “Peripheral Nerve Blockade” provides a nice review of a large number of blocks, including indications, limitations, complications, and “how to” information. It is also well illustrated. Four chapters are provided to address the areas of thoracic and cardiac surgery and important respiratory and cardiac physiology. There are separate chapters dealing with respiratory function, cardiac anatomy and physiology, thoracic procedures, and cardiac procedures. These chapters are a very nice section in the text. Likewise, the chapter entitled “Anesthesia for Neurosurgery” is well written. It covers neurophysiology, cerebral protection, and neuropharmacology thoroughly followed by a section devoted to specific procedures. In the final section on postoperative and consultative practice, the chapter on critical care is well organized and provides a thorough overview of a complex subject.
Overall, the third edition of Clinical Anesthesia continues to be an excellent comprehensive anesthesiology textbook. Of course, it is not able to provide the same depth on any given subject that texts devoted to subspecialty areas provide, but it should serve as an excellent text for residents throughout training. It is also a good reference for the practicing anesthesiologist, particularly to provide a relatively quick review of an area or issue not frequently dealt with. The editors have met their goal as stated in the preface to this edition, and at $165.00, it is reasonably priced for the wealth of information it contains.
