Essence of Anesthesia Practice, 2nd Edition. By Michael F. Roizen, Lee A. Fleisher. W.B. Saunders, 2002. Pages: 642. ISBN: 0721692672. Price: $59.
The second edition of Essence of Anesthesia Practice enlarges and expands the topical coverage in the unique format introduced in the first edition. Divided into five sections, the text covers disease states, operative procedures, traditional drugs, alternative medications (a new section), and more complex perioperative testing. In one-page synopses devoted to a single entity (disease state, procedure, or drug), the contributing authors summarize the incidence, etiology, and anesthetic implications of numerous rare (and common) medical conditions and surgical procedures. For pharmaceuticals, summaries include basic pharmacology, indications, effects, and complications. Although exclusively text-based and thus devoid of figures, the 500+ contributors make this a diverse and interesting reference. As well, a condensed version for the Palm operating system allows access to a subset of the information via the popular handheld computers.
Coverage of disease states is broad, ranging from osteoporosis and omphalocele to familial dysautonomia and silicosis, and the summaries are succinct but informative. One key reference from the literature is included as a source for further reading. Another welcome feature is the inclusion of a code from the International Classification of Diseases, 9th Revision–Clinical Modification with each disease state. Each page is divided into three sections: an overview of the disease, procedure, drug or test; a table of effects and/or considerations classified by organ or system; and a synopsis of perioperative implications and concerns.
The section on alternative medicine is valuable in that it provides a ready reference to the most common herbal medications. The potential for drug interactions with nontraditional medicines is a growing concern among anesthesiologists, and these potential problems are addressed in this section of the text. Common nonprescription drugs (such as pseudoephedrine) seem to also be included here, although aspirin is in the “traditional” drug section.
The introduction goes to some length to disclaim the “cookbook” approach to anesthesia practice. In this regard, the authors have succeeded in providing comprehensive summaries of topical and useful information suitable for the active practitioner. The assumption that the audience knows the basics of anesthesia allows for a fuller discussion of fine points of care in the limited space allotted by the format. One unusual feature is the 10-page table of abbreviations included before the first section. Presumably, this allows for extensive use of abbreviations in the text and the condensation of more material into the one-page limit. A disadvantage is that many practitioners will be forever referring back to the index for interpretation of the numerous acronyms, such as RIMA (reversible inhibitor of monoamine), MVD (microvascular decompression), and GRAS (generally recognized as safe). The editing is good, but occasional logistic gaps and overlaps do occur, such as the discussion of prone positioning complications in a section on herniated nucleus pulposus rather than under lumbar laminectomy. Procedures are listed strictly in alphabetical order, with anterior cervical fusion under A but femoral-popliteal bypass under B . Gas embolism is listed with the other operative procedures (though rarely posted as such on the operating room schedule), whereas amniotic fluid and fat embolism are listed (appropriately) as diseases.
The disease section is appropriate for practitioners faced with unfamiliar or rare comorbidities, but the procedures section includes amputation and bowel resection, with which we should already be very familiar. The drug and testing sections are well written and include cost considerations. Overall, this useful and practical reference is a good value for the clinical anesthesiologist or senior resident. It would be less useful for a new trainee or one without a firm grasp of U.S. medical terminology and customs.