The Ambulatory Anesthesia Handbook

Abstract

The Ambulatory Anesthesia Handbook, Rebecca S. Twersky, ed. St. Louis: Mosby-Year Book, 1995, ISBN 0-8151-8447-1, 542 pp (paperback), $34.95. What does one expect from a handbook? Portability? Succinctness? Ease of finding material? Up-to-date information? This pocket-sized tome has an identity problem. It is portable, and mostly up-to-date, but succinctness and ease of finding material are inconsistent. Several of the chapters overwhelm the reader with information. Facts and studies abound (two chapters have more than 100 references each), but one struggles to find the answer to the question of the moment. The 14 chapters cover preoperative evaluation and laboratory testing, descriptions of common ambulatory surgical procedures, management dilemmas of both pediatric and adult patients, anesthesia for both pediatric and adult patients, postanesthesia care, discharge process, complications, quality assurance, and cost containment. The chapter authors are practitioners of ambulatory anesthesia, mostly in academic centers. Their contributions vary in quality. Some are barrages of facts, with no attempt at synthesis or interpretation. Others are well-written examinations of all sides of a controversy with the logic behind carefully drawn conclusions clearly explained. Most chapters have references that are as recent as 1993 or 1994. Because much of ambulatory anesthesia is the same as any other anesthesia, some overlap with other textbooks is inevitable. The chapters on pediatric anesthesia are particularly well aimed at the ambulatory population. The chapter on regional anesthesia covers most of the commonly performed blocks and is well illustrated. The chapter on cost containment reviews each step of the ambulatory surgery experience, with observations on potential cost savings. There are several innovative attempts to make this book user-friendly. Many chapters have boxes that call attention to key points. A series of 17 appendices provides quick access to commonly used information. This reviewer is disappointed in the editing and production of The Ambulatory Anesthesia Handbook. Some chapters present the same material in boxes, tables, and text. Too many boxes make the production appear busy and cut up. Boxes should be reserved for the most significant points to be made in the chapter, and the level of importance should be consistent from chapter to chapter. How does one titrate a depolarizing muscle relaxant to maintain "1 out of 4 twitches"? Wavelength is not measured in amperes, and the "three meter tape No. 425" mentioned in Chapter 2 probably refers to the 3M brand. Attention to detail is as important in the production of anesthesia handbooks as in the administration of anesthesia. There is a wealth of information in this book. It is a bargain at $34.95. In preparing the next edition, which is eagerly awaited by this reviewer, the authors and editors should consider culling some of the less relevant material, synthesizing the torrent of facts in many of the chapters, and clearly stating their recommendations and the thinking that led to them. Thomas J. Conahan, MD Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA 19104