Anesthesia, 4th ed

Abstract

Anesthesia, 4th ed., Ronald D. Miller, ed. New York: Churchill Livingstone, 1994, ISBN 0-443-08906-X, 2886 pp (two volumes), $195.00. The fourth edition of Anesthesia represents a significant advance over the third edition, published only 4 yr ago. Not only has the editor kept the book current (cited references are as recent as 1993), but he has enhanced the book itself. Despite the expanded coverage, growth in the physical size of the book has been contained by the use of thinner paper, slightly narrower margins, and a four-column layout for the index. These physical changes have made the book only marginally less comfortable to read than its excellent predecessor. Table 1.*Table 1The book is laid out with the text in two columns and incorporates plenty of tables, diagrams, and line drawings, which are presented without borders. Outlines head the chapters, guiding the reader. The text is one color (black) instead of two, and there are no sidebars, chapter summaries, subordinate text in alternative typefaces, or study questions. Although these innovations have been used effectively in some recent anesthesia texts, serving to capture and direct the reader's attention, omitting them results in a clean and uncluttered page. This book's 86 chapters are divided into six sections: Introduction; Scientific Principles; Anesthesia Management; Subspecialty Management; Critical Care Medicine; and Ancillary Responsibilities and Problems. New chapters cover separately several topics formerly incorporated elsewhere: laser surgery, laparoscopy, organ transplantation, and brain death. The editor of a multiauthored text confronts two decisions: whether to edit for uniformity of style and whether to eliminate redundancy and overlap. Dr. Miller has permitted diversity in the writing of the various chapters and has presented each chapter as a complete treatment of the topic, allowing replicate coverage of some material. As it is unlikely that anyone will ever read this book cover to cover in one sustained effort, the diversity and richness of the coverage that result from these decisions override the advantages of uniformity and efficiency seen in smaller books. Likely more important to the success of the book is the innovation introduced with the third edition, the close review by a board of consulting editors. Color plates appear in Anesthesia for the first time with this edition. The color cardiac echocardiograms are very effective; the atlas of regional anesthesia procedures is less useful. The color drawings are not as detailed or as numerous as those in texts devoted to regional anesthesia. Good line drawings, used elsewhere in the book, might have conveyed the same information at less cost and in less space. Major medical texts serve readers in three ways. First, those learning anesthesia for the first time may read such a book to acquire the fundamental knowledge they need to enter the specialty. This book has some drawbacks for such users. It is too big to serve as a first book, but that is why there are introductory texts. The redundancy might become tedious if one tried to read the book straight through. However, even new learners would be ill advised to undertake this task. Instead, they should do as more experienced users do--approach the book with a question in mind. This second purpose is best managed by consulting the Table ofcontents and the chapter outlines; the index occasionally fails to direct the reader to pertinent material. The self-sufficiency of the individual chapters makes this the use to which this book is best suited. The third use for such a book is to provide continuing medical education for experienced practitioners. The frequent, thorough updating and the authoritative review by a board of consulting editors make this an ideal text to supplement a program of reading in journals. Is this the only anesthesia text a serious student of the specialty needs? Probably not: comparable chapters in competing books are sometimes more successful; specialized texts offer more profound coverage of specific areas; other texts aim more directly at the needs of the new learner. Is it beyond improvement? Probably not: this reader would welcome a computer-based index, similar to that offered by Scientific American. (The text of Anesthesia occupies fewer than 15 megabytes, making a floppy-disk-based index practical.) In the future, publishing major medical texts via the CD-ROM formal or some other form of electronic storage medium will allow the inclusion of search mechanisms, linking of entries, sound, and video (think of demonstrations of techniques, electrocardiograms, and echocardiograms). Nevertheless, this new edition belongs on the desk (not on the bookshelf) of everyone who is involved in anesthesia care. Frank L. Murphy, MD Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA 19104