Basics of Anesthesia, 5th ed.

Abstract

Basics of Anesthesia, 5th ed. Stoeltin RK, Miller RD, eds. Philadelphia: Churchill Livingstone/Elsevier, 2007. ISBN 13:978-0-443-06801-0. 697 pages, $82.95. First published in 1984, Stoelting and Miller's Basics of Anesthesia has reached mythic status in the world of anesthesia education. Guided by the goal of concisely presenting the anesthesia knowledge base to the wider community of anesthesia practitioners, Basics of Anesthesia has become the introductory textbook for many residency teaching programs. In this 5th edition revision of the classic text, Stoelting and Miller chose to have 62 experts update the chapters while taking on the roles of editors as well as contributors. They have also provided access to a companion Web site, which broadens the usability of the book. Similar to the 4th edition, the book is divided into 7 sections but now consists of 46 total chapters compared with the previous edition's 36. The increase in number is a result of the addition of 5 new chapters as well as the subdivision of topics from several previously included chapters into stand-alone chapters. The section headings include: Introduction, Pharmacology, Preoperative Preparation and Intraoperative Management, Special Anesthetic Considerations, Recovery Period, Consultant Anesthetic Practice as well as Appendices. The title page at the start of each section nicely details the included chapters and starting page numbers within it. The content of each chapter is also clearly summarized on a title page into headings and subheadings. This organizational schema is then faithfully reproduced within the chapter text through the use of bold and colorful division headings. This not only allows one to quickly locate information of interest, but fosters the development of a mental framework that allows the rapid assimilation of new knowledge. Although many of the figures and tables seen in the 4th edition are included in this new one, they have all been updated to a new visually appealing format and many of the figures have been updated to dazzling computer-generated images. Overall, comparison of the new text with the previous one reveals that the contributors successfully preserved the organization and much of the content of the previous edition while expanding only as neces-sary. This continuity of format preserves the spirit of the original text. Content from several areas illustrates how the book has been updated to reflect the latest practice standards and research findings. The new chapter “Medical Informatics” provides a clear summary of the application of the principles of evidence-based medicine to the field of anesthesia by outlining examples of clinical “decision support” for questions germane to perioperative care. By illustrating and encouraging critical evaluation of the literature, the chapter sets the foundation for the incorporation of research findings throughout the rest of the textbook. The new chapter “Clinical Cardiac and Pulmonary Physiology” reviews the basic principles necessary to put important pathophysiology and its pharmacologic management in proper context. Other highlights include an expanded section on preoperative evaluation, including a discussion on the potential benefit of perioperative beta-blockade as well as the principles of cardiac risk assessment. However, it stops short of dogmatically dictating management, wisely leaving open the door for the further refinements of strategy sure to come. Although the goal of this textbook is to present a concise overview of the scope of anesthesia practice, the depth is at times inconsistent. The chapter on airway management includes an updated overview of the various adjunct airway devices (including the glidescope) and a fairly in-depth discussion of the approach to fiberoptic intubation. However, much of the information is too cursory, and there is a notable lack of the photographs and illustrations necessary to really understand the use of these tools. The strategy of limiting the presentation to an overview is also seen in the chapter “Peripheral Nerve Blocks.” Although regional anesthesia has seen a renaissance with the application of ultrasound technology, the chapter underemphasizes its growing role. Moreover, the photos used to illustrate ultrasound's benefits in the performance of conduction blockade are of poor quality and belie the advantages ultrasound presents to the practitioner. Furthermore, the chapters on “Bioterrorism and Natural Disasters” and “Medical Direction in the OR,” while interesting, seem out of place in an introductory text, especially one that has grown from 507 pages to 697 pages. The new edition does excel in its use of Elsevier's educational Web site, evolve. This is an avant-garde upgrade in the age of the internet and so-called wiki knowledge-gathering strategies. Access available at the “student” level, though, is somewhat anemic, with the student really only given online access to the tables and figures available within the book. The “instructor” resources, however, demonstrate great promise. Not only does one gain access to tables and figures for presentation preparation, but also there are tools to create online accessible quizzes and chatrooms and to upload educational materials of one's own creation. For the motivated anesthesia educator, there is an infinite potential for creative utilization of the book's underlying content in creating really unique companion educational materials. Updates to the content of the book will also be available online. By maintaining the flavor of the previous editions, staying true to its mandate to provide solid introductory content and modernizing to keep current with available educational modalities and preferences, this 5th edition of Basics of Anesthesia more than lives up to expectations. Therefore, it should continue to occupy the rarefied position of the primary introductory textbook of anesthesia for medical students and beginning trainees as well as the go-to text for those preparing for the written board exam or the seasoned professional in need of a focused review. Brian Egan, MD, MPH Assistant Professor Assistant Program Director Co-Director, PGY-1 Year Assistant Director of Medical Student Education Department of Anesthesiology Columbia University New York, NY [email protected]