The Pharmacologic Basis of Anesthesiology

Abstract

The Pharmacologic Basis of Anesthesiology, T. A. Bowdle, A. Horita, E. D. Kharasch, eds. New York: Churchill Livingstone, 1994, ISBN 0-443-08878-0, 754 pp, indexed, $99.00. The editors created this book because they wanted to read it. They are anesthesiologists and academic pharmacologists who could not find a reference book that answered their own questions about the basic science, pharmacokinetics, and clinical pharmacology of anesthetic drugs. The text is divided into nine sections of three to five chapters each so that there are 33 chapters in addition to the introduction to the fundamentals of cellular neuropharmacology. The chapters are written by a total of 47 authors--five from Europe, one each from Australia and Japan, and the remainder from North America. The section titles include Opioids, Local Anesthetics, Benzodiazepines, IV Induction Agents, Ketamine, Neuromuscular Blockade, Inhalation Agents, Adjuvants, and Emerging Concepts. The focus of the book is primarily on anesthetic drugs, with chapters on cellular pharmacology, pharmacokinetics, and clinical pharmacology for each major class of drugs. No attempt has been made to make the book a handy reference for every drug used by an anesthesiologist. Most drugs acting on the cardiovascular system are excluded, although beta-blockers are included. The chapters are quite detailed and current, although the number of references varies, as might be expected with a multiauthor text. The number of references does not always bear a relationship to the importance of the drug or the length of the chapter, but most chapters are very well referenced. By and large the information seems current. In general, there is an emphasis on basic knowledge rather than the use of the drugs, and this is a strength of the book. Fundamental understanding will be improved in those who take the time and effort to read it. The emerging concepts include novel drug delivery, nitric oxide, and emerging concepts in pharmacokinetics. These are excellent, informative, and up-to-date chapters. No real explanation of how the topics were selected is offered, but the authors believe they are "promising new areas of research" and "have potential for enormous growth." As in any field of human endeavour where selectivity has been allowed, one can criticize omissions, e.g., there is little general pharmacology and almost no new information on cytochrome P-450 enzymes and their relevance. The potential for the use of isomers of drugs is almost totally ignored, antacids/H2 receptor antagonists are missing, and there is no information on the mechanism of drug interactions. This book is excellent so far as it goes. Any reader of the book will benefit; indeed, the editors admit they "learned an enormous amount of interesting pharmacology" in creating and editing the book. The major problem lies in its omissions and selectivity. It is quite a large text with an expansive title not to be comprehensive. Walter S. Nimmo, MD Inveresk Clinical Research, Department of Anaesthesia, University of Edinburgh, Edinburgh EH14 4AP, United Kingdom