Department of Anesthesiology Rush Medical College atRush-Presbyterian-St. Luke’s Medical Center Chicago, IL60612
Pharmacology and Physiology in Anesthetic Practice. 3rd ed. Robert K. Stoelting. Philadelphia: Lippincott-Raven, 1999. ISBN 0-7817-1621-7. 814 pp. $95.00.
The third edition of Pharmacology and Physiology in Anesthetic Practice has again succeeded in providing indepth and concise information on aspects of pharmacology and physiology that are relevant to the perioperative management of patients. As in the two previous editions, the book is divided into two general sections, with the first 38 chapters titled “Pharmacology” and Chapters 39 through 54 titled “Physiology.” As two-thirds of the volume is devoted to pharmacology, this book could easily, and unfortunately, be shelved with general pharmacology texts. Although much of the first chapter on pharmacokinetics and pharmacodynamics could be found in more general text books, the inclusion and discussion of content-sensitive half-times, times to recovery from anesthetics, and drug effects at excitable and transmembrane proteins directly convey the importance of these principles to the understanding of the actions and the differences of drugs used in anesthetic practice.
The first chapter has also undergone the most dramatic changes from edition to edition, reflecting the continuing advancement in the understanding of the pharmacology of anesthetic drugs. This excellent introductory chapter is followed, in Chapters 2 through 8, by more extensive discussions of the inhaled anesthetics, opioid agonists and antagonists, barbiturates, benzodiazepines, nonbarbiturate injection drugs, local anesthetics, and neuromuscular blocking drugs. These seven chapters are the most likely to be intensively studied by trainees, and the extensive use and appropriate placement of figures and tables are extremely helpful in assimilating the information contained in the text. Each of these chapters contains general, as well as organ system specific, pharmacokinetic, pharmacodynamic, and toxicologic data and clinical information regarding the use and administration of the drugs. These chapters are also extensively referenced and remarkably up to date (many references from the mid 1990s), although this is nearly an impossible task for a textbook of this nature. The remaining chapters in the pharmacology section are arranged by the general pharmacologic class. These groupings have remained the same since the first edition, but have been updated both in content and reference. Although each of these chapters provides a good general overview of the pharmacology, clinical utility, and anesthetic considerations within the pharmacologic class, they are not intended to be as extensive, nor do they contain the extensive references found in the first eight chapters. However, the excellent use of figures and tables, again, are an invaluable aid in organizing the materials and provide quick references for comparison of the pharmacologic differences of the drugs within the class. Unfortunately, because many more new drugs have been released into some of these pharmacological categories, compared with the classes of drugs more commonly used in anesthetic practice, these chapters, at times, lacked listings of the more recently released drugs.
At first glance, it would appear that the physiology section of the third edition has undergone less dramatic evolution, compared with the pharmacology section of the textbook; this is not the case. Although these chapters are not as thoroughly referenced as the chapters in the pharmacology section, there has been extensive updating of references, revisions to the text, and the addition of many new and more detailed illustrations and tables. The chapters on the central nervous system, the physiology of the heart and lungs, the electrocardiogram, and acid-base balance are of particular importance to anesthesia practitioners.
The textbook is attractively covered, and the text and figures are sharp and visible. Figures and illustrations are all in black and white, but this does not affect their quality or interpretability. The table of contents is extremely useful, as it identifies the pages on which particular drugs are discussed, making it quicker to locate the material, rather than having to search the index. The subject index is extensive, in most cases expanding two to three levels under a particular topic. The text itself is well written and reads more easily than that found in similar textbooks. This edition contains substantially more new and important information than the previous edition, making it an essential addition to medical and departmental libraries and an excellent reference for those in need of updating their knowledge of the pharmacology and physiology of drugs in anesthetic practice.