Pharmacology for Anaesthesia and Intensive Care, 3rd Edition. By Tom E. Peck, M.B., B.S., B.Sc., F.R.C.A., and Sue A. Hill, M.A., Ph.D., F.R.C.A. Cambridge, United Kingdom, Cambridge University Press, 2008. Pages: 378. Price: $70.00.
Providing skillful medical care in the arena of anesthesia and intensive care requires a robust and broad knowledge of physiology, pharmacology, and pharmacokinetics. Pharmacology for Anesthesia and Intensive Care, 3rd Edition, expertly reviews pharmacokinetics and pharmacology, progressively building the reader’s understanding of these important concepts.
This edition is organized into three broad categories. First, the authors begin by building a foundation of knowledge in basic principles of pharmacology: Absorption through excretion, chemistry subgroups and isomerism, mechanisms of drug action, and pharmacokinetics. The middle of the book is devoted to core drugs used in anesthetic practice including general anesthetic agents, analgesics, local anesthetics, muscle relaxants, and anticholinesterases. Finally, the last part of the book has excellent and thorough coverage of cardiovascular drugs, antiemetics, intravenous fluids, diuretics, drugs affecting coagulation, drugs used in diabetes, corticosteroids, and antimicrobials. The discussion of each drug includes considerations of how it could interact with and affect anesthetic management.
In addition to concise yet thorough chapters, this book has features that are useful for quick reference, including a “medicinal chemistry mini-dictionary” covering molecular building blocks from Acetyl through Xylidine. The excellent tables and figures are too numerous to list. Some prime examples of useful tables include metabolism of drugs by cytochrome P450 system, cardiovascular effects of inhaled anesthetics, physiologic interactions of muscle relaxants, composition of intravenous fluids, and a summary of antibacterial drugs and their activities. Examples of helpful illustrations include isobolograms, depiction of one- through three-compartment models, and a step-by-step demonstration of the concentration effect of inhaled anesthetics. Finally, the book is well indexed, allowing rapid location of specific drugs or concepts.
The attribute that sets this book apart from mere reference texts is the devotion of the authors to develop true comprehension. The text includes a review of basic manipulation of logarithms and exponents, reiteration of key points to reinforce understanding, concrete examples with common drugs to drive home teaching points, and helpful graphs and illustrations to visualize complex pharmacokinetic concepts. Without moving too slowly, the text is accessible to those who are a bit rusty on their basic sciences. For example, when introducing a basic formula early in the book, the authors kindly remind the reader that “the square brackets denote concentration.” It was refreshing to read a textbook that was so accessible and methodical in developing a true understanding of difficult concepts.
The only negative aspect of this text is that the drugs are identified as they are found in the British National Formulary, using some different nomenclature than common U.S. formularies. Also, a couple of drugs mentioned in the text are not approved for use in the United States.
Improvements since the last edition include a complete overhaul of the mathematics section giving a strong base in pharmacokinetics, a new chapter on intravenous fluids, and an expanded section on the molecular mechanism of anesthesia. This edition includes all new drugs used in anesthetic and intensive care practice today.
Pharmacology for Anesthesia and Intensive Care, 3rd Edition, encompasses a superb fusion of pharmacokinetics and pharmacology with practical advice for the daily delivery of anesthesia and intensive care medicine. The book’s two authors present a single style and voice that is easy to read and understand. The book progressively builds the reader’s knowledge when it is read from cover to cover; alternatively, each section is written well enough to stand strongly on its own. During my reading of this text, a number of my colleagues, residents and attending physicians alike, questioned me when this book would be available for purchase, and they are eagerly awaiting its publication. I strongly recommend this book as a valuable addition to the library of anyone who practices anesthesia and intensive care medicine.
Mindy N. Cohen, M.D.
University of Colorado at Denver Health Sciences Center, Englewood, Colorado. firstname.lastname@example.org
© 2009 American Society of Anesthesiologists, Inc.