Anesthesia. 6th ed. Miller RD, ed. Philadelphia: Elsevier/Churchill Livingstone, 2005. ISBN 04430661: 2 vols., 3376 pages, $299.00. ISBN 0443066531: online, 3376 pages, $299.00. ISBN 0443066566: book with E-dition, $399.00.
The 6th edition of Miller’s Anesthesia arrives 24 years after the 1st edition as the premier reference text of anesthesiology. Challenged during earlier editions, it is now so complete and excellent that no competitors are likely to appear. It seems quaint to read the preface of the 1st edition where Miller wrote, “There is still no comprehensive, up-to-date American reference work that covers the entire field of anesthesia.” He also noted that, “This text, while comprehensive, is not encyclopedic.” The 6th edition is encyclopedic.
The 6th edition builds on the strengths of the 5th, retaining the same six sections, from scientific principles to ancillary responsibilities, and the very readable format. The presentation style and enormous content of the text reflects in part that chapter contributors had previous versions to build upon. 77 of the 146 current chapter contributors participated in the 5th edition, and 10 even contributed to the 1st. The 6th edition thus represents a polished version of a book that was already shining. Still the 6th edition of Miller’s Anesthesia represents an enormous undertaking and achievement. Table 1 lists some numerical facts about the text.
Purchasers of the textbook also receive a CD with 11 videos that illustrate some technical procedures. Two examples are “Ultrasound-guided peripheral venous access” and “Caudal block in pediatrics.” Each video is to the point and lasts only a couple minutes. The videos add to the comprehensiveness and value of the text. The 6th edition contains several chapters not found in the 5th, e.g. “Anesthesia for robotic surgery,” and “Perioperative blindness.” Another improvement is a list of key points at the end of each chapter, in addition to the summary.
Copyright of this text is 2005, which probably means most chapters were written in 2004. An inspection of 8 chapters (those divisible evenly by 10) reveals 2181 references, of which 45 are dated 2003, four 2004, and none 2005. This time gap between appearance of new information and its inclusion in a reference text occurs commonly, although some readers may find this lack of freshness at odds with the note by Miller in the Preface that all contributing authors were instructed to revise their chapters to ensure a contemporary treatment.
Miller’s Anesthesia offers a good solution to aging information, a companion Web site that is routinely updated. The Web site contains the entire contents of the printed text in a fully searchable format, as well as new content, updated weekly and overseen by the editors. Two additions to the text material were dated within the month when viewed by this reviewer. They covered focused areas, e.g., anesthesia-assisted heroin detoxification, and were incorporated into the main text. The Web site contains other useful items, such as self-assessment questions and an image library useful for making PowerPoint slides for educational presentations. For answering specific questions, the reviewer found the electronic version better and quicker than the printed textbook, while for general reading about a subject the textbook seemed preferable.
Miller’s Anesthesia does not cover well one large area of anesthesia practice, that commonly known as practice management. So anesthesiologists will find little or no information about anesthesia conversion factors, billing compliance rules, or group contracting. Entering such currently hot topics as “pay-for-performance” into the text and Web site search engine offers no hits.
Another area that deserves coverage in such a comprehensive text for anesthesiologists is lifelong learning. This would balance the chapter on teaching anesthesia. Information on learning might include such topics as what makes a practitioner competent and how to critically evaluate journal articles. For the science of anesthesiology though many of the chapters in Miller’s Anesthesia offer the best review available. There is also no equal to the breadth of coverage or authority of this text. Although the textbook and Web site are expensive, every academic anesthesiologist should purchase them, and anesthesiologists in every practice should have access to the information. The many improvements in the 6th edition necessitate its acquisition even for those owning the 5th.