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Morgan & Mikhail’s Clinical Anesthesiology, 5th Edition

DiLorenzo, Amy N. MA; Schell, Randall M. MD, MACM

doi: 10.1213/ANE.0000000000000298
Media Reviews: Media Review

Department of Anesthesiology, University of Kentucky Chandler Medical Center, Lexington, Kentucky,

The fourth edition of Clinical Anesthesiology, known to many as Morgan and Mikhail’s textbook of Anesthesia, claimed to be “the most current, concise, and readable text in all of anesthesiology” when published in 2006. The new edition of Clinical Anesthesiology (5th edition), published in 2013, continues this claim of being “the most user-friendly, clinically relevant overview of the practice of anesthesiology.”

Those who enjoyed the practical presentation of the fourth edition of this textbook will not be disappointed in the new edition. The stylistic goal, “to be written simply enough so that a third year medical student can understand all essential basic concepts yet, comprehensive enough to provide a strong foundation for a resident in Anesthesiology,” is unchanged. The fifth edition is divided into five sections: Anesthetic Equipment & Monitors, Clinical Pharmacology, Anesthetic Management, Regional Anesthesia & Pain Management, and Perioperative Care & Critical Care Medicine. The sequencing of chapters is appropriate, and the fifth edition continues the pattern of having a chapter on physiology, such as Cardiovascular Physiology & Anesthesia before a chapter on anesthesia management such as Anesthesia for Cardiovascular Surgery. Each chapter still begins with summary numbered key concepts that are identified and expanded on in the body of the chapter. The writing remains concise, covers the basic principles, and graphics remain simple and visually appealing. Case discussions, intended to deal with clinical problems and promote application of key concepts, remain at the end of the chapter along with suggested readings rather than extensive referencing of sources.

In the foreword to the fifth edition, Drs. Morgan and Mikhail acknowledge the new editors: Drs. Butterworth, Mackey, and Wasnick for taking Clinical Anesthesiology to “a new level.” The new team of editors and authors have updated the chapters and added 3 new ones on topics of current interest: (1) Ambulatory, Nonoperating Room & Office-Based Anesthesia, (2) Perioperative Pain Management & Enhanced Outcomes, and (3) Safety, Quality, & Performance Improvement. The chapter on Perioperative Pain Management and Enhanced Outcomes that focuses on how to combine multiple individual evidence-based elements of perioperative care (i.e., multimodal analgesia, avoidance of fluid overload, stimulation of gut motility) into a coordinated effort with synergistic, beneficial effect on surgical outcomes is cutting-edge and informative. The updated chapter on Peripheral Nerve Blocks takes especially good advantage of the new full color presentation and includes ultrasound images of anatomy pertinent for many blocks. There are approximately 70 new figures and 20 new tables in the textbook. Many chapters include updated Guidelines at the end (i.e., American Society of Anesthesiologists Task Force on Chronic Pain Management Anesthesiology 2010) and pertinent Web sites. The Profiles in Anesthetic Practice, brief essays or perspectives on a topic related to the chapter and written by recognized experts, were included in the third and fourth editions but are no longer present in the fifth edition.

The Research and Review by residents who are acknowledged in the front of the textbook suggests the authors value the input from one of the main expected consumers, anesthesiology resident learners. However, it will likely be used for examination review and as a clinical refresher by many different levels of learners. This textbook does not provide the in-depth, fully referenced learning source that advanced learners may desire. Statements and explanations of concepts in chapters are not referenced and as such, the evidence for specific statements of “fact” cannot be easily confirmed.

It is probable that you will recognize the larger size of the fifth edition before you notice the changes previously described. Those who choose to carry around reference textbooks may prefer to use an electronic version (i.e., Kindle, iPhone/iPad app). We purchased the iPhone app ($89) from the App Store to review. The app is very easy to navigate, and with one click, figures such as regional nerve block techniques become easy to view and are high quality images. The text may be accessed as an online resource ( and as a Kindle version. The online version, McGraw Hill Access Medicine (Access Anesthesiology), is provided as an electronic resource at many institutions. The text, figures, references, and suggested readings are similar to the hard copy without additional audio or video content. One can copy and paste sections of the text into other documents. The beginning of each chapter has related content from other source textbooks that can be accessed by a simple click. The figures are similar in quality but can be enlarged or even downloaded as a PowerPoint slide to embed in presentations. Medications in the text have an active link that provides easy access to a drug index with drug monographs. Many of the suggested readings and references at the end of chapters have active links to Web sites and articles including PubMed, although some of the reference links are not present. Some, but not all of the practice guidelines referenced at the end of many chapters, have an active link to the article containing the appropriate guidelines.

Morgan and Mikhail’s Clinical Anesthesiology Flashcards (Richard Urman, Jesse Ehrenfeld) are also available (i.e., Amazon; approximately $36.00). The 2-sided cards (320 total) include case studies, Q&A, and “must-know facts” in clinical anesthesiology and are likely to be used for exam review.

It has been >20 years since Drs. Morgan and Mikhail developed a widely used textbook in anesthesiology that was written simply and presented material in a way that students could easily grasp essential basic concepts. The new edition is user-friendly, does focus on clinical relevance, and includes most up-to-date topics. If you desire extensive background or depth of explanations for concepts, you will need to consult additional sources. The fifth edition of Clinical Anesthesiology is a succinct overview. Learners at many stages of their training or practice will find it like an old friend, comfortable and easy to be with. However, many who desire portability will find it “easier to be with” if they carry it around in an electronic format.

© 2014 International Anesthesia Research Society