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Clinical Pharmacology for Anesthesiology

Ingrande, Jerry MD, MS

doi: 10.1213/ANE.0000000000000954
Media Reviews: Book Review
Free

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, jerryi@stanford.edu

The terms “anesthesiologist” and “pharmacologist” are not exclusive. One cannot excel clinically at administering an anesthetic without an adequate knowledge of applied pharmacology. To this end, a strong foundation in the principles of pharmacology, including pharmacokinetics, pharmacodynamics, and the effects of specific comorbid conditions and patient demographics on said pharmacokinetics and dynamics, is paramount to deliver a safe and efficient anesthetic. There are currently only a few textbooks dedicated to these pharmacologic principles. Ken B. Johnson’s Clinical Pharmacology for Anesthesiology is an excellent and welcome addition to this small collection.

Johnson has done well compiling experts in the field of clinical pharmacology and anesthesiology to formulate the 37-chapter textbook. The book is a comprehensive account of both core pharmacological concepts and applied pharmacology specific to the field of anesthesiology. Clinical Pharmacology for Anesthesiology is more than an encyclopedic description of medications used during the perioperative period. Readers who are looking for a basic laundry list of medications and their use may want to look elsewhere. However, those who are looking for a stand-alone anesthetic pharmacology textbook will be pleased with this work.

The first section of the book provides an important segue into the rest of the text. Before delving into the pharmacology of specific anesthetics and perioperative medications, Section I introduces the reader to foundational concepts of clinical pharmacology, including pharmacokinetics and pharmacodynamics. Section I also includes 2 highlight chapters of the book devoted to drug interactions and simulation.

It is in this initial section where this textbook succeeds where others have failed. One of the drawbacks of many anesthetic pharmacology texts is that they are written with either the clinical anesthesiologist or the clinical pharmacologist in mind. The former generally has little-to-no specialized training in clinical pharmacology and yearns for a text that provides useful information about anesthetic drugs and dosing consideration but wants little in the form of mathematical modeling and simulation that the latter group craves. This book strikes an outstanding balance between the 2. The key mathematical equations and models are introduced and appropriately support the text. The illustrations elegantly compliment the text and are easy to interpret. Readers who are seeking more details, or who are interested in the mathematical concepts of modeling, can find this information in an expertly written appendix: Origin of Mathematical Models for Anesthetic Drug-Drug Interactions.

Subsequent chapters introducing relevant anesthetic and perioperative medications are well written and evidenced-based. Recommended dosing regimens of these medications are supported by published pharmacokinetic/pharmacodynamic models rather than relying on anecdotal author opinion and personal style. These chapters are complete and comprehensive—the reader will be hard-pressed to find a drug or class of drug that is not covered in the text. Not only are the conventional anesthetic agents (IV hypnotics, inhalational agents, opioids, etc.) described but also chapters exclusively discussing anticonvulsants, anticoagulants, and vasoactive agents are present, exemplifying the extensive coverage of this text.

In fact, it is in these latter chapters where this book really stands out from its contemporaries. Unlike other textbooks in this field, Johnson’s text incorporates an entire section dealing with the pharmacological management of special patient populations. Full chapters are devoted to how patient characteristics such as obesity, advanced age, heart failure, and acute blood loss affect pharmacologic management. This section also contains a well-written and detailed chapter covering pediatric pharmacology. Topics such as propofol infusion syndrome and the effect of anesthetics on neuronal development illustrate the breadth of this chapter.

The book concludes with 2 sections dealing with dosing considerations during the perioperative period and for specialized case types, including neurosurgery, cardiovascular surgery, and obstetrics. The chapter covering anesthetic management during endoscopy is not only expertly written but also especially relevant in light of the nationwide attention surrounding the development and use of commercially available TCI software for conscious sedation.

There were only 2 minor areas that deserved further mention in this book. Although IV fluids and corticosteroids are mentioned briefly in other sections, full chapters devoted to the pharmacology of intraoperative fluids and corticosteroids were lacking. In addition, although this text can be purchased and downloaded for portable electronic devices and tablets, accompanying electronic media that would allow the user to interact with and perhaps run simulations of various dosing regimens would have been the perfect platform to demonstrate the application of the pharmacokinetic/pharmacodynamic models and principles described in the initial sections of the book.

Nevertheless, Clinical Pharmacology for Anesthesiology is a complete pharmacology textbook. The attending anesthesiologist, resident, and even medical student with a keen interest in anesthesiology and/or pharmacology will find this book to be an enjoyable and important text. This text skillfully marries basic pharmacology with clinical practice. Clinical Pharmacology for Anesthesiology is an outstanding textbook that will give its readers the information they need to make rational and evidence-based decisions regarding the pharmacologic management of their patients.

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RECUSE NOTE

Ken B. Johnson is the section editor for Anesthetic Clinical Pharmacology for Anesthesia & Analgesia. He was not involved in soliciting this review nor in the handling of this book review, which was handled independently by the Co-Section Editor for Media Reviews, Eugene A. Hessel, II.

Jerry Ingrande, MD, MS

Department of Anesthesiology, Perioperative and Pain Medicine

Stanford University School of Medicine

Stanford, CA

jerryi@stanford.edu

© 2015 International Anesthesia Research Society