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Stoelting’s Pharmacology and Physiology in Anesthetic Practice, 5th ed.

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

doi: 10.1213/ANE.0000000000000945
Media Reviews: Book Review

Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina

Department of Anesthesiology, University of Kentucky, Lexington, Kentucky,

Department of Anesthesiology, University of Kentucky, Lexington, Kentucky

For nearly 20 years and 3 editions, the single-authored textbook, by Robert Stoelting titled Pharmacology & Physiology in Anesthetic Practice, was valued for clear and concise explanations of physiology and the medications that we use in the care of patients. When the 4th edition was published in 2006, Simon Hillier participated as the co-editor with Stoelting. The 5th edition (2015) is a multiauthored textbook with 34 contributors. In this new edition, instead of a single author, 3 editors took a hybrid approach in which a small number of authors oversaw major blocks, and final editing was done by Pamela Flood and James Rathmell in an attempt to keep the text in “one voice” similar to previous editions. The editors acknowledge that there will be errors and limitations in this new edition and have invited the readers to “peer review” and become collaborators in future editions by sending their comments, corrections, and suggestions to To honor the founding author of this classic text, the title was changed to Stoelting’s Pharmacology and Physiology in Anesthetic Practice.

The 5th edition is similar in length to the 4th edition (900 pages and 903 pages, respectively). Although previous editions were formatted in 2 major sections, pharmacology followed by physiology, the new edition is broken down into 9 system-based parts (pharmacology and physiology principles, neurologic, circulatory, pulmonary, blood, gastrointestinal, endocrine, miscellaneous, and special populations). Most of these parts are organized with chapters pertaining to physiology immediately followed by chapters pertaining to the related drugs. This format may allow readers to more easily organize the associated physiology and medications in their learning. For example, in the 5th edition, the topic Blood and Hemostasis is covered in 5 consecutive chapters (Physiology of Blood and Hemostasis, Blood Products and Components, Procoagulants, Anticoagulants, and Physiology and Management of Massive Transfusion).

For the most part, the text has been rewritten with the addition of color tables and figures. However, some chapters (i.e., Inhaled Anesthetics, Intravenous Anesthetics, Gastrointestinal Physiology) carry forward much of the material from the last edition. This is not necessarily a criticism; when something is already clear, concise, and correct, why attempt to change it? Many of the references are dated, but this may be due to the nature of the subject content. For example, although there are different authors of each chapter, <20 of >300 references in the chapter on Inhaled Anesthetics and Intravenous Sedative and Hypnotics, and 0 of 33 references in the Gastrointestinal Physiology chapter, are from the year 2006 (4th edition) or more recent. If there was an outline at the beginning of each chapter and identification of key points at the end of each chapter, this might help the learner organize key concepts.

There are multiple recently introduced drugs included in this updated version, including clevidipine, levosimendan, and sugammadex. Keeping in line with the 4th edition, this text contains both a drug index and a subject index at the back of the book. Having a separate drug index is helpful in efficiently finding information regarding medications.

We selected several relatively recent pharmacology and physiology topics—including newer oral anticoagulants (dabigatran and rivaroxaban), lipid emulsion for local anesthetic toxicity, POISE trial and extended release metoprolol, hydroxyethyl starch and acute kidney injury, and possible neurotoxicity associated with inhaled anesthetics in children—to review in detail. All these topics were thoroughly covered, with the exception of the discussion of inhaled anesthetics and neurotoxicity, which was quite abbreviated.

To complement the full text, Stoelting’s Handbook of Pharmacology & Physiology, 3rd Edition ($74.99 [USD], Wolters Kluwer), was also just released. Although this has 4 authors (Stoelting, Flood, Rathmell, and Shafer), the authors acknowledge all contributors to the full textbook as well. Similar to the 2nd edition of the handbook, this version follows the format of the full text and is meant to serve as a companion and cross-reference to the full text. This edition is in outline format as opposed to the previous version, which was written as multiple short paragraphs. The handbook contains many, but not all, of the same figures and tables from the full text. It too has been visually updated with the addition of color.

Another positive addition is the availability of an electronic version of the complete book with page numbers that correlate with those in the hard copy. When you purchase the hard copy, a complimentary download of the enhanced eBook for iOS, Android, PC, and MAC is included. The eBook search function brings up text and figures, identifies the chapters containing the material, provides figure numbers and corresponding thumbnails, lists a portion of the text where the topic is found, and highlights the corresponding words in the text. When reading the electronic version, it is simple to highlight and take notes that can be shared with colleagues.

As a text that is concise, easy to read, and combines the 2 foundations of the practice of anesthesiology, it will be useful for both students and teachers of anesthesiology. It has been 9 years since the 4th edition was published, and those who already own this edition and appreciate its content will want to purchase the new 5th edition.

Robert Stoelting’s original goal of “providing an in-depth but concise and current presentation of the aspects of pharmacology and physiology that are relevant either directly or indirectly to the perioperative management of patients” has been continued in the new 5th edition, edited by Flood, Rathmell, and Shafer.

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Dr. Pamela Flood is the wife of Dr. Steven Shafer, Editor-in-Chief of Anesthesia & Analgesia. This manuscript was handled by Dr. Eugene A. Hessel II, and Dr. Shafer was not involved in any way with the editorial process or decision.

Susan M. Martinelli, MD

Department of Anesthesiology

University of North Carolina

Chapel Hill, North Carolina

Amy N. DiLorenzo, MA

Department of Anesthesiology

University of Kentucky

Lexington, Kentucky

Randall M. Schell, MD, MACM

Department of Anesthesiology

University of Kentucky

Lexington, Kentucky

© 2015 International Anesthesia Research Society