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Handbook of Clinical Anesthesia, 4th edition


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European Journal of Anaesthesiology: November 2001 - Volume 18 - Issue 11 - p 782
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Handbook of Clinical Anesthesia, 4th edition P. G. BARASH, B. F. CULLEN and R. K. STOELTING Lippincott Williams & Wilkins, Philadelphia, USA, 2001, 963 pp.: indexed. Price $39.95 ISBN 0-7817-2918-1.

This edition replaces the third edition of 1997. It contains an enormous amount of information, many useful diagrams and a large number of boxed lists and summaries. The book is very portable, but it is not easy to read. The misspelling of Arthur Gudel’s (sic) name persists from the third edition, and this is representative of the generally poor standard of proof reading. I often found myself puzzling over whether I was reading a misprint or a passage that the author had intended. It was easy to decide that the author did not mean to cite placenta praevia as the commonest cause of postpartum haemorrhage (p. 616), but not so easy to decide what was meant by ‘first attempt at laryngoscopy in a best attempt’ (p. 299), and I am still flummoxed by several passages, such as the second paragraph about Jehovah’s witnesses on p. 29. There are no references, so the book is necessarily didactic in tone, but many statements are unhelpful, confusing, doubtful or plain wrong, such as the total daily dose of acetaminophen (p. 768), or the suggestion of treating somatic reflexes in brain-dead organ donors with vasodilators (p. 741). What are the authors concerned about when they say that positive pressure ventilation should be avoided with the LMA ‘although gentle assisted ventilation is both safe and effective if peak inspiratory pressure is kept below 20 cm H2O ’ (p. 508)?

Readers familiar with the third edition will not find the fourth edition to be particularly different. The introduction claims several new sections including herbal medicine (which is not indexed and I have yet to find), and conscious sedation. On looking up conscious sedation in the index one is advised to see ‘Sedation/analgesia’. Under ‘Sedation/analgesia’ one is advised to ‘see also Conscious sedation ’.

A new edition should really have had more revision. The chapter on acid-base, fluids, and electrolytes contains no mention of hyperchloraemic acidosis. Neonatal anaesthesia continues to give the impression that awake intubation is a reasonable procedure. I doubt whether a ‘wake-up’ test is now performed during spinal surgery (p. 587) in the USA or anywhere, or that intramuscular ketamine is often used as the primary anaesthetic for dental surgery in mentally retarded children (p. 736). Discussion of the problems of PONV and operative hypothermia surely deserves more than one side in a book of nearly 1000 pages? No mention of target-controlled intravenous anaesthesia is to be found. Many of the boxes contain redundant material and are too far away (often several pages) from the text. The style of writing is not concise, and in a 2001 edition it is aggravating to encounter so many examples of imprecise or trite advice, such as ‘when tracheal intubation is unexpectedly difficult, it may be prudent to allow the parturient to awaken – rather than persist with unsuccessful and traumatic attempts at intubation ’ (p. 613), or ‘bacterial pneumonia is relatively common early after heart transplantation, so preparation of the anesthesia machine with a fresh, sterile breathing circuit and bacterial filter seems prudent ’ (p. 747).

Who should buy this book? The experienced anaesthetist will find a lot to argue with, whilst an inexperienced practitioner could be misled. And yet, it is so wonderfully portable and such a marvellous source of controversy, that it is a valuable educational device.

© 2001 European Academy of Anaesthesiology