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Handbook of Clinical Anesthesia, 4th edition

Calder, I.

European Journal of Anaesthesiology: September 2002 - Volume 19 - Issue 9 - p 695-696
Book Reviews

London, UK

Handbook of Clinical Anesthesia,4th edition

P. G. Barash, B. F. Cullen, R. K. Stoelting (eds)

Lippincott, Williams & Wilkins: Philadelphia, PA, USA, 2001, 963 pp; indexed, illustrated

ISBN: 0-7817-2918-1; Price US$39.95

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 post-partum 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 acetominophen (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 laryngeal mask airway '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 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 deserve 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, while an inexperienced practitioner could be misled. Yet, it is so wonderfully portable and such a marvellous source of controversy that it is a valuable educational device.

I. Calder

London, UK

© 2002 European Academy of Anaesthesiology