Book reviews

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 `®rst attempt at

laryngoscopy in a best attempt' (p. 299), and I am still

¯ummoxed 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, confu-

sing, doubtful or plain wrong, such as the total daily

dose of acetaminophen (p. 768), or the suggestion of

treating somatic re¯exes 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 ®nd

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 ®nd), 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, ¯uids, 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 dif®cult, 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 relat-

ively common early after heart transplantation, so

preparation of the anesthesia machine with a fresh,

sterile breathing circuit and bacterial ®lter seems

prudent' (p. 747).

Who should buy this book? The experienced

anaesthetist will ®nd 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.

IAN CALDER

London, UK

The Association of Anaesthetists of Great Britain and

Ireland 1932±1992 and the Development of the

Specialty of Anaesthesia. Sixty Years of Progress

and Achievement in the Context of Scienti®c, Political

and Social Change

THOMAS B. BOULTON

Association of Anaesthetists of Great Britain and

Ireland, London WC1 3RA, 1999, 785 pp., indexed,

illustrated.

ISBN: 09536639 0 6.

Price £30.00

European Journal of Anaesthesiology 2001, 18, 782±784

782 Ó 2001 European Academy of Anaesthesiology