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Books, Journals, New Media
November 22/29, 2000

Anesthesia: Anesthesia, vols 1 & 2

Author Affiliations

Harriet S.MeyerMD, Contributing EditorDavid H.MorseMS, Journal Review EditorRobertHoganMD, adviser for new media


Not Available

JAMA. 2000;284(20):2649. doi:10.1001/jama.284.20.2649

Anesthesia, edited by Miller, first published in 1981, has become the standard textbook in anesthesiology. The fifth edition has six sections: "Introduction," "Scientific Principles," "Anesthesia Management," "Subspecialty Management," Critical Care Medicine," and "Ancillary Responsibilities and Problems." In addition, there is an appendix on the different American Society of Anesthesiologists practice guidelines, including those for such practices as pulmonary artery catheterization, difficult airway management, transesophageal electrocardiography (TEE), and sedation and analgesia by nonanesthesiologists. New chapters on TEE and finding professional information on the Internet have been added. For the first time, the textbook comes with a CD-ROM, which provides verbal and visual description of the more difficult technical problems in anesthesiology.

The chapters are well written and up-to-date. For example, the chapter on uptake and distribution, an old subject, has references as late as 1998. The chapter on monitoring the depth of anesthesia includes a discussion on bispectral electroencephalographic monitoring, a very recent addition to the anesthesia armamentarium. The manual infusion schemes outlined in the chapter on intravenous drug delivery systems are very practical. In the chapter on preoperative evaluation, the author critically analyzes the results of significant studies on the subject, providing the clinician with a better understanding. In the same chapter, the protocols for the evaluation of cardiovascular, respiratory, and liver problems are extremely helpful.

The chapters in the book are well referenced, some extensively so. For example, three chapters have 742, 892, and 1216 references. The figures are either in color or black and white, the latter unbelievably clear. The color plates and the figures in the chapter on TEE and the atlas of peripheral nerve block procedures are very nicely done. The CD-ROM is extremely helpful in understanding difficult technical procedures such as TEE and double lumen endotracheal intubation. Finally, chapters are included that one does not expect in an anesthesiology text, on subjects such as brain death, the anesthesiologist's work environment and teaching with simulators, information on the Internet, quality assurance, and teaching anesthesia.

This book is not without deficiencies. In the chapter on basic principles of pharmacology, the references are not listed in the text, making it difficult for someone to follow up on a subject. In the chapter on metabolism and toxic effects of inhaled anesthetics, the authors state that "sevoflurane is currently used in Japan" when this anesthetic agent has been used clinically in the United States for 2 to 3 years. There is no discussion of popliteal sciatic nerve block in the chapter on nerve blocks. The chapter on trauma has no discussion of trauma as it applies to a specific organ system, eg, chest trauma, nor a discussion of regional anesthesia for trauma. In the chapter on postoperative pain, there is no discussion of the role of peripheral nerve blocks, no comparison of epidural opioids with intravenous opioids, and no analysis of the outcome studies done after epidural opioid analgesia. Because of the format of the book, several topics are repeated. For example, three chapters discuss renal physiology. Since the topics are discussed first in the physiology section and then in the clinical section, repetition cannot be avoided, but it could have been minimized if the physiology had been discussed more succinctly in the clinical section.

There are now two other general textbooks in anesthesiology, one of which has become a worthy competitor, but Miller's is the most comprehensive. There is something for everyone: residents at all levels, fellows, clinicians, researchers, and administrators. Although the text is massive, readers can easily find what they seek—for example, the clinician can go straight to the section on subspecialty management—and each chapter can stand on its own. Finally, the inclusion of the American Society of Anesthesiologists practice guidelines and the CD-ROM make this book invaluable.