REVIEWS OF EDUCATIONAL MATERIAL
Copyright © 2010, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins
Michael J. Avram, Ph.D., Editor
Clinical Anesthesia, 6th Edition. Edited by
Paul G. Barash, M.D., Bruce F. Cullen, M.D.,
Robert K. Stoelting, M.D., Michael K. Cahalan, M.D.,
M. Christine Stock, M.D. Philadelphia, Lippincott
Williams & Wilkins, 2009. Pages: 1,640. Price: $199.00.
Clinical Anesthesia, 6th edition, by Barash et al. continues the
tradition of targeting the need between the introductory level
books, such as Basics of Anesthesia by Stoelting and Miller,1
and the most comprehensive textbooks, such as Miller’s
Anesthesia.2 Such a focus serves a wide variety of readers,
including the trainee looking for a primary reference,
those preparing for recertification, and those needing to
refresh their knowledge before a special case. In this new
edition, they have expanded into multimedia. Each vol-
ume comes with access to a web site that contains a search-
able full-text version of the book, online testing, an image
bank, and downloadable podcasts for use on computers
and many smartphones.
As with previous editions of Clinical Anesthesia, it is ex-
pansive in its coverage of anesthesiology. The chapters are
largely very readable and of reasonable length for the topics
covered. It is generally written in a fashion that provides the
clinically relevant facts in a manner that flows easily. The
illustrations, charts, and photographs convey ideas or sum-
marize data efficiently. This edition adds two new chapters:
(1) Echocardiography and (2) Inflammation, Wound Heal-
ing and Infection. The chapter on Echocardiography is
largely straightforward, with labeled pictures both in the
textbook and on the web site. The chapter on Wound Heal-
ing and Infection brings the reader to a greater appreciation
of how our intraoperative and postoperative management of
patients affects their surgical outcome. Although at times it
goes into greater detail on the molecular biology than may be
necessary, the chapter succeeds in making the subjects clini-
cally relevant. At the end of the chapter is a short section
labeled “Areas for Future Research.” In this section, the au-
thors list several questions that would make for clinically
relevant research topics. For those in training, these ideas
may stimulate their interest in research. This is a feature that
would be good for the other chapters to have.
An important issue with any textbook is the content and
how well it is presented. In the 6th edition, approximately
one third of the 141 contributors are new, and there are five
editors. Given the overlapping scopes of coverage by so many
authors, there will be redundancies and areas of disagree-
Mark A. Warner, M.D., served as Handling Editor for this article.
Anesthesiology, V 112 • No 3
Anesthesiology 2010; 112:767–9
ment. The editors have allowed reasonable redundancies and
some points of contention to remain. Many who are pre-
paring for initial board examination or for recertification
may be frustrated by this lack of consensus and may want
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the editors to “pick the right answer.” For a book of this
scope and with this many contributors, I believe the edi-
tors have done a remarkably fine job of managing the
content and the writing styles. Indeed, to simply “pick an
answer” to a controversial question would be a disservice
to the readers, as it would give the illusion of clarity when
clarity does not yet exist. The editors’ efforts have resulted
in a cohesive textbook, without sacrificing the quality or
coverage of individual chapters.
Although most of the web-based features have signifi-
cant room for improvement, the online access to the text is
nice to have when the book itself is not readily available.
The searchable full-text service is strictly that—a version
of the textbook loaded on a website. It does only literal
searches (i.e., does not search along common synonyms).
It does not offer suggestions for spelling errors. How it
determines the ranking of its “hits” for some queries is still
a question. I found no integrated video and that was es-
pecially disappointing for the sections on echocardiogra-
phy and the use of ultrasound guidance for nerve blocks.
Accessing the references using the links provided is prob-
lematic unless you already subscribe as an individual to the
online document suppliers provided.
The searchable image bank does provide downloadable
images. Most images are of good quality. However, some of
the images are of very low resolution (e.g., the American
Society of Anesthesiogists’ official seal). The window pro-
vided to view the images is rather small and cannot be resized.
This is a problem because a good number of the images will
not be fully displayed until the size is set to 50%, and this has
to be done for each image.
The enhanced podcasts are rather short, are only eight
in number, and are largely abbreviated text being read,
supported by static images, charts, or graphs. As with the
online text, the opportunity to provide video to commu-
nicate dynamic processes such as transesophageal echocar-
diograhy or ultrasound guidance for nerve blocks is
missed.
The interactive quiz bank is a good feature that simply
does what it says. It is not as sophisticated as the Anesthesi-
ology Continuing Education program produced by the
American Society of Anesthesiologists. The number of ques-
tions (363) is quite reasonable, and the quality of the ques-
tions is good.
767 March 2010
768
Overall, the 6th edition of Clinical Anesthesia is an excel-
lent book that will meet the needs of a broad range of readers.
Although the online features have room for improvement,
the book itself is “the best of breed.” It is still the best single
volume text on anesthesiology and belongs in every practi-
tioner’s collection.
John W. Bethea, Jr., M.D., University of Mississippi
Hospitals and Clinics, Jackson, Mississippi.
jwbethea@anesthesia.umsmed.edu
References
1. Stoelting RK, Miller RD: Basics of Anesthesia, 5th edition.
New York, Churchill Livingston, 2006
2. Miller RD: Miller’s Anesthesia, 7th edition. New York,
Churchill Livingston, 2009
(Accepted for publication October 15, 2009.)
Anaesthesia and Intensive Care A-Z: An
Encyclopaedia of Principles and Practice, 4th
Edition. By Steven M. Yentis, B.Sc., M.B.B.S.,
F.R.C.A., M.D., M.A., Nicholas P. Hirsch,
M.B.B.S., F.R.C.A., F.R.C.P., Gary B. Smith, B.M.,
F.R.C.A., F.R.C.P. Philadelphia, Churchill Livingstone,
2009. Pages: 584 (paperback). Price: $136.00.
This book was last revised in 2004. With several new and revised
entries, this edition reflects ongoing advances in the fields of
anesthesia and critical care. According to the preface, the authors
initially created the book as a review for candidates taking the
Royal College of Anesthetists’ Fellowship examinations, which
explains its format of short, high-yield entries.
Like the popular street atlas London A-Z, which covers
every street, highway, major point of interest, park, school,
and tube station in London, this book is comprehensive. It
consists of hundreds of alphabetized entries ranging from the
common to the obscure. Topics relevant to the practice of
anesthesia and critical care include pharmacology, diseases,
physiology, anatomy, and history. As the title suggests, the
entries are arranged alphabetically, with extensive cross-ref-
erences to ensure full coverage of topics and ready access to
related information. The cross-references are numerous and
are easily identified by bold print. The alphabetical arrange-
ment makes up for the lack of an index. There are many
tables, graphs, and figures in black and white and grayscale
that are generally well done and useful. Some entries have a
relevant reference generally from the last decade, which we
favor, although these references supply only the journal and
author information without the article’s title. Having just
completed Part I of the American Board of Anesthesiology
certifying examination and the examination for Mainte-
nance of Certification for Anesthesia, we put this book
Mark A. Warner, M.D., served as Handling Editor for this article.
Anesthesiology, V 112 • No 3 • March 2010
Reviews of Educational Material
through the paces. Every topic that we could recall from the
tests had an entry in the book.
The authors should be commended for the impressive
breath of content, but some criticisms have to be discussed.
Much of the difficulty we experienced with the book is a
result of the differing British and American anesthesia certi-
fying systems. Most of the principles remain the same regard-
less of geographic location, but the American Board of An-
esthesiology examinations distinguish between anesthesia
and critical care. In a 584-page book covering anesthesia and
critical care, this breadth necessarily comes at the expense of
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depth of coverage. There is a palpable British influence
throughout the text with entries such as “triservice apparatus,
an anesthetic apparatus adopted by the British Armed Forces
for battle use.” The entry on postoperative shivering lists
pethidine and pentazocine as possible treatments, and the
differences in units of measurements led to an entry recom-
mending 8 mmol of magnesium sulfate for use in advanced
cardiac life support. Although it is easy enough to remove the
extra vowels in words like anaesthesia, most American anes-
thesia providers would not be familiar with those drugs or
dosages. The British influence does have its advantages.
There are many instances where A-Z’s approach yields a
slightly different emphasis or explanation that brings the
American reader a new view of the topic.
The question is for whom and for what purpose is this book
useful? The authors have produced clear, succinct text and help-
ful illustrations that provide high-yield information in a single
volume. Its format and style are reminiscent of a handbook, but
it is too bulky for that use. The lack of a thematic organization to
the text, such as preoperative assessment, makes it difficult to
recommend as an introductory text for anesthesia or critical care
practitioners. The authors bill the book as a review for the Brit-
ish certifying examination, with which we have no experience.
As a review book for the written examination for the American
Board of Anesthesiology, the length is too long, its format too
awkward, and it does not emphasize key study points. A good
review book should alert the reader to especially important,
commonly tested concepts, and it should delineate concepts as
distinctive, most common, or most likely to occur. However,
there is a niche for Anaesthesia and Intensive Care A-Z. We
believe that this book may be most useful as an intraoperative
reference, especially for trainees, or as a first-line reference to use
while completing practice questions from another source. Its
often fresh approach to familiar topics, presumably reflecting
the differences in British training and practice, is useful espe-
cially in learning about difficult concepts. Finally, its unique
format of highly cross-referenced entries, reminiscent of Inter-
net text with embedded links, will appeal to many modern read-
ers accustomed to this integrated content.
Xa D. Johnson, M.D.,* Linda Liu, M.D., *University of
California, San Francisco, San Francisco, California.
johnsonx@anesthesia.ucsf.edu
(Accepted for publication October 27, 2009.)
Reviews of Educational Material