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Fundamentals of Anaesthesia, Third Edition

T he third edition of Fundamentals of Anaesthesia is an aesthetically pleasing text with clear and concise tables and descriptive figures. It is organized somewhat differently than other texts by being divided into 4 sections: clinical anesthesia, physiology, pharmacology, and, lastly, physics, chemistry, clinical measurements, and statistics. The first section seems relatively short and lacks detail especially with regard to clinical subspecialties. For example, it has a chapter on special populations including pediatrics, obstetrics, head trauma, ambulatory surgery, and the obese patient. Given the breadth of topics reviewed in this chapter, only the very basics of anesthetic management are discussed. Other chapters in the clinical anesthesia section include regional anesthesia and clinical anatomy. The regional anesthesia chapter is divided into neuraxial and peripheral nerve block techniques. The subsection on neuraxial anesthesia is simplistic and easy to understand. For instance, the figures of the lumbar spine anatomy clearly delineate the layers of tissue a spinal needlemust traverse to access the subarachnoid space. The subsection on epidural blocks includes helpful tables that compare local anesthetics with regard to strength, volume, and duration and that compare and contrast spinal and epidural blocks including onset, duration, drug volume, and quality of block. This subsection would be beneficial for first-year anesthesia residents, interns, and medical students. Overall, the section on peripheral nerve blocks is scant and insufficient, given the current focus on ultrasound-guided blocks and the importance of regional anesthesia for both inpatient and outpatient surgery. For example, there is no mention of ultrasoundguided blocks, only minimal discussion of nerve stimulation, and no description of the technique for interscalene block, much less the strengths and weaknesses of blocking the brachial plexus at different levels. The chapter on clinical anatomy reviews the basic anatomy of each body system including innervation, blood supply, and lymphatic drainage. Although the figures of the brachial plexus and cross section of the axillae may be helpful for review, the chapter generally lacks clinical relevance by not explaining why a particular part of the anatomy is important or how it is applicable to anesthetic management. The second section is on physiology, divided by organ systems. Each chapter is thorough and detailed, but often lacks relevance to anesthetic management. An exception is the chapter on physiology of pain, which provides excellent coverage of the neurophysiology of pain in addition to explaining the types of pain. Included is a nice table of chronic pain syndromes and a brief description on how to approach their treatment. The third section covers pharmacology including 2 detailed chapters on pharmacokinetics and pharmacodynamics. The chapter on analgesic drugs is similar to most other texts and includes discussions on opioids and other analgesic drugs. The chapter on neuromuscular-blocking agents has a useful figure depicting the mechanism of actions of depolarizing versus nondepolarizing drugs. The local anesthetic chapter includes a great description of their mechanism of action and a detailed discussion of their clinical effects and toxicity. Unfortunately, specific local anesthetics are discussed only briefly and without clinically relevant information such as why one would choose one agent over the other. The last section of the book includes a chapter on physical chemistry, taking the reader back to college chemistry days. Given the frequent use and manipulation of medications to serve our clinical needs, this section provides a useful review of chemistry essentials without digging up your old chemistry textbook. In summary, Fundamentals of Anaesthesia is a good review of anesthesia and an excellent review of anatomy and physiology. However, the information on regional anesthesia is limited and outdated. I would not recommend this book for upper-level residents as preparation for boards or as a reference for clinical practice. It is perhaps most useful for medical students or beginning residents.