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Book Review: New Balanced Anaesthesia

vascular or pregnancy chapters. The description of myocardial oxygen supply and demand excludes a systematic consideration of factors affecting coronary perfusion pressure and resistance. Electrical cellular events during a cardiac action potential would be better summarized by a graph on the same time scale of the electrocardiograph of the action potential with phase 4 to 0 identified, changes in electrical conductance and transmembrane ion movements. The terms “equilibrium potential” and “conductance” are not even mentioned let alone discussed. There are no specific area on physiological principles underlying clinical measurement. The effect of nondiffusible anions in equilibrium charge differences between plasma and interstitial fluid should be correctly termed “Gibbs Donnan” (not “Donna”) equilibrium. In contrast the pharmacology section is recommended. Receptor and nonreceptor drug effect are well discussed. All the figures are clear and well referenced. Recommended reading includes general pharmacodynamics, the pharmacokinetics of injected drugs, comparative pharmacology of inhalational agents, neuromuscular relaxants and local anaesthetics. Second-dose sensitivity with pancuronium (but not with vecuronium, atracurium or mivacurium) is now considered to be due to a slow dissociation constant KEO for pancuronium from a deep biophase binding compartment. The book restates the now outdated postulate that it is due to a margin of safety, 70% receptor occupancy which must occur before the onset of neuromuscular blockade. The formula for etidocaine is wrong and very confusing to the otherwise logical explanation of structure-activity relationships. A priming dose of mivacurium actually reduces the maximum effect of subsequent doses. In general, the pharmacology chapters have more detail than physiology. If the latter were expanded to the same standards as the former, the book could be recommended as an up-to-date and concise summary of physiology and pharmacology relevant to anaesthesia. R. BOYLE Department of Anaesthetic Services, Royal Women’s Hospital, Brisbane, Qld