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Former Chair, Department of Anesthesiology, University of Wisconsin, Wayne, PA
David C. Lai, ed.
Park Ridge, IL: Wood Library Museum, 2002. ISBN 1-889595-08-x. 212 pp., $30.00.
This slim paperback collection of 39 previously published articles, addresses, editorials, and chapters by and about Ralph Milton Waters, MD was issued in 2002 in commemoration of the 75th anniversary of his arrival at the University of Wisconsin to found the first academic department of anesthesiology. Most were published between 1919 and 1951, although there are two addresses and the foreword to one book dating to the decade after 1957.
Donald Caton, MD, in the stimulating Foreword to this volume, provides the 21st century reader a reminder of the primitive state of anesthesiology in 1913 when Waters first began to practice, and he underscores Dr. Waters’ extraordinary vision, which he successfully implemented to transform anesthesiology from a technically oriented handmaiden of surgery, dominated by dentists, nurses, surgeons, and obstetricians, into a medical specialty whose practitioners are vital to patient welfare and whose research efforts, educational programs, and clinical practices play such a prominent role in contemporary medical schools and hospitals all over the world.
While this reviewer applauds efforts to inform the contemporary anesthesiology community of Waters’ role in the creation of a valued medical specialty with its own intellectual and research base, this book is seriously flawed. Simply reprinting a collection of earlier papers and speeches is an inadequate effort to inculcate cultural literacy in the third and fourth generation of Waters’ professional descendants. Seventy-five years after Waters’ founding the department, one would anticipate analyses of his contributions and a commentary about the world of anesthesiology at the time the papers were written. One would expect that the Editor would explain why these particular publications were chosen over others for inclusion. Learning which papers were excluded and why would be of considerable interest. The volume also lacks an index, greatly hampering the reader who wishes to obtain guidance about the presence and whereabouts of the many topics in these papers. Paper titles are a cumbersome and incomplete guide to the matters addressed by Dr. Waters.
The book is divided into six sections: Biography, Autobiography, Safety, Resuscitation, N2O, CO2 and Too Much O2, and Professionalism. Unfortunately, the publications within a section often do not conform to the section title. For example, while Biography includes the Editor’s abridged version of a 1949 biography of Waters in the British Journal of Anaesthesia by his then colleague Noel Gillespie, that section also includes descriptions of the initial employment of endotracheal anesthesia (1928; 1931), chloroform, and a 1937 staff meeting (clinical case conference) at Wisconsin. Thus, this section includes publications that are not biographical in the usual sense of the term, and this confuses the reader. One must also ask why the biography of John Snow is located in the Autobiography section rather than in Biography. There are similar inconsistencies in the other sections. Furthermore, despite Dr. Waters’ focus on educational matters and the fact that a number of the papers in the volume are, in fact, about education in anesthesiology, there is no section devoted to education! Neither are there sections dealing with history or research. The value of this book is further diminished by the failure to include commentaries about such matters as the status of anesthesiology at the time of publication of the papers as well as their import for the subsequent development of anesthesiology. Grouping papers of similar types would have facilitated the writing of such commentaries and enhanced the reader’s understanding of the wide scope of Dr. Waters’ contribution and his legacy to the specialty.
Despite the inadequacies of this book, the reviewer came away with a renewed appreciation for the pioneering efforts of Dr. Waters. Nevertheless, the definitive analysis of Waters’ writings and their import for anesthesiology has yet to be written.
Clinical Assistant Professor of Anesthesia, University of Pennsylvania, Director of Cardiac Anesthesia, Presbyterian Medical Center, Philadelphia, PA
S. N. Konstadt and N. C. Nanda, eds.
Philadelphia: Lippincott Williams & Wilkins, 2001. ISBN 0-7817-2629-8 (CD-ROM). $225.00
Despite the tantalizing title, TEE on CD: An Interactive Resource fails to deliver much more than an electronic version of material previously published in print. This CD-ROM is based on two well-established texts in the field of transesophageal echocardiography: the Atlas of Transesophageal Echocardiography ( Lippincott Williams & Wilkins, 1998, $189.00) and Clinical Transesophageal Echocardiography (Lippincott Williams & Wilkins, 1995, $199.00). The content of both is faithfully but unimaginatively reproduced in an electronic format for this new offering from the same publisher.
Installation of the software is largely automated and should not provide a challenge for even a novice computer user. The system requirements are modest and the product is compatible with any Windows- or Macintosh-based computer purchased within the last 5 years. Once installed, activation of the program starts the "reader," which allows users to access the full content of the two texts, a video library and a self-assessment section.
The program’s greatest shortcoming overall is that it allows only one "text" window (showing the body of the text) and one "graphics" window (showing a single figure, table, or list of references) to be open at a time. A great improvement would be to allow users to access both texts, and multiple chapters in either text, simultaneously in multiple windows. This would allow easier cross-referencing of facts and conceptual material. This reviewer believes that the ability to open multiple figures at once in separate windows is essential for a work such as this. The publisher does allow users to print hard copies of the text and figures using Adobe Acrobat Reader, but this is a poor compromise for a product that should fully exploit the advantages of an electronic format. Hyperlinks do provide rapid access to the relevant figures and references, but they do not provide links to other related areas of the text. The "advanced searching capability" simply produces a list of the chapters that contain the specific word or phrase searched for.
The only original content on the CD-ROM is in the video library and the self-assessment sections. The video library consists of 65 short transesophageal echocardiography segments. Unfortunately, the clips are haphazardly named (such as "Hypotension" and "Aortic Density") and then listed alphabetically. Organization of the videos on an anatomical or pathological basis (or both, given the medium) would significantly enhance the utility of this section. Several of the videos have been heavily edited to remove identifying information, but in the process both the multiplane compass as well as the depth markers have been removed. As a result, images of advanced pathology are very difficult to interpret and will be a complete mystery to novice echocardiographers. Despite the fact that the product’s packaging lists "30 minutes of narrated TEE videos," there is no narration or annotation of any kind for the images in the video library.
The self-assessment section of the program is noted to contain "over 100 multiple-choice questions." The reviewer could not verify this figure due to the fact that the quiz closes automatically after completing 40 questions. Restarting the self-assessment a second time provides a second quiz of 40 questions, roughly half of which are new. In the course of reviewing this self-assessment material, two video clips were encountered whose images were uninterpretable, and there was one factual error in the self-assessment sections, which states that MVA = PHT/220 (MVA = mitral valve area; PHT = pressure half time). In fact, MVA = 220/PHT. Most of the images for the self-assessment quiz are recycled from the video library.
The original texts cited are unquestionably valuable clinical references. TEE on CD: An Interactive Resource is less expensive than buying both books individually in print. Unfortunately, this financial incentive seems to be the only reason to purchase this product. Those clinicians who are attracted by the promise of interactive multimedia educational materials should look elsewhere
Associate Professor, Department of Anesthesia, Stanford University School of Medicine, Stanford, CA
Paul G. Barash, Bruce F. Cullen, and Robert K. Stoelting.
Lippincott Williams & Wilkins, 2002. ISBN/ISSN: 0-7817-3852-0 (CD-ROM); 0-7817-3955-1 (On-line Deliverable). $60.00
Clinical Anesthesia for the PDA is the first (and so far, only) textbook of anesthesia formatted for handheld computer use. This provides the essential content of the 4th edition of the Handbook of Clinical Anesthesia, including basic principles, preparation, pharmacology, management, specialty topics, critical care, post anesthesia, and consultant care. It includes many essential tables and formula lists.
The software product works on both the Palm and PocketPC operating systems. Both versions are included in the product and are very memory efficient, using only 1 MB on the Palm and 1.75 MB on the PocketPC.
This reviewer has been carrying this useful resource on my handheld computer, using it in the OR for both reference and resident teaching. The tables in the appendix include easily accessed information on useful formulas, electrocardiography, pacemakers, drug lists, herbal medications, American Heart Association guidelines, resuscitation protocols, difficult airways, malignant hyperthermia, bacterial endocarditis, and more. The ability to pull up this information in the OR will addict you to this technology if you are not already using it.
The product is very user-friendly in its search, index, and content utilities. It looks and handles like the other Skyscape titles (such as the free medical calculator Archimedes or the comprehensive anesthesia drug resource Omoigui’s Anesthesia Drug Handbook). Of note, all Skyscape titles can "cross-index" together, greatly increasing their search capabilities. Quick links are provided to any of the other Skyscape titles that you have installed on your handheld.
The software can either be purchased on CD-ROM or simply downloaded (for instant gratification) from Skyscape (www.skyscape.com). Skyscape has become the premier source for medical handheld software (both Palm and Pocket PC).
In summary, this is a very useful, nicely formatted, and user-friendly software product. Every anesthesiologist should have a handheld computer and this reference in their pocket.
Eugene McDermott Center for Pain Management, Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, Texas
P.P. Raj, L. Lou, S. Erdine, and P.S. Staats.
New York: Churchill Livingstone, 2003. ISBN 0-443-06596-9. 335 pp., $79.95.
Written by four thought leaders in interventional pain management, the aim of this book is to provide the trainee with an easy-to-follow, step-by-step training manual for advanced interventional techniques. Special emphasis has been placed on radiographic imaging as a safe way of performing these procedures.
There are 44 chapters, the first five of which describe the basic physics of radiology, equipment used for radiographic imaging, radiation safety, pharmacology of agents used and the physics and principles of cryoneurolysis and radiofrequency lesioning.
The more than 40 procedures described are not limited to spinal pain and include trigeminal nerve, glossopharyngeal nerve, brachial plexus, intercostal nerve, suprascapular nerve, thoracic and lumbar sympathetic nerve, splanchnic nerve, celiac plexus, and hypogastric nerve blocks. Also included are discography, intradiscal electrothermocoagulation, vertebroplasty, decompressive neuroplasty, epiduroscopy, augmentation techniques, and intrathecal implantation.
For each procedure the history, relevant anatomy, indications, equipment, drugs, patient positioning, technique, complications, helpful hints, efficacy, and current procedural terminology (CPT) codes are given. There are more than 380 figures, including anatomical drawings and x-rays images. Each chapter is well referenced. The procedures are clearly described by these highly experienced practitioners. This is a very valuable addition to the few well-written books relating to interventional pain management. It is an excellent resource for the trainee as well as for practicing interventional pain physicians.
Associate Professor of Anesthesiology and Neurosurgery, Yale University School of Medicine, New Haven, CT
Michael Bailin, ed.
Philadelphia: Lippincott Williams & Wilkins, 2002. ISBN/ISSN: 0-7817-1408-7 (CD-ROM). $345.00.
Electronic publications offer many advantages over printed text. Advanced search capabilities make it easy to find information on a specific item and large, high-resolution color images help to illustrate important points. Electronic publications also require a much shorter lead-time than printed media, making rapid updates possible. All of the major publishers use this technology, offering CD-ROMs with information on many topics pertinent to anesthesia practice. Most of the major textbooks and journals are now available online or on a CD-ROM, but few new publications have been developed specifically for electronic publication.
The Harvard Electronic Anesthesia Library (HEAL), edited by Michael Bailin and developed by faculty at the four teaching hospitals of the Harvard Medical School, was developed exclusively for electronic publication. HEAL is an electronic textbook that covers the entire field of anesthesiology and can be used by anyone from medical students and residents through physicians in practice. It works with Windows or Macintosh operating systems, and its modest requirements (Table 1) enable it to run on almost any computer. For this review, HEAL was tested on a Dell workstation (512 megabytes, a 1.7 GHz Intel processor, and the Windows 2000 operating system) and an Apple iBook (512 megabytes, PowerPC G3 processor, and System 10.2.4).
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Double-clicking on the HEAL icon or selecting it from the Start menu launches the program. The user interface is well designed, making it easy to use by anyone who has read a textbook and used the Web. The first menu allows the user to choose from the Table of Contents, a list of authors, a Media Library, and a self-test. The Table of Contents is similar to that of other anesthesia textbooks, covering "General Considerations" (e.g., pharmacokinetics and gas laws), Airway Management, and subspecialty topics such as neurosurgical anesthesia and pediatric anesthesia (Fig. 1). The program is designed to let the user browse for topics of interest in the Table of Contents or search for a specific series of keywords. The product includes a search engine that allows the user to look for keywords, contributors, or specific subjects. Navigating the book is easy; a sidebar shows the reader’s location within the chapter, along with other subheadings within the same chapter. There were, however, no hyperlinks between chapters (e.g., the section on airway management in trauma surgery could have contained references back to the first airway management chapter).
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Despite its excellent organization and content, HEAL does have a few flaws. The program sometimes takes ten or more seconds to draw a page; this seems to occur more commonly on the Macintosh. The bottleneck appears to be the server program that is started in the background. The Web client, which is used to display the book, must communicate with the server before displaying any page. HEAL also occasionally became unresponsive on both test computers, and occasionally displayed only blank pages on the Windows computer. Stopping the program and restarting it fixed both of these problems. Moreover, closing the Web client did not automatically stop the server; it was necessary to stop it manually, either from the System Tray in Windows or from the Application Bar on the Macintosh.
Despite these shortcomings, HEAL is a good example of how computers can make it easy to find and use clinical information. The product is worth serious consideration by anesthesiology residents and physicians in practice.
Associate Professor of Anesthesia, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA
E. I Eger II, J. B. Eisenkraft, and R. B. Weiskopf.
Chicago: HealthCare Press (distributed by Baxter HealthCare Corp.), 2002. 327 pp. Two DVDs accompany text.
Professor Eger and coauthors have prepared a treatise on modern inhalation anesthetics that belongs on every bookshelf. The presentation is comprised of three parts. A printed textbook summarizes current knowledge about modern inhaled anesthetics. Two DVDs contain video recordings of lectures. Within these lectures are O.R.-examples of the clinical techniques that apply the theory contained in the lecture. The DVDs each contain a section with multiple-choice questions and answers.
Textbook: This book provides a sequel to Eger’s 1974 textbook Anesthetic Uptake and Action (Williams & Wilkins). The older agents (ether, cyclopropane, halothane, enflurane) covered in the 1972 text are almost totally eliminated from this new work. The text is reexpanded to contain the data from the Compendium for Desflurane and comparison studies of sevoflurane. This makes the text the definitive work comparing today’s major volatile liquid anesthetics, isoflurane, desflurane, and sevoflurane. When appropriate, nitrous oxide is also compared.
In the course of 275 pages, the important aspects of inhalation anesthetics are explored in 16 chapters. The classical rendition of history, physical properties, MAC (monitored anesthesia care), mechanism of action, kinetics, mutagenic, organ systems (immune, breathing, circulation, neuromuscular, CNS, liver, kidney), metabolism, and vaporization is followed by chapters on clinical applications and techniques. Each chapter begins with an abstract and a set of clearly stated objectives in the form of questions to be answered by the reader. At the end of the book, there are additional specific and in-depth questions related to the content of each chapter. These questions, with their answers, are presented on the two DVDs (see below)..
Digital Video Disc (DVD): If the project ended with the textbook, this would be an excellent consolidation of our knowledge of inhaled anesthetics. But this Baxter Distinguished Professor Series product takes the subject of modern inhaled anesthetics and treats it again, in a totally different manner. On the two accompanying DVDs are video lectures where Professor Eger summarizes the content of each chapter in a 20 to 60 minute lecture. In each lecture, Professor Eger interacts with residents and student nurse anesthetists at Wake Forest University and North Carolina Baptist Hospital. The teacher often pauses the lecture as he waits for answers from his students. Within the lectures themselves, Professor Eger uses videos of actual anesthetics administered by the group of learners described above. We see the residents and SNAs trying the techniques that Professor Eger explains in theory. The grouping of in-depth textbook, audiovisual slide presentation interactively with students, combined with real O.R. scenes depicting entire periods of the anesthetic, form a masterpiece of creative multimedia education. The DVDs also contain the multiple-choice questions relating to each chapter in the textbook. They are presented as individual questions. Answers are available with a click of the mouse button.
Despite Professor Eger’s stated relationships with Baxter HealthCare, Inc., the text and video present a balanced view of today’s major inhalation vapors, isoflurane, desflurane, and sevoflurane. More information is presented related to desflurane than to sevoflurane or isoflurane.
A few features of the overall package (textbook + DVD) are less than ideal. The book’s font size and line spacing provide too much white paper and too little ink. Figures are in blue, but this addition of color doesn’t benefit the reader in any obvious way, and it may be inconvenient for the reader who wants to make copies of graphs. There are typos in the text. The DVD sound level is very low, so it is difficult to hear the lectures well. The menu is only partly interactive; in some situations, it is difficult to get back to the main menu to choose between didactic lectures and features like Q&A or Clinical Answers. The chapters of the DVD appear as titles, all designated Chapter 1. If the DVD Controller is set to display Titles, the chapter number (but not name) is displayed. The section on vaporizers deals mostly with vaporizers for desflurane (Tec 6®D and Aladdin®) and almost ignores the variable bypass vaporizers used for isoflurane and sevoflurane. The chapter on kinetics lacks the insightful model presentations of Eger’s 1972 text. Expanding the kinetic model and the structure-behavior relationship would add to the student’s ability to apply the principles covered in the lectures and text. The lecture figures are fair photographs of projected images. Incorporating the original image figures would make the text on the slides much clearer and possibly allow the learner to download their content.
Overall, this textbook plus DVD describing inhalation anesthetics is an exceptional information source for anesthesia care providers and students of this field. It belongs on every bookshelf just as the contained information belongs in every mind.
The Journal solicits reviews of new books and multimedia from its readers. If you wish to submit a review, before proceeding please send a letter of intent, identifying the book or multimedia in question, to Norig Ellison, MD, Department of Anesthesia, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283. The Journal reserves the right of final decision on publication.
Vadhera RB, Douglas MJ (eds): Issues in Obstetric Anesthesia, ANESTH CLIN NA 21:1–206, 2003. ISSN 0889-8537. 206 pages, $162.00 annual subscription for four issues.
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