Book reviews

The Pharmacology of InhaledAnaesthetics; 1st EditionEdmond Eager II, James B. Eisenkraft and

Richard B. Weiskopf, eds.

We approached this book review by

seeking the advice of a senior house

officer in our department (M.C.) who

had just passed the Primary FRCA.

This is an American textbook aimed

at Anaesthesiologists and Certified

registered Nurse Anaesthetists in North

America. We found ourselves addres-

sing the question of whether this book

offers anything useful to British readers,

especially trainee anaesthetists appearing

for the primary FRCA examination.

The book is divided into five sections

but this is not clear in the Table

of Contents. The five sections only

become obvious when the CME

instructions are perused. The constant

referral to ‘learning objectives’ is

annoying and is similar to the hated

‘SATS’ tests that many schoolchildren

have to suffer. Learning Objectives are

in the form of questions, answers of

these questions are found in the given

chapter. The summary of matter in the

chapter is presented in the form of an

abstract, similar to that given in a paper

and this is certainly a useful feature,

especially before the more taxing chap-

ters such as that on pharmacokinetics.

On the abstract page is also an index for

the chapter, which made navigating

some of the longer chapters easier.

The book seems to concentrate on

sevoflurane and desflurane to the detri-

ment of other agents. I was disappointed

that the EEG abnormalities of enflurane

anaesthesia only got a brief mention. At

the end of the book are some MCQ

questions. The questions are not in the

same format as the RCA exams, as there

is only one correct answer per stem, but

would still be useful for a trainee who

was approaching the examination or for

other anaesthetists testing their know-

ledge retention. The book is extensive

and a complete reference for the inhaled

agents, which are the mainstay of our

anaesthetic practice. We found it par-

ticularly useful when preparing teaching

material but were disappointed that

only half a page was dedicated to

chirality. The history section is also

short and a more comprehensive review

can be found in the larger textbooks.

The chapters on physical properties and

pharmacokinetics are detailed and the

explanation of structure activity rela-

tionships is particularly good. All the

possible theories about mechanisms of

action are well written, and include

some newly proposed theories. MAC

has been explained in a separate chapter.

Various types of MAC are explained

including MAC bar.

The second section deals with ef-

fects on major organ systems. Various

methods of monitoring the depth of

anaesthesia are covered in the chapter

on CNS effects. The third section

describes metabolism, hepatotoxicity

and renal effects of various agents.

Overall, there are 10 references in the

index to Compound A, with clear

explanations of its production and

effects on the liver and kidney. Sec-

tions 4 and 5 are mainly clinical and

the section on vaporisers is particularly

well covered.

Two DVDs and a navigational map

brochure accompany the book. As soon

as the DVD was loaded in my home

PC, the screen navigation tool came up.

This initializing process is straight-

forward and the minimum computing

requirements for use of the DVDs are

stated on the cover. A proportion of the

DVD contains lectures by Dr Eger to an

audience of anaesthesiology residents.

The content of the lectures could be

compressed and there are annoying

shots of the audience at quite frequent

moments during the lectures. I would

prefer the lectures to be in the form of

an interactive ‘PowerPoint’ presenta-

tion with a voiceover.

The overall pace of the lectures is

slow and the clinical scenarios are also

laboured. I have a feeling that there was

distinct leaning towards one particular

volatile agent in the lecture, perhaps the

sponsor’s name on the outside cover

was a give-away. The MCQ’s appear

on the DVD but there is no program-

ming available to allow the candidate to

select an answer and then see if they are

right; this could have been a useful

addition. The full screen DVD qual-

ity is good but when ‘PowerPoint’

slides are shown they are hazy. In one

of the videos, Dr Brain’s method of

LMA insertion has been incorrectly

demonstrated.

In summary, The Pharmacology of

Inhaled Anaesthetics is very well presen-

ted. The overall standard is good, the

style is readable and the content is

very informative and clinically useful,

although there is an obvious slant to the

modern agents. The DVDs provided

with the book are user friendly and

informative, especially for new trainees,

but the style may be alien to British

trainee doctors. This book is a strange

mixture of informative text and refer-

ences with lectures that could be con-

densed to perhaps a quarter of the time.

The textbook is a probable buy for a

large department with access to a com-

puter with a DVD and good sound card

installed, but would not be worth

purchasing for the British trainee, des-

perate for value for money in pursuit of

the FRCA.

Richard Griffiths

Mahesh Chaudari

Peterborough Hospitals,

Peterborough PE3 9GZ, UK

Holding Court with the Ghostof Gilman Terrace: SelectedWritings of Ralph MiltonWaters, M.D.David C. Lai, ed.

The Wood Library-Museum of Anaesthesiol-

ogy, 2002

Ralph Milton Waters was appointed as

Professor and Chairman of Anaesthesi-

ology in Madison, Wisconsin, in 1933.

Anaesthesia, 2003, 58, pages 513–514.....................................................................................................................................................................................................................

� 2003 Blackwell Publishing Ltd 513� 2003 Blackwell Publishing Ltd 513

To celebrate the 75th Anniversary of

this event, the Anaesthesia History

Association and the History of Anaes-

thesia Society together with the Uni-

versity of Wisconsin Medical School

Department of Anaesthesiology and

Office of Continuing Medical Educa-

tion, the Wisconsin Society of Anaest-

hesiologists and the Wood Library-

Museum of Anaesthesiology held a

combined meeting in Madison. Many,

if not most, prominent American

anaesthesiologists trace their education

back to the process started by Waters via

the aptly named Aqua Alumni Tree.

David Lai is placed in the fourth

generation of the education and profes-

sionalism commenced by Waters.

The book, with a foreword by Don-

ald Caton, is inspired by The History of

Anaesthesiology Reprint Series, published

by the Wood Library-Museum of

Anaesthesiology. It is a collection of

40 papers from the writings of Waters

and others to complement the 75th

Anniversary meeting. David Lai divides

the material into six sections comprising

Biography, Autobiography, Safety,

Resuscitation, N2O, CO2 and Too

Much O2, and finally the main theme

of Professionalism.

In the first section is a short biogra-

phy by Noel A. Gillespie. This traces

some of Waters’ ancestry from pioneers

who came to Salem, Massachusetts,

in 1604, his education at Western

Reserve University, and, following

qualification, his transition ‘by gradual

degrees’ from a general practitioner to

anaesthetist in Sioux City. He moved

to Madison in February 1927 to be the

‘professional man in charge of anaes-

thesia’ at the new State Hospital. Much

insight into his character is gained by

the description of the department in

Madison as a ‘benevolent autocracy’

where ‘The Chief’ not only discusses

which house to buy or apartment to

rent with his residents, but then helps

them move.

Many themes run through the papers,

for example the practice of keeping

anaesthesia records. Here not only are

clinical details recorded, but also an

estimate of the degree of patient satis-

faction, and that of the surgeon or

dentist with the anaesthesia. Morbidity

and Mortality meetings are described

where residents would assume the chair.

The proceedings of the Anaesthesia

Staff Meeting of October 30, 1937,

are reprinted. Cases included a 66-year-

old woman, described as an ‘extreme

age’, who died after thyroidectomy.

The management of the anaesthetic is

dissected including the consideration of

a cervical block, the possibility that the

dose of luminal was too large and the

use of sodium iodide in the postoper-

ative period.

The need for the professional anaes-

thetist is enforced and reinforced. Spe-

cialism in medical practice is also

examined in a paper by Waters on

Pioneering in Anaesthesiology. Exam-

ining his own development, he believed

that independence, self-reliance and

originality were some of his qualities,

but cautioned that the freedom did not

lead to boldness, rashness and foolhardy

practice. Waters own writing is clear,

interesting and often illustrated with

humour. From this body of work,

David Lai has put together a book that

will give the reader an excellent insight

into Ralph Milton Waters, his person-

ality, his professionalism and his legacy

to anaesthesia.

Neil Adams

West Suffolk Hospitals Trust,

Bury St Edmunds,

Suffolk IP33 2QZ, UK

514 � 2003 Blackwell Publishing Ltd

Book reviews Anaesthesia, 2003, 58, pages 513–514......................................................................................................................................................................................................................