Ambulatory Anesthesia and Surgery

Paul F. White, ed. Philadelphia: WB Saunders, 1997, ISBN 0-7020-1799-X, 936 pp., $120.00. The increasing emphasis on surgery and, consequently, on anesthesia being performed and, in many situations, being mandated to be performed on an ambulatory basis is known to all physicians and many patients. This has been appreciably accelerated by the emphasis on the bottom-line approach to the delivery of health care. Improvement in perioperative care, availability of anesthetic drugs of quicker onset and offset, and less invasive surgical techniques have all been supportive of the movement of more surgical care to the ambulatory venue. Over the past decade, there have been several successful anesthesiology textbooks that have focused on this area of patient care, including a 1990 text edited by the editor of the book under review. Is there a need for another book on ambulatory anesthesia and surgery? After reading Dr. White's new text, this reviewer found that the answer to this questions was an obvious yes. As good as White's previous efforts were, this book is appreciably better and addresses more topics not covered before. The entire field is addressed from a broader, more global vantage point in addition to including newer drugs and techniques not previously available. The presentations in this text are the works of 119 different contributors from all over the world, although the majority of them represent the practices and attitudes found in North America. This plethora of contributors presented a major effort on the part of the editor and the eight section editors to limit duplication while promoting cohesiveness and integration of content and presentation. The quality of the individual sections and chapters obviously varies but generally is very good to excellent and supportive of their stated intent by title. The publisher has done a very good job in the presentation of the material. As expected, there is one index at the end of the book, but what was not expected was a single integrated section of references of 88 pages for all of the chapters. This has cut down on the number of pages because there is less duplication of references. However, the book is still 936 pages, by no means brief. This single reference section permits one to see how often each reference has been cited. The classic article by J.H. Nicholl had seven citations from different chapters, as noted in the unified reference section. One of the major contributors in this field of patient care had 47 different references cited as first author. The next most frequently cited first author had 19 publications cited. The section and chapters written by some of our surgical colleagues were of interest since they gave insights on this area of patient care from a different perspective, including office-based anesthesia. Also of interest were the differences in the practices of ambulatory anesthesia and surgery from a global point of view. Despite the fact that we have a shrinking globe because of improved communications, there are vast differences in the prevalence of ambulatory care based on social, cultural, economic, and medical conditions. The editor has done a service by including this very interesting section, which points out that there still are differences in this world in which we live and that methods of delivery of medical care may not be universally applicable. It would have been helpful to this reviewer if, on page 759, there would have been some comment on the statement in the text about the difference in the incidence of postdural puncture headaches with the use of "5-ga" needles as opposed to "4-ga" needles. In addition to the expected sections on preoperative assessment and preparation, pharmacologic principles and applications, assessing recovery and outcome, and pediatric considerations, there are sections on organizational and management issues, medical economics, and legal issues. There is actually a ninth section with its own section editor that deals with problem-based case studies that, in reality, are problem-based approaches to controversial issues. In summary, this is an excellent book, which would be a worth-while addition to one's personal library and should be available to others involved in anesthesia care in the ambulatory area. At the very least, the book should be in the library of every ambulatory unit, where it can be readily available. The book will be frequently used. It is well written, with some novel approaches to the presentation of the material. There is something for everyone with an interest in this expanding field of patient care. Herbert D. Weintraub, MD Department of Anesthesiology; George Washington University; Washington, DC 20037