Drugs in Anaesthesia and Intensive Care: Fifth Edition
Without question, the field of anesthesiology is intimately intertwined with the rapidly advancing pharmaceutical industry. As anesthesiologists, we are expected to make informed decisions and provide patient education regarding appropriate drug indications, dosing, side effects, interactions with the patients’ over-the-counter and other prescribed medications, intraoperative drug use, and postoperative analgesia, among other things. New drugs are continually introduced to the practice of medicine, and we must understand how these drugs affect anesthetic management. It is imperative that anesthesiologists have a convenient, current, reliable reference that addresses the complicated pharmacological environment in which we practice.
Drugs in Anaesthesia and Intensive Care: Fifth Edition was written with these demands in mind. The aim of the text, as outlined in the preface by authors Edward Scarth and Susan Smith, is “to summarize concisely the main pharmacodynamics and pharmacokinetic properties of drugs with which the practicing anaesthetist might be expected to be familiar” and to provide “an ordered scheme for the presentation of information.” In this fifth edition, the authors have made multiple improvements from the previous edition. They have updated the formulary of drugs reviewed to include direct oral anticoagulants, among others. They have also subjected the book to a peer review process to ensure factual accuracy and clinical utility. The book covers a wide array of drugs encountered in clinical practice, including anesthetic agents, antibiotics, analgesics, and many medications regularly taken by patients. It excludes, however, complementary alternative-medicine products.
The book itself is pocket-sized and therefore convenient for daily use. Drugs are listed by their generic name in alphabetical order, including almost 200 drugs common to anesthesia practice. The page layout is logical, with clear headings, so one can rapidly scan for the section of interest. The book is also user-friendly, with features such as two attached ribbon bookmarks, alphabetical markings on the fore-edge of pages, and drug names on page corners to facilitate rapid searching. It also contains multiple indexes that allow one to find drugs based on pharmaceutical class and medical use.
Each drug is outlined in one to two pages, with concise reviews of its pharmacology, indications, dosing, side effects, and toxicity. Perhaps the most useful section for each drug lies under a “Special points” heading in which the authors aim to highlight any specific concerns regarding the drug. This inclusion acts as an anesthesia-specific commentary on how the drug of interest may interact with certain anesthetic agents, how it can interact with a patient’s comorbidities, and other points relevant to the practice of anesthesia.
Although this book is easy to use and contains valuable information, it has multiple drawbacks that may limit its utility, depending on one’s anesthetic practice. First, despite containing a large library of drugs, a number of newer drugs that can significantly alter anesthesia practice are absent (apixaban and ticagrelor come to mind). This omission is certainly unintentional and is likely due to the inevitable gap that exists between current information available electronically and that in textbooks because of the lag between publication submission and printing. Second, it is not an ideal textbook if you are looking for a dosing reference. The text generally lists a standard adult dose and only occasionally provides doses in units per kilogram, which limits its usefulness in a pediatric practice. Third, the book would benefit from cross-referencing generic drug names with trade names so as to expedite the referencing process.
Despite its downsides, Drugs in Anaesthesia and Intensive Care: Fifth Edition could be a valuable addition to one’s library. It provides a convenient, user-friendly pocket reference. Scarth and Smith certainly delivered on their aim to summarize the material concisely and present the most commonly encountered medications in an anesthesia practice. The anesthesiologist who prefers a physical reference book to an electronic reference and who is willing to accept the information gap that exists between electronic and print resources should consider purchasing this book.
Conflicts of interest
This submission was handled by Dr. Gregory L. Bryson, Deputy Editor-in-Chief, Canadian Journal of Anesthesia.