Anesthesia and Uncommon Diseases, 5th Edition.  By Lee A. Fleisher, M.D. Philadelphia, Saunders, 2005. Pages: 658. Price: $125.00.

The fifth edition of Anesthesia and Uncommon Diseases  is a long-awaited and meaningful upgrade from the fourth edition that was published in 1998. This text has been in existence since 1973, authored by Jordan Katz (Emeritus Professor of Anesthesiology, University of California San Diego, San Diego, California), Jonathan Benumof (Professor of Anesthesiology, University of California San Diego), and Leslie B. Kadis for the first three editions. The fourth edition saw extensive revisions and reorganization under Benumof’s sole editorship and remained unchanged for a long time. This version was outstanding in its organization and remained essential reading for residents and practitioners confronted with complex patients and unusual pathology. It amply fulfilled its goal: “to bring vital, yet scattered clinical information to the practicing anesthesiologist and nurse anesthetist.” Although much has changed in the understanding of many of these complex problems since the time of the last edition (examples are newer insights into the mitochondrial myopathies and muscle diseases, the genetics of the more common endocrine diseases, cancer therapy, discoveries of hepatitis E and G, the impact of alternative and complementary medicine, and the problems encountered by the ever-increasing use of herbal supplements in the general population), no new editions appeared. The appearance of this text in its fifth edition could not have been timelier. In these days of ubiquitous Internet access, one can, by the click of a mouse, search virtually any disease or condition (common or uncommon) and retrieve a mass of information, in seconds, which sometimes makes this reviewer feel that the days of the printed text as a source of instant knowledge are fast fading. So how does this edition rate in the Internet age?

Lee Fleischer, M.D. (Professor and Chair, Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania), has assumed the reins as editor of the fifth edition. Multiauthored texts are here to stay, and this book is no exception, reflecting its theme. The fifth edition has significantly more contributors than the previous edition, representing a broad spectrum of academic anesthesiology. The essential structure has been maintained with a system-by-system format. What is immediately obvious is that this book is larger, although the number of pages is slightly reduced (658 vs.  670). With 21 chapters (as opposed to 16 in the previous edition) as well as 145 illustrations, this edition is significantly more comprehensive. The striking use of color is apparent. There is also the use of a visually pleasing blue in varying shades to highlight and shade the numerous boxes, tables, and algorithms—a much needed feature to simplify and summarize complex issues. What are also abundant are detailed line diagrams and photographs.

New chapters in this edition include those on congenital heart disease, obesity and nutritional disorders, infectious diseases and bioterrorism, mitochondrial diseases, herbal medications, trauma and acute care, and burns, as well as chapters devoted to pediatric patients and geriatric patients. The chapter on uncommon problems related to cancer has been omitted in the fifth edition.

Central to the review of this book is the question of what the word uncommon  really means when it comes to the disease process and how relative it is when viewed in context of the present time and place. Lowenstein’s introduction articulately addresses these questions. For example, I would argue that obesity in this country is not an uncommon problem (as the author rightly states) and therefore not to be counted as such, as opposed to disorders of socioeconomic starvation such as marasmus and kwashiorkor, which are virtually nonexistent in the west, exceptions being disorders of willful starvation like anorexia nervosa—both covered in detail.

Cardiovascular diseases are covered in two chapters in this edition; the first covers the usual suspects—cardiomyopathies, cardiac tumors, uncommon causes of ischemic heart disease, pulmonary hypertension, pericarditis and its implications, and a very detailed summary of the unusual causes of valvular lesions and arrhythmias, ending with discussions of the transplanted heart. What has been added to this edition is a new chapter on congenital heart disease. This provides the reader with an outstanding review of an innately complex subject. The authors go into an appropriate amount of detail describing the various complex congenital lesions and coarctation. I found the details of normal and abnormal physiology very well written, complemented by well-reprinted line diagrams and photographs.

Chapter 12 involves infectious diseases and bioterrorism. Detailed coverage of the anesthetic implications of hepatitis, human immunodeficiency virus, tuberculosis, and slow viruses are included, as well as topics that I hope will always remain very uncommon if not nonexistent—the infectious agents of bioterrorism, anthrax, plague, smallpox, and tularemia, as well as the agents sarin, ricin, and botulinum toxin. One wonders what the next edition might add. Time will tell.

Chapter 14 deals with mitochondrial diseases and explores the anesthetic management of the inherited and acquired disorders. Malignant hyperthermia is dealt with in the chapter on muscle diseases, which is comprehensive and well illustrated.

Herbal medications are covered in chapter 16, which provides a brief survey of the problems associated with the uses of the most common supplements and their anesthetic implications. Chapter 19 deals with pregnancy, and aside from the core topics such as preeclampsia and cardiomyopathies, it deals with the anesthetic implications of in vitro  fertilization and comprehensively covers the different types of assisted reproductive techniques, which seem to be growing in number and complexity. No mention is made, however, of fetal surgery, which will probably occur with greater frequency in the future.

The last two chapters deal with uncommon geriatric and pediatric problems. The chapter on pediatric patients is exceptionally thorough and well written, with an abundance of line diagrams and photographs of the multiple and rare syndromes and their anesthetic management. It sufficiently covers the gamut of uncommon pediatric syndromes by system, including the craniofacial anomalies, neural tube disorders, and congenital thoracic and abdominal pathology.

To summarize, the fifth edition of Anesthesia and Uncommon Diseases  is a clearly written, practical text with many A+ features. Dr. Fleischer and his contributors should be congratulated on producing a fine book. I have no hesitation in recommending this text for the library of every student and practitioner of anesthesiology who desires to update his or her foundation of knowledge and clinical practice of perioperative medicine. The potential enrichment to the reader is well worth the $125. I hope that the appearance of this text in CD-ROM format is not too far off in the future.

Mayo Clinic Scottsdale, Mayo Clinic Hospital, Phoenix, Arizona.