Perioperative Drug Manual, 2nd Edition.  By Paul F. White, Ph.D., M.D. Philadelphia, Elsevier Saunders, 2005. Pages: 542. Price: $54.95.

This second edition of the Perioperative Drug Manuel by Paul White presents a succinct description of the key characteristics of the majority of drugs (approximately 750) that anesthesiologists are likely to encounter in practice. Both drugs that the anesthesiologist uses and those that patients are likely to be taking preoperatively are covered, including antineoplastic, antiviral, and herbal medicines. A key feature of the book is its compact size, which enables it to be kept handy for an at-a-glance reference in the anesthesia machine, recovery room, or some other convenient location, although it is slightly too big for a pocket reference. The book’s format is one of its major strengths.

The Table of Contents reveals that the book is organized alphabetically by drug category: antiarrhythmics, calcium channel blockers, opioid agonists and antagonists, and so on, while the index lists all drugs by both their generic and trade names. Forty different drug categories are included, making the monograph comprehensive. Information regarding a particular drug or a treatment for a particular problem is readily available. Within broad categories, the drugs are listed alphabetically, with the generic name of the drug highlighted and in bold. The description of each drug is concise but includes the trade name, indications, pharmacokinetics, pharmacodynamics, dose, contraindications, drug interactions, and key points. The pharmacokinetics section provides the time of onset after intravenous administration (and oral administration when appropriate), the time to peak action, and the duration of activity. Useful information, including the volume of distribution and the T|n$β or elimination half-life, is also provided. This latter information, which otherwise might be difficult to access quickly, might be useful especially in cases of drug overdose or prolonged administration in the intensive care unit. In some instances, the author rather heroically even comments on the ability of the substance to occur in breast milk and cross the placenta and blood–brain barrier. In addition, a brief comment is provided on its metabolism (hepatic and, in some instances, whether a cytochrome P-450 is involved) and secretion into the urine and feces. This section is to be commended for the abundance of information it squeezes into a limited space.

In the pharmacodynamics section, the clinically important effects of the drug on various organ systems are described. Particular attention is paid to alterations of the central nervous system, cardiovascular system, gastrointestinal tract, lungs, and kidneys. When well established, the mechanism of drug action is succinctly described. For example, esmolol is described as a short-acting, selective β antagonist. Consultation of this handbook should assist the clinician in rapidly understanding the pharmacologic effects of the drug of interest. The dosage section is self-explanatory and adds to the value of this book as a quick reference for personnel needing to refresh their memories on an infrequently used drug. When known, a dosage for children is stated.

In the updated and revised second edition, a valuable new Key Points section has been added. The author describes in a sentence how the drug may interact with anesthetics in both the short and long term and what precautions, if any, should be observed. This information is intended to enable the clinician to provide a safer anesthetic in an environment in which many new drugs are being introduced. This objective is likely to be achieved. There is expanded coverage of blood substitutes and all new sections on transplant drugs and herbal medicines. The appendix has a table for nonopioid and opioid analgesic combinations to demystify the myriad of analgesic combinations available.

Although this is an excellent monograph, there are some shortcomings. In the next edition, a table of narcotic equivalencies would be helpful, as would inclusion of the properties of some other adjuvants used intraoperatively, such as methylene blue. Indigo carmine should probably not be lumped with the radiologic contrast dyes, which could be discussed in more detail in view of anesthesia’s increasingly frequent presence in the radiology suite. Because of their markedly different properties, the drug pairs oxycodone–propoxyphene and butorphanol–levorphanol would be better described in separate sections. The classification of the narcotics as agonists, antagonists, or both was very helpful in the first edition and should be considered for subsequent editions as well.

Although the price tag of $55 may discourage some, overall, the second edition is a welcome reference for novices for commonly used drugs and for experienced clinicians for infrequently encountered drugs. The author has displayed a masterful command of the subject matter and eloquently presents the material.

University of Michigan, Ann Arbor, Michigan.