Clinical Anesthesia, 6th Edition.  Edited by Paul G. Barash, M.D., Bruce F. Cullen, M.D., Robert K. Stoelting, M.D., Michael K. Cahalan, M.D., M. Christine Stock, M.D. Philadelphia, Lippincott Williams & Wilkins, 2009. Pages: 1,640. Price: $199.00.

Clinical Anesthesia  , 6th edition, by Barash et al  . continues the tradition of targeting the need between the introductory level books, such as Basics of Anesthesia  by Stoelting and Miller,1 and the most comprehensive textbooks, such as Miller's Anesthesia  .2 Such a focus serves a wide variety of readers, including the trainee looking for a primary reference, those preparing for recertification, and those needing to refresh their knowledge before a special case. In this new edition, they have expanded into multimedia. Each volume comes with access to a web site that contains a searchable full-text version of the book, online testing, an image bank, and downloadable podcasts for use on computers and many smartphones.

As with previous editions of Clinical Anesthesia  , it is expansive in its coverage of anesthesiology. The chapters are largely very readable and of reasonable length for the topics covered. It is generally written in a fashion that provides the clinically relevant facts in a manner that flows easily. The illustrations, charts, and photographs convey ideas or summarize data efficiently. This edition adds two new chapters: (1) Echocardiography and (2) Inflammation, Wound Healing and Infection. The chapter on Echocardiography is largely straightforward, with labeled pictures both in the textbook and on the web site. The chapter on Wound Healing and Infection brings the reader to a greater appreciation of how our intraoperative and postoperative management of patients affects their surgical outcome. Although at times it goes into greater detail on the molecular biology than may be necessary, the chapter succeeds in making the subjects clinically relevant. At the end of the chapter is a short section labeled “Areas for Future Research.” In this section, the authors list several questions that would make for clinically relevant research topics. For those in training, these ideas may stimulate their interest in research. This is a feature that would be good for the other chapters to have.

An important issue with any textbook is the content and how well it is presented. In the 6th edition, approximately one third of the 141 contributors are new, and there are five editors. Given the overlapping scopes of coverage by so many authors, there will be redundancies and areas of disagreement. The editors have allowed reasonable redundancies and some points of contention to remain. Many who are preparing for initial board examination or for recertification may be frustrated by this lack of consensus and may want the editors to “pick the right answer.” For a book of this scope and with this many contributors, I believe the editors have done a remarkably fine job of managing the content and the writing styles. Indeed, to simply “pick an answer” to a controversial question would be a disservice to the readers, as it would give the illusion of clarity when clarity does not yet exist. The editors' efforts have resulted in a cohesive textbook, without sacrificing the quality or coverage of individual chapters.

Although most of the web-based features have significant room for improvement, the online access to the text is nice to have when the book itself is not readily available. The searchable full-text service is strictly that—a version of the textbook loaded on a website. It does only literal searches (i.e  ., does not search along common synonyms). It does not offer suggestions for spelling errors. How it determines the ranking of its “hits” for some queries is still a question. I found no integrated video and that was especially disappointing for the sections on echocardiography and the use of ultrasound guidance for nerve blocks. Accessing the references using the links provided is problematic unless you already subscribe as an individual to the online document suppliers provided.

The searchable image bank does provide downloadable images. Most images are of good quality. However, some of the images are of very low resolution (e.g  ., the American Society of Anesthesiogists' official seal). The window provided to view the images is rather small and cannot be resized. This is a problem because a good number of the images will not be fully displayed until the size is set to 50%, and this has to be done for each image.

The enhanced podcasts are rather short, are only eight in number, and are largely abbreviated text being read, supported by static images, charts, or graphs. As with the online text, the opportunity to provide video to communicate dynamic processes such as transesophageal echocardiograhy or ultrasound guidance for nerve blocks is missed.

The interactive quiz bank is a good feature that simply does what it says. It is not as sophisticated as the Anesthesiology Continuing Education program produced by the American Society of Anesthesiologists. The number of questions (363) is quite reasonable, and the quality of the questions is good.

Overall, the 6th edition of Clinical Anesthesia  is an excellent book that will meet the needs of a broad range of readers. Although the online features have room for improvement, the book itself is “the best of breed.” It is still the best single volume text on anesthesiology and belongs in every practitioner's collection.

University of Mississippi Hospitals and Clinics, Jackson, Mississippi.