Sota Omoigui’s Anesthesia Drugs Handbook, Third Edition. (2000)

Associate Professor Department of AnesthesiologyUniversity of Vermont College of MedicineBurlington, Vermontjames.rathmell@vtmednet.orgSota Omoigui’s Anesthesia Drugs Handbook, Third Edition. By Sota Omoigui, M.D. Malden, Blackwell Science, 1999. Pages: 628. Price: $39.95.Sota Omoigui’s Anesthesia Drugs Handbook is a pocket-sized handbook that lists more than 140 drugs used in clinical anesthesia practice. The book’s forward states that, for attending anesthesiologists, the handbook is an up-to-date rapid reference for use in clinical practice, and, for residents, it is a concise overview for use in patient care and board examination preparation. Omoigui and his colleagues should be commended for their organizational skills. They have taken easily attainable information from readily available sources and brought it together into one concise and usable volume. But, it is only a handbook. The information provided is limited, and references are few.The handbook is well-organized and easy to use. Agents are listed in alphabetical order by generic name, and there is an appendix that lists agents by brand and generic names. Each agent is presented in a standard format that describes drug uses, dosing, elimination, storage information, and a brief review of the pharmacology. The index is complete and lists drug names and other relevant topics, such as adverse reactions. However, the amount of information provided for each agent is scant. There is often significantly less than what is found in the manufacturer’s insert.Is there enough information presented for the handbook to be useful in clinical practice? By and large, yes. The information provided for aprotinin, for example, includes brief details about the use of this drug in cardiac surgery and its pharmacology. High-dose and low-dose regimens are listed (but there is no rationale for choosing between the two). Appropriate warnings are included regarding test dosing. For the lidocaine entry, the listed uses include regional anesthesia, treatment of ventricular arrhythmias, and attenuation of the “pressor response” to intubation. A dizzying array of dosing guidelines follows. Drug combinations are described without reference or explanation. For intravenous regional anesthesia, 200–250 mg lidocaine (40–50 ml solution, 0.5%) is suggested. The text instructs,If desired, add fentanyl 50 μg to enhance the block and/or muscle relaxant (pretreatment doses only), for example, pancuronium 0.5 mg. This combination may enable the use of lower concentrations of local anesthetic (e.g., lidocaine 50 mL of 0.25% for upper extremity block).Although these suggestions might be effective, how is the uninitiated student to sort through and come up with a safe and useful combination? Familiarity with the clinical use of many of the agents listed is needed for rational use of the handbook.The handbook includes an appendix with several protocols and tables. The protocols (malignant hyperthemia protocol, advanced cardiac life support algorithms) are copied from the original sources. Tables provide information for various intravenous infusions (e.g. , alfentanil, lidocaine) and epidural dosing (e.g. , fentanyl, hydromorphone), and they list infusion rates based on body weight.It is impossible to escape the entrepreneurial spirit of this publication; the book makes it clear that this and all of Dr. Omoigui’s publications are available on the Internet. I could not resist looking to see what is offered. At www.medicinehouse.com, the homepages of State-of-the-Art Technologies, Inc. and The L. A. Pain Clinic are presented. Dr. Omoigui’s handbooks are presented for sale alongside products that range from herbal supplements for weight loss to magnets for magnetic pain therapy. There is little useful information for patients or practitioners on the Web site. When the author states in the preface that the handbook is available on the Internet, he means available for purchase; the information in the handbook is not accessible from this Web site. Sota Omoigui’s Anesthesia Drugs Handbook arranges clinically useful facts into a format that is concise, small enough to keep in a pocket, and well-organized. It allows quick access to brief descriptions of many medications used in the clinical practice of anesthesia. A warning to anesthesiology residents: Do not use this handbook as a primary source to study for your boards—the examination is not that easy.