Physiology of Spinal Anesthesia

PHYSIOLOGY OF SPINAL ANESTHESIA, 2nd Ed. By Nicholas M. Greene. Baltimore, Md., Williams and Wilkins Co., 1969. 243 pp. $9.75. The first edition of The Physiology of Spinal Anesthesia appeared in 1958. Its avowed purpose was to review and evaluate the literature "dealing with the physiological response to spinal anesthesia." While interest in spinal anesthesia has steadily waned during the intervening decade, a victim of the increasing escalation of medico-legal action, continued productive work has gone on, sufficient to warrant a new edition. Dr. Greene has brought to this task the same careful scholarship and precision that marked the earlier book. The sum and substance have remained essentially unchanged. Significant information concerning the cardiovascular and pulmonary effects of spinal anesthesia have been added to buttress the original presentation. Some new material in obstretrics has brought this area up to date, especially in the effects of spinal anesthesia on cerebrospinal fluid pressure and respiration at term during pregnancy. Indeed, all sections of the book have been expanded. A brief chapter on "Epidural Anesthesia" has been added in which the physiologic changes induced by this mode of analgesia are contrasted with spinal anesthesia. The changes examined relate to "the zone of differential blockade, difference in amount of local anesthetic used, and difference in cerebrospinal fluid pressure." Those who are looking for a guide to clinical practice and the technic of spinal anesthesia will find little here, but those who are seeking to understand the process whereby spinal anesthesia is accomplished, and the changes induced by the consequent sympathetic denervation, will be richly rewarded. The extensive bibliography appearing at the end of each chapter enhances the value of this book as a source of reference. If there is a deficiency it is in the manner of citation. This reviewer found the flow of prose and thought marred by the introduction of authors cited and dates of publication in the body of the sentence. This is particularly pertinent since the bibliography is exhaustive, organized alphabetically, and most easy to use. The author has indeed accomplished his purpose to review and evaluate the physiological effects of spinal anesthesia, and in so doing, has produced what is now a classic in its field. This monograph, as a source of candid presentation and mature judgment is to be heartily recommended to student, physician and scientist who have an interest in the consequence of sympathetic denervation produced by spinal anesthesia in man.