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Meyler's Side Effects of Drugs Used in Anesthesia, 15th ed.

Meyler's Side Effects of Drugs Used in Anesthesia. Elsevier, Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067; $95.00; 215x285 mm; pp. 271; ISBN: 978-0-4445-3270-1.

Leopold Meyler (1903 to 1973) was a physician whose interest in the side-effects of drugs followed an adverse personal experience. A series of encyclopaedic editions and annuals followed. This book of 264 pages plus index is abstracted from the 15th edition of Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions published in 2006. It is therefore unsurprising that the most recent cited reference is from 2006.

The drugs covered in this edition include general anaesthetic agents (inhalational and intravenous), local anaesthetics, neuromuscular blocking drugs and a somewhat bizarre collection of muscle relaxants (including baclofen, botulinum toxins, carisoprodol, chlormezanone, dantrolene and some others). Strangely, doxacurium is included in the muscle relaxant section and not with the other neuromuscular blocking drugs.

The information is presented in a typical encyclopaedia format with two columns on each page. Each section is followed by subtitles (organs and systems, long-term effects, susceptibility factors and drug-drug interactions) and further subtitles although there does not appear to be a consistent set format. No tables are used.

All aspects of the side-effects of these drugs are covered together with case reports which tend to be anecdotal. In describing the side-effects, no distinction is made between uncommon or idiosyncratic reactions, e.g. liver damage with halothane and complications and technical errors, e.g. phrenic nerve palsy with cervical plexus block. Expected side-effects e.g. respiratory depression with opiates, is not distinguished from the respiratory depression occasionally seen after small doses of midazolam in elderly patients. There are no critical summaries of contents in each section. No distinction is drawn between Level I and Level IV scientific evidence. Some important recent meta-analyses have not been included, e.g. in the section on nitrous oxide it is stated that, "nausea and vomiting seldom occur," which is an unreferenced comment.

There are many problems and errors with the references. For example, in the section on nitrous oxide myelopathy, the cited reference is entitled "Sildenafil citrate associated priapism"' in the section on propofol ten references are duplicated with different numbers and in the section on mortality associated with general anesthesia, the information is attributed to a paper about halothane contracture tests and another about Duchenne's muscular dystrophy. There are many other examples.

Some of the reasonable conclusions drawn are not supported by the cited reference(s). An example is that sevoflurane should be a suitable agent for neuroanesthesia (p. 30), the only reference given is a 1993 paper entitled, "Sevoflurane does not increase intracranial pressure in hyperventilated dogs".

There are sections that are poorly organised and even repeated, e.g. pain on injection of propofol is covered on page 65 and again on 67. Other editorial slips include seizures spelt "seizwes" (p. 30) and that sevoflurane is "metabolised" to compound A by carbon dioxide absorbers (p. 34).

There is much valuable information in this volume, however its usefulness is undermined by its many mistakes and that it is somewhat dated. In view of these problems, we find it difficult to recommend this text to a specific audience.

N. M. Cass, L. Cass

Melbourne, Victoria
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Author:Cass, N.M.; Cass, L.
Publication:Anaesthesia and Intensive Care
Article Type:Book review
Date:Mar 1, 2010
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