As “they” say, time flies. It has been over 25 years since we began work on the first edition of Medical Management of the Surgical Patient. It is hard to believe that so much time has passed and that there have been so many changes in the practice of medicine. In 1977, coronary bypass surgery was just beginning to be a common procedure, angioplasty was in its infancy and there was no such thing as endoscopic surgery. No one had any idea that AIDS was about to enter the scene. If anyone has said that peptic ulcer disease was an infectious disease, he would have been laughed at and no one was talking about the morals and ethics of medical care. Things have changed!

It seems to us that there is something special about a fourth edition. Getting a first or second edition done isn't easy, but not unusual. A third edition is a “tipping point,” it means that the book is of some real use. A fourth edition affirms a book as a standard.

And we certainly hope that is the case. We have gathered in this volume a large group of experts in perioperative care. There are two nationally known conferences in perioperative medicine: Thomas Jefferson and University of California, Davis. Many of our authors are experts from those institutions. Those of us at Emory have been working on these problems since 1977.