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Problems in Pediatric Anesthesia.

Section Editor(s): Elison, NorigCasta, Alfonso MD; Cladis, Franklyn MD

Book and Multimedia Reviews: Media Review

Associate Professor of Anesthesiology (Casta)

Assistant Professor of Anesthesiology The Children’s Hospital of Pittsburgh Pittsburgh, PA (Cladis)

Problems in Pediatric Anesthesia. Stoddart PA, Lauder GR, eds. London: Taylor & Francis, 2004. ISBN 1-84184-212-5. 226 pp, $99.95.

This is a pediatric text that uses a case based method to achieve its educational objective. There are 35 chapters that deal with a variety of pediatric clinical scenarios. The clinical dilemmas presented are common enough to provide useful insight to the anesthesia student, resident, or fellow yet complex enough to maintain the interest of the more experienced anesthesiologist. The pathology discussed is extensive and includes congenital heart disease, obstructive sleep apnea, reactive airway disease, central nervous system pathology, sickle cell, and infectious disease, to name a few. Anesthesia for almost every pediatric specialty is discussed including anesthesia for radiology and the postanesthesia care unit.

The discussions are generally thoughtful and complete. By combining physiology with clinical pearls the chapters provide a nice review adequate for most anesthesiologists. The “learning points” presented at the end of each chapter highlight this. The format of case followed by discussion makes for easy reading and this is enhanced by the well laid out pictures, diagrams, tables, and illustrations. In particular, chapter 9 deals very well with the perioperative management of a child with Fontan who presents for an adenotonsillectomy. Likewise, chapter 33 discussing cholecystectomy in a child with sickle cell disease is very thorough and well written.

A criticism of the material is that a few of the chapters lack depth in the discussion section (PACU chapter) and some of the references are dated. Also some of the chapters present information that is a bit controversial. For example in children with obstructive sleep apnea, the recommendation is to avoid opioids postoperatively. This may not be considered the standard of care in some centers, particularly if the child is recovering in a monitored setting. The foreign body chapter does not discuss the potential airway complications associated with exposure to vegetable oils. For some patients, it may be prudent to leave the airway intubated after the removal of the peanut. Also endoscopic procedures are being performed more commonly in infants. Unfortunately, there are no cases discussing the anesthetic management of commonly performed endoscopic procedures in this age group. The non-British reader may have some difficulty adjusting to the different spelling and use of units, but this is a minor criticism in an otherwise informative and entertaining book.

The population that will benefit the most from this book are those still in training. The format is ideal for a review of challenging pediatric anesthetics, especially in preparation for an oral exam.

© 2005 International Anesthesia Research Society