Book And Multimedia Reviews: Media Review
Pediatric Emergencies; Volume 19, Number 2 (June 2001) of Anesthesia Clinics of North America Hamid RKA, editor. Philadelphia: WB Saunders, 2001. ISSN 0889-8537. 203 pp, $145.00 annual subscription for four issues.
This monograph, devoted to the anesthetic and perioperative management of pediatric emergencies, is short enough to read in several sitting, but most chapters contain adequate information to efficiently inform the reader of current thinking and practice about a wide range of pediatric emergencies. Most chapters in this multiauthored text are quite complete and up-to-date, but a few have some deficiencies that minimally detract from this otherwise practical volume. Although this reviewer would have expected the book to be organized differently (beginning with the most general topics such as trauma and intraoperative resuscitation and then progressing to the more subspecialty-oriented subjects), the excellent annotated table of contents made finding specific topics quick and easy. Most chapters are well referenced, with both classic and current articles. The index is complete and appears to be accurate. One drug dosage error was noted (rocuronium 2.0 mg/kg, rather than 0.6–1 mg/kg, is recommended on page 233 for rapid sequence intubation). Several chapters recommend the use of rapacuronium, which was withdrawn from the market soon after the publication of this volume. There are a few brief unclear or misleading passages resulting from idiosyncrasies of writing and syntax, but overall the book is lucid and easy to read.
The first three chapters of the book are devoted to pediatric neurosurgical emergencies: hydrocephalus, neural tube defects, and arteriovenous malformations. These chapters should be read together, as there are issues that are applicable to all aspects of pediatric neuroanesthesia that are only presented in one of the three. For example, the implications of increased intracranial pressure and brainstem dysfunction on the airway are presented in the discussion of the Arnold-Chiari malformation (neural tube defect chapter), but are not mentioned in the chapter on hydrocephalus. The authors discuss the pathophysiological underpinnings of most common neurosurgical conditions, but usually discuss only one approach to the anesthetic management. The otolaryngologic emergencies chapter is notable for not only its complete coverage of the topic, but also for its discussion of the pros and cons of alterative management strategies. Ocular trauma is a common condition in pediatrics (although the authors imply that 34% of children sustain penetrating eye injuries, they mean instead that 34% of these injuries occur in children). A chapter devoted to this subject discusses several new agents, but the potential advantages of remifentanil for smoothing emergence and extubation and regional anesthesia for postoperative analgesia are not mentioned. Recent developments in operative and anesthetic management of neonatal surgical emergencies are superbly reviewed. In particular, things that have changed from the “classic” teachings, such as management of congenital diaphragmatic hernia and timing of surgery, are emphasized, and numerous valuable clinical “pearls” are presented. The chapter on cardiac emergencies, though not intended to be a comprehensive treatise, is a complete and current summary of the subject. Preoperative care and medical management is crucial in these patients and is well described, as is the long-term plan for the most common lesions. Importantly, because interventional catheterization can now be employed to palliate or treat several of these emergencies, anesthetic management in the catheterization laboratory is also discussed.
As would be expected, there is a major chapter on pediatric trauma management, including neurotrauma and spinal cord injury. Although the chapter is thorough, several statements merit comment. The author implies that propofol and thiopental are induction agents that preserve hemodynamic stability (p. 313), although this statement is corrected and qualified in the accompanying table. The controversy of fluid resuscitation and management with isotonic crystalloid, hypertonic crystalloid, or colloid is not fully discussed. The statement that succinylcholine should not precipitate hyperkalemia until more than 5 days after spinal cord injury may be overly liberal; authoritative data suggest 72, and possibly 48 h postinjury as a safer limit. The recommendation of applying in-line axial traction for cervical spine injuries during intubation is highly controversial, as several adult and cadaver studies have demonstrated an increased risk of cervical cord injury with this maneuver. Spinal shock is not discussed. Diagnostic peritoneal lavage is suggested, but data do not support the routine use of this technique in children, especially with expectant management of low-grade splenic injury.
Chapters on intraoperative resuscitation and resuscitation outside the operating room are complete and up-to-date, as is the review of malignant hyperthermia, which also discusses the critical issues of counseling and when to recommend biopsy. A short chapter discusses the pathophysiology of the three common causes of acute pulmonary edema. The chapter on ventilation outside the operating room describes new but frequently applied modalities, such as high-frequency ventilation (oscillatory and jet). It unfortunately neglects to discuss the crucial and radical changes that have occurred in conventional ventilator strategies for acute respiratory failure and their far-reaching implications on ventilator-induced lung injury and the intraoperative ventilator management in these patients.
In summary, this volume offers numerous excellent reviews for the generalist anesthesiologist about anesthesia for pediatric emergencies. Occasional chapters have a few deficiencies that may be ameliorated by consultation with other sources.
David M. Polaner, MD
Department of Anesthesia
The Children's Hospital