A Practice of Anesthesia for Infants and Children, 4th ed.
Charles Cote, MD, Jerrold Lerman, MD, I. David Todres, MD.
Philadelphia: Saunders, Elsevier, 2008. ISBN-13: 978-1-4160-3134-5. Hardbound, 1192 pages, $149.00.
In the 4th edition of “A Practice of Anesthesia for Infants and Children,” Drs. Cote, Lerman, and Todres have achieved their goal of providing a textbook on the practice of pediatric anesthesia that has in their words “blossomed from a synopsis of local practices into an international authoritative and evidence-based tome.” They accomplished this feat by including chapters written by pediatricians, internists, surgeons, a lawyer, and a pharmacologist, as well as well-known experts in pediatric anesthesia. In most multiauthored textbooks with contributors from different parts of the world, there is usually a disparity in style, variability in the quality of writing, and the inevitable repetition in the content of chapters. It is to the credit of the editors of this textbook that there is a remarkable uniformity in the quality of the text material. The chapters are well organized into sections, which include an introductory overview of the field of pediatric anesthesia, a section on drug and fluid therapy, sections on the functions of the different organ systems, surgical specialties, emergency situations, pain management, and less common “special topics.” Despite the large number of high-quality color figures, tables, and illustrations that are presented in an easy-to-read format, the cost of the book is remarkably low compared to older textbooks on this subject matter.
These older pediatric anesthesia textbooks are beginning to appear dated. In contrast, the book by Cote et al. provides more recent information in major new chapters on topics that were not covered previously. For example, the section on anesthesia for fetal surgery (e.g., ex-utero intrapartum treatment procedures) introduces readers to a completely new field that has opened up in the last few years. It has a thought-provoking section on the justification for fetal analgesia and anesthesia. Recent data implying a significant deleterious effect of anesthesia on the developing brain would suggest that fetal anesthesia will be a fertile area for future clinical investigations of central nervous system developmental function in this at-risk pediatric population. These potentially deleterious effects of anesthesia on the developing brain have been covered in part in the section on the “extremely” premature infant. However, more important data have been made available after publication of the book and it is reasonable to expect more cutting edge research in this area in the future. The textbook also offers important new chapters on medical-legal issues, infectious diseases, the extremely premature infant, and has highlig hted chapters devoted to ultrasound-guided regional anesthesia, chronic pain, and the acute postoperative pain management. The increased focus on pain management emphasizes the obvious fact that children also feel pain and have the same need as adults for appropriate pain control. The textbook not only focuses on new drugs and techniques but also has information on older “traditional” medications in the revised chapter on pharmacology. As a result, this textbook retains its relevance to an international group of practitioners who commonly used medications that are either no longer or have never been available for clinical use in the United States. The inclusion of a discussion regarding the indications and rationale for using some drugs that are not available in the United States (e.g., the oxytocin antagonist, atosiban) will be of interest to many specialists in this country.
The section on special topics examines areas of particular relevance to practitioners of pediatric anesthesia. Given the ever increasing demand to anesthetize children in locations remote from the operating room, the inclusion of chapters on anesthesia and sedation outside the operating room is essential. The chapter specifically devoted to total IV anesthesia, which has become more commonplace even in the United States, is particularly useful for cases involving neurological monitoring and airway procedures. In this chapter, Dr. Morton reviews the pharmacokinetics and pharmacodynamics of medications delivered IV and provides easy to understand explanations of how and why this technique works. “Production pressure” to be more efficient in both operating rooms and remote locations (e.g., diagnostic imaging and endoscopy facilities) is an unfortunate reality, and this pressure puts a premium on the need to achieve an adequate depth of surgical anesthesia without delayed awakening (i.e., the fast-track concept). Dr. Morton provides clear explanations on how total IV anesthesia can be used to safely accomplish this task.
The authors’ decision to include online access to the textbook material through the Expert Consult website also deserves to be acknowledged. It took only a few minutes to complete the registration process by following the easy to understand instructions included in the front cover of the textbook. There are obviously many advantages to having electronic access to the textbook material from any place with an Internet connection (including handheld devices), in particular when working in locations remote from the operating room. An additional benefit of providing electronic access to the text was to permit the authors to limit the printed references to a selected number of “annotated references” in an information box at the end of the chapter, while listing all of the references in the electronic version and making them accessible via hyperlink. The annotated references served as a welcome cue for the important “articles to know” in each chapter. The electronic text further offers access to downloadable images and video clips from the chapters. The authors should consider providing links or the URL for video clips at various other websites, particularly those devoted to ultrasound-guided regional anesthesia. This is extremely valuable for those of us involved in resident and medical student education. Finally, electronic access will permit the authors to update their work as new information becomes available. A full, separate section on the effects of anesthesia on the developing brain should be a priority in an early update.
In summary, it is difficult to single out a “best” section (or chapter) in this extremely well-written textbook. The one thing that resonated with us when we read the book was the idea that each chapter was written and edited in a fashion to make the reader feel as though they were “listening in” on a conversation between an experienced consultant pediatric anesthesiologist and a trainee in the operating room. All of the important points related to the anesthetic management of pediatric patients are covered in depth and eloquently presented. In our opinion, this book belongs in the library of every pediatric anesthesiologist (and departmental libraries with teaching programs). This comprehensive textbook is also an excellent reference source for those practitioners (and trainees) who are only “occasionally” called upon to care for children undergoing surgery or diagnostic/therapeutic procedures.
David G. Mann, MD
Mehernoor (“Meb”) F. Watcha, MD
Department of Anesthesiology
Texas Children’s Hospital