Pediatric Anesthesia,4th edition
G. A. Gregory (ed.)
Churchill Livingstone: Philadelphia, USA, 2002, 936 pp; indexed, illustrated
ISBN: 0-443-06561-6; Price £125.00 (Hardback)
This is the fourth edition of this fully comprehensive reference textbook on paediatric anaesthesia, the first having been published in 1983. It is a multiauthor, single-volume reference text, with the Editor, G. A. Gregory, still contributing a wide range of chapters. There are 36 other authors all currently working in North America, although some have gained their qualifications from other English-speaking countries. All but three are affiliated directly with anaesthetic departments. Acknowledged experts in their fields have written most of the chapters, many of the contributors having written well-known standard texts. The number of chapters written by non-anaesthetists is minimal. The subject-matter is dealt with in four fairly standard sections: principles, management, practice and special considerations of paediatric anaesthesia, with the 29 chapters divided between them, followed by two appendices and an index.
In the Preface to the first edition, Gregory remarked that there had recently been an explosion of research on infants and children, but that it was dispersed throughout the literature and not readily available for the academic, practitioner or house officer, especially in the middle of the night. His goal at that time was to provide a physiological and pharmacological approach for anaesthetists of the paediatric patient as well as the clinical information needed to care for these patients. Anatomy and embryology were also included. In the Preface to the latest edition, the aim was extended to include the latest information available and to make it more readable and interesting. Chapters have been revised and added, e.g. training of the paediatric anaesthetist, and the references updated.
Taken in isolation, the content of each chapter is excellent, but as we have unfortunately come to anticipate in these multi-author texts, there seems to be very little editing and cross-referencing between chapters. This makes the user, especially one not from North America, very reliant not only on the index, but also on chapter subheadings. Surely, every chapter should be started with a content page listing the subheadings? Where is the section on palliated ± repaired cardiac lesions in older children? Was it in Chapter 18 and I just missed it? I searched for it in the index, but could not find it. Other subjects adding to the bulk of this book were repetition of basic and advanced cardiopulmonary resuscitation (something you cannot get enough of?), and sections on diagnostic cardiac catheterization. Some chapters had superb graphics, flow charts, photographs, Tables and lists, while others unexpectedly had none. That fact, coupled with the lack of a Table of subheadings, made these particular chapters seem like a morass of text. In the middle of the night, I might well feel like I was wasting my time searching for anything there. Greater consistency would be greatly appreciated.
Overall, this is still the all-inclusive text that it ever was. Those at the outset of their career in paediatric anaesthesia will find it invaluable with its structure based around paediatric pharmacology and physiology, although I feel it may have somewhat limited use come examination time - that absence of subheading lists again. Some will undoubtedly find the order and content of some chapters confusing, but I think this just reflects its North American origins. For example, malignant hyperthermia makes a big and early impact on the chapter on heat disturbances, while thermoregulation and heat balance are left to bring up the rear.
Unlike in 1983, there is now a competitive market in paediatric anaesthesia textbooks. Weighing in at 2.5 kg, this is a sizeable baby. The hand of the Editor could have been more obvious. There seemed to be bonus marks for the number of references in many of the chapters. We all like to see the seminal papers listed, but some of the old references cannot be considered as such. In contrast, other chapters had excellent up-to-date lists. I think we are all expecting the appearance of websites in the reference lists - something for the fifth edition?
C. G. Hill