A Practical Approach to Pediatric Anesthesia.

Abstract

Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan. onafiu@med.umich.eduA Practical Approach to Pediatric Anesthesia. Edited by Robert S. Holzman, M.D., Thomas J. Mancuso, M.D., and David M. Polaner, M.D. Philadelphia, Lippincott Williams & Wilkins, 2009. Pages: 690. Price: $87.00.The science and art of pediatric anesthesia continues to expand at an almost relentless pace with new developments and innovative surgical procedures in the smallest of children, including those yet unborn (fetal surgery). Therefore it is a daunting task to produce a book on pediatric anesthesia that is both comprehensive and easy to carry around as a quick reference. I think the authors/editors of this book have wisely chosen a safe middle ground.A Practical Approach to Pediatric Anesthesia is a new paperback textbook on the subject of pediatric anesthesia with contributions from several well-known names in the specialty. The book is divided into 4 sections and has 37 chapters of varying length and breadth. Like all pediatric texts, the editors used the first section to highlight the uniqueness of the pediatric patient regarding to physiology and pharmacology. This section also contains a rather complicated (vide infra) discussion of fluid and electrolyte therapy, which is critical to the perioperative management of the pediatric patient.The second section is a short discussion of the operational aspects of pediatric anesthesia. The authors have covered topics from pediatric anesthetic equipment to general perioperative care of children. Regarding the latter, they have included an extremely well-written chapter on pediatric pain management. This section concludes with some practical tips on pediatric operating room management and a brief foray into quality assurance and quality improvement.Section three of this book is justifiably the longest, because it is an organ system-based discussion of anesthesia care for the pediatric patient. The approach is a head-to-toe format, beginning with central nervous system normality and abnormality. Each chapter begins with a short discussion of embryology and progresses to cover physiology and then clinical and pathologic correlates of interest to the clinician. Some may find this approach of “basic science to mask-vent-tube” a bit daunting, but the authors have deftly explained how biocellular derangements can impact anesthetic care. For example, the chapter on cardiovascular system explains the embryogenesis of Tetralogy of Fallot as being a result of “abnormal trunco-conal septation,” making it easy to grasp the reasons for right ventricular outflow tract obstruction and hypertrophy, overriding aorta and high ventricular septal defect. The anesthetic implications of avoiding increases in pulmonary vascular resistance from hypoxia, preoperative anxiety, “Tet spells,” and other reasons are all easy to visualize after reading the introductory pages. This section on systemic anesthesia is packed full of nuggets of information that will be useful to anesthesia trainees, nurse anesthetists, and anesthesiologists.The fourth and final section of this book discusses special situations in anesthesia. It begins with a chapter on fetal surgery, a subspecialty that is becoming increasingly relevant with the steadily growing number of fetal surgical interventions being performed. The section continues with an incredibly informative chapter on neonatal anesthesia and resuscitation. There is a great chapter on anesthesia for the preterm, very-low-birth-weight infant that highlights several problems peculiar to these smallest of all patients. This chapter is packed full of practical tips including choosing the right electrocardiogram leads, selection and placement of blood pressure cuffs to avoid bone fractures, and careful attention to thermometry and thermoregulation.Even though this is an excellent text for both residents and pediatric anesthesia practitioners, it does leave itself open to some criticisms. After reading the first two chapters of the book, my first response was to put it down with a vow never to continue. Getting through the “philosophy of oxygen consumption,”“surface law,” and “allometric scaling” in a chapter that was supposed to be discussing practical fluid and electrolyte management was a bit tedious. For a purported practical textbook, I thought these first two chapters were rather “heavy.” However, the more I read of the book the clearer it became that one cannot judge a book by its first two chapters. It may be prudent to revise these chapters in future editions of the book. I also thought the single paragraph discussion of ultrasonography was rather limited. It is obviously impossible to cover all aspects of pediatric anesthesia in a mid-range book like this. Still, a chapter on pediatric ultrasound for vascular access and regional block would have been useful, given the increasing popularity of this tool.In conclusion, this is a well-bounded, well-written book with extensive up-to-date references that many who take care of children will find useful both as a portable reference for the operating room and as a quick desktop consult. This is a good mid-range pediatric anesthesia book that should grace many departmental and personal libraries.Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan. onafiu@med.umich.edu