Anesthetic Management for the Pediatric Airway

Abstract

At first glance, a book titled AnestheticManagement for the Pediatric Airway: Advanced Approaches and Techniques would appeal only to anesthesiologists caring for children with complex airway pathology or undergoing airway surgery. However, as airway management issues can occur unexpectedly, a book on this subject should be suitable to all anesthesiologists caring for children. The book is the first edition and was published in 2019 by Springer Nature, Switzerland AG, and edited by Diego Preciado (Professor of Otolaryngology) and Susan Verghese (Professor of Anesthesiology and Pediatrics)—both at the Children’s National Health System and George Washington University, DC. All authors, including pediatric surgeons, are based in the United States from institutions across the country. The inclusion of international experts may have broadened the scope of the book. The book consists of 18 chapters that encompass both anesthesia and surgery of the pediatric airway, including chapters on airway reconstructive surgery, extracorporeal membrane oxygenation (ECMO), preoperative considerations, and management of children with preexisting airway pathology. There is an accompanying eBook edition (not reviewed) and an advertised “Extras Online,” which we were unable to obtain. Unlike most books relating to airway management, this book is specific to pediatric anesthesia, and we are unaware of a comparable text. There are a number of excellent chapters covering areas of pediatric airway management that provide the reader with a comprehensive overview of the subject matter. Chapter 5 deals with anesthesia for endoscopic airway surgery, chapter 12 describes the management of airway trauma, and chapter 13 deals with the implications of the increasing number of obese children having airway surgery. There is also a comprehensive overview of airway pathologies (chapter 3) that could occur in any child attending as an emergency in nonspecialized pediatric centers. The heterogeneous nature of any pediatric population requires a dedicated chapter on neonates, and the specific anesthesia and surgical factors unique to this patient cohort are discussed in chapter 6. Chapters 4 and 7 are general content chapters describing anesthesia care for routine surgeries (eg, tonsillectomy) and the broad principles of difficult airway management. Both chapter 11, “Anesthetic Management in Emergent Pediatric Foreign Bodies," and chapter 7 would benefit from images of normal pediatric anatomy, the relevant pathology, and the type of equipment required. This paucity of images and figures is noticeable in many chapters; for example, the chapter on ECMO (chapter 14) would benefit from a labeled schematic figure. Their inclusion would also break up the large, text-only sections in many chapters. Current clinical concerns in pediatric anesthesia (eg, opioid complications and neurotoxicity), particularly in the younger age group often requiring airway-related surgery, are well described. The adverse effect of opioids on respiratory function is well known, and we felt that the inclusion of a complete chapter on opioids was unnecessary. Additionally, although opioid-sparing regimes are mentioned, specific pharmacological options such as alpha-2 agonists or ketamine use are not explored in this chapter. There are a number of ongoing prospective trials investigating neurotoxicity in children. Despite its importance, this topic could be covered, in the setting of airway anesthesia, in a general fashion under the headings of the “Current Controversies in Anesthesia” (chapter 1). We found a number of issues with the book both in terms of structure and content. The Table of Contents’ layout has no subsections, leaving the reader with uncertainty as to whether each chapter can be read on its own or must be read in conjunction with the broader topic chapters. Overall, there is excess content with significant repetition of certain themes. For example, preoperative assessment is covered in chapter 2 but is repeated in many other chapters, often in as much detail (chapter 8). A number of discrete chapters overlap significantly with others and improved editing could have resulted in the amalgamation of some. We found that the History section in chapter 1 was very interesting; however, a more concise and specific history of airway anesthesia would suffice. This book was reviewed by an experienced airway and pediatric anesthesiologist and anesthesia residents. Our opinions were that the chapters’ layout and repetition made the book uninviting to read and the addition of more diagrams and illustrations would have made the large sections of text more appealing, especially to residents. These issues combined with a listed price of $149.99 prevent us from recommending the purchase this book for the general reader. Anesthesiologists specializing in this area may benefit from having a single comprehensive resource available on the topic. Stephen Mannion, MD, MRCPI, FCARCSIDepartment of AnaesthesiologySouth Infirmary Victoria University HospitalCork, IrelandSchool of MedicineUniversity CollegeCork, Ireland[email protected] Kirsten Joyce, MB, MCAIKieran Crowley, MRCPI, MCAIDepartment of AnaesthesiologySouth Infirmary Victoria University HospitalCork, Ireland