Manual of Pediatric Anesthesia, 5th edition

Abstract

Manual of Pediatric Anesthesia, 5th edition Steward DJ, Lerman J. New York: Churchill Livingston, 2001. ISBN 0-443-06562-4. 559 pages, $50.00. According to the preface, the fifth edition of the Manual of Pediatric Anesthesia was written and designed to provide a concise, but comprehensive, pocketbook guide to pediatric anesthesia practice. Compared with the 1979 first edition, which specifically carried a disclaimer that it was not a comprehensive text, the manual has grown in size and scope. Many sections have expanded to reflect the evolution of pediatric anesthesiology and pediatric surgical techniques. The chapters dealing with such current issues as pain management, sedation, and anesthesia in areas remote from the main operating room have been expanded. Many new references (as recent as 1999) were added and some old ones considered classic or interesting by the authors were retained. A few (e.g., old abstracts that are now in full paper format or older editions of current texts), however, should have been updated. From a beginning that mostly reflected the practice at the Hospital for Sick Children in Toronto, the manual now reflects the state of the art in North America. The contribution to this edition of Dr. Lerman, an American-trained Canadian anesthesiologist, is evident. Some Canadian bias remains, however. For example, the discussion of the use of succinylcholine in children (page 60) does not include any reference to the US Food and Drug Administration-mandated warning about its elective IV use in children. The authors suggest that the problem of masseter spasm can be avoided by not routinely giving succinylcholine to a patient who is anesthetized with halothane. The manual is divided into two basic sections dealing with “Foundation of Pediatric Anesthesia,” which summarizes basic anatomical, physiological, and psychological aspects of pediatric anesthesia, and “Anesthesia for Specific Procedures,” which covers the whole spectrum of pediatric surgical procedures from myringotomies and division of tongue-tie to liver and heart-lung transplantation. This is followed by three appendices: “Anesthesia Implications of Syndromes and Unusual Disorders,” “Cardiopulmonary Resuscitation, including Neonatal Resuscitation,” and a very useful listing of “Drug Doses.” The latter appendix, however, would have been more useful if the authors consistently gave the common trade names as well as generic names of all drugs. For some reason, we are told that midazolam is Versed, propofol is Diprivan, and meperidine is Demerol; but we are left wondering why metoclopramide, cimetidine, and ondansetron are not given equal treatment. Also, some of the recommended doses in the appendix differ slightly from those appearing in the text. The chapter dealing with “Medical Conditions Influencing Anesthesia Management” is extremely well written, although the recommendations for managing a child with an upper respiratory tract infection are a bit too liberal (the decision to proceed would be up to the parents’ “feeling in the matter”). The section dealing with “Anesthesia for Specific Procedures” contains many useful pearls. It is a “how-to,” step-by-step, very practical guide, and it stresses ways to avoid potential problems in specific situations. The chapter on “Cardiovascular Surgery and Cardiologic Procedures” is well outlined and thorough, but regrettably lacks any illustrations. When one of us was scheduled to walk an anesthesia resident through his first pyloromyotomy case, we gave him the manual and asked him to check out “anesthesia for pyloromyotomy” (pages 293–5). He found a good description of the pathophysiology with an outline of the perioperative management requirements. He read that he should “observe special precautions for neonates.” When he referred to the Index to find the specifics, he could not find them listed. He went to the Table of Contents and, after a thorough thumbing-through, found that Chapter Two (“Anatomy and Physiology in Relation to Pediatric Anesthesia”) contained an excellent review of neonatal physiology. He also read that he should use “rapid sequence induction with cricoid pressure.” He returned to the Index and found no specific mention of the technique. We told him to look up the chapter on pharmacology, which contained a good discussion on the use of different anesthetic agents that can be used for induction, with such practical hints as to not inject rocuronium soon after Pentothal in a small IV to avoid precipitation. For the trainee, the book is easy to carry (considerably smaller than other existing manuals) and has very useful practical information, but could be made more user friendly by better cross-referencing between various chapters. Overall, this manual has a place in the drawer of the anesthesia machine for the general anesthesiologist who wants a ready reference to consult in the operating room. The book would be also recommended as supplemental reading for pediatric anesthesiologists who want to gain an insight into the practice of one of the current recognized leaders in pediatric anesthesia.