Regional Anesthesia in Infants, Children, and Adolescents

Abstract

Regional Anesthesia in Infants, Children, and Adolescents, Bernard Dalens. Baltimore: Williams & Wilkins, 1995, ISBN 0-683-09653-2, 511 pp, $105.00. Regional Anesthesia in Infants, Children, and Adolescents contains 19 chapters and provides both basic science review and clinical detail on the application of regional anesthesia in this age group. The first three chapters provide a background in the areas of anatomy, pain physiology, and pharmacology with a focus on the pediatric patient. The balance of the book is devoted to the discussion of indications for regional anesthesia and detailed descriptions of specific regional and local nerve blocks. This text is an excellent English translation of a book originally published in French. It represents an expansion of the outstanding chapter Dr. Dalens wrote for the 3rd edition of Miller's Anesthesia text. The stated goal of this text is to "demystify" regional anesthesia in pediatrics. To this end, the first three chapters provide a detailed but not exhaustive discussion of the scientific basis for regional anesthesia. The pharmacology section emphasizes potential toxic effects of the various agents in different age groups. American nomenclature is used and toxic doses are cited. Unfortunately (as is the case throughout the text), the Table providingtoxic dose ranges is not well referenced. Other chapters involving the anatomy and physiology of the nervous system provide an excellent basis for the discussions of specific blocks that follow. The 4th through 19th chapters contain detailed descriptions of each regional block and some local anesthesia techniques. These are surprisingly easy to read for a text that has been translated. Each technique is described in adequate detail and several approaches are included for most standard blocks. The text covers virtually all blocks that would reasonably be attempted in pediatric anesthesia practice. In addition, there are extensive chapters devoted to head and neck blocks that are rarely used even by the most experienced pediatric anesthesiologist. A description of possible complications and an analysis of the risk/benefit ratio for each block is included at the conclusion of each chapter. Unfortunately, there are several instances where the complications cited are debatable (e.g., delayed micturition for caudal blocks). Some of the references provided are quite dated. The accompanying illustrations consist primarily of black and white line drawings that are marginally helpful. Color plates such as those that precede the Dalens chapter in Anesthesia are a glaring omission. Most importantly, while the practice techniques described are certainly at the leading edge of current pediatric anesthesia practice, they reflect the current state of the art in western Europe. The techniques and observations do not always match practice patterns in the United States (e.g., ketamine infusion cited as a primary treatment for bronchospasm). In general, the format of the book works well, providing both a scientific basis for regional anesthesia and "road maps" for its practical execution. The book will prove a useful addition to the library of the pediatric anesthesia practitioner, especially those with a strong interest in regional blocks. Joseph P. Cravero, MD Departments of Anesthesia and Pediatrics Dartmouth-Hitchcock Medical Center Lebanon, NH 03756-0001 Linda J. Rice, MD Department of Anesthesiolog All Children's Hospital St. Petersburg, FL 33701