Smith's Anaesthesia for Infants and Children

Abstract

Every department of anaesthesia has a collection of reference textbooks or bench books where unusual cases can be found, normal practice can be confirmed and those unfamiliar to a speciality area can brush up their knowledge usually prior to a teaching session or an exam. Previous editions of this book are the reference paediatric tome for many departments and this seventh edition comprehensively covers the subject. It comes with a DVD tucked into the back cover. I shall review the two individually. The book has 36 chapters by 73 authors, all North American. Each chapter is laid out in an unsurprising manner of basic principles, general approaches, specific surgical problems and a fourth section entitled ‘Associated Problems with Paediatric Anaesthesia’. Within the basic principles sections are thorough reviews of respiratory and cardiovascular physiology. A very practical chapter on fluids and electrolytes with numerous helpful summaries of specific problems follows, then a comprehensive review of pharmacology and finally a chapter on temperature regulation. It is difficult to know why this last subject was singled out for its own chapter. It is certainly important, but so are subjects such as neuromuscular physiology or glucose and the pituitary-adrenocortical axis. The general approach section covers psychology, preoperative assessment and medication, equipment. In this third section, I hoped to find a discussion of cuffed versus uncuffed tracheal tubes but was disappointed. Monitoring the level of consciousness also disappoints rating a mere two paragraphs, in this, a modern textbook. The next chapter on induction of anaesthesia has some old-fashioned ideas e.g. rectal thiopentone, some old photographs and repeats much of the equipment chapter. The intra- and postoperative management chapter repeats parts of the equipment, fluid and pharmacology chapters. Some two pages cover pain management in this section as does a subsequent 15-page chapter. This chapter on pain management is authoritatively written and comprehensive, covering acute and chronic situations. The regional anaesthesia chapter is well written and well illustrated but this makes the two pages on local anaesthetics in the pharmacology chapter redundant. The third section on specific surgical problems is wide-ranging, starting with a fascinating chapter on foetal surgery, the standard neonatal chapter follows with only two paragraphs on the premature infant and nothing on the non-operative management of gastroschisis. To me, whose practice does not include cardiac surgery, the CVS surgery chapter is clear and accessible and is followed by a systematic review of all other sub-surgical specialities. Within the section is a chapter entitled ‘Office Based Paediatric Anaesthesia’, which gives an interesting insight into North American practice. A long chapter on trauma has all of the author's favourite gory pictures and a photograph purporting to show manual in-line stabilization with no attempt to stabilize the shoulders or torso. The final section covers malignant hyperpyrexia, systemic (medical) disorders, cardiopulmonary resuscitation, safety and history. Altogether this is a huge book made more so by chapters having up to nine pages of references and much duplication of information. Some of the information will prove useful on a day-to-day basis, some occasionally for reference and some little more than a curiosity. Some information, such as the basic life support protocol, is already out of date. The DVD points the way forwards for textbooks of the future. In practice, this ran easily on my 4-yr-old PC and will apparently run on a Mac as well. The DVD has a single user licence. It opens to a contents page outlining the seven sections: airway, CVS disease, trauma, regional anaesthesia, general surgery and syndromes with a further miscellaneous section. There are some excellent slides and video clips on this DVD, all slides can be downloaded in .jpg or .pdf format. I would highlight the airway section (particularly the authors' method of preventing mouth breathing during fibreoptic intubation) and the collection of anatomy and practical pictures in the regional anaesthesia section. If you did not see enough gory pictures in the trauma section of the book they are here again, this time in colour. The paediatric syndromes section covers the more commonly encountered problems and the surgery section shows videos of several operations. Both sections are quite useful for consultants but very useful for trainees. This size of images is somewhat limited and the lighting in some is less than excellent but nonetheless this is a marvellous way to explain much of paediatric anaesthetic practice and will form an outstanding educational resource.