Pediatric Anesthesia: The Requisites in Anesthesiology. By Ronald S. Litman, D.O. Philadelphia, Elsevier-Mosby, 2004. ISBN: 0-323-02216-2. Pages: 361. Price: $79.95.
Pediatric Anesthesia: The Requisites in Anesthesiology is the newest addition to the Requisites series edited by Roberta L. Hines. This volume is edited and largely authored by Ronald S. Litman, D.O. He draws from his extensive experience as a pediatrician and anesthesiologist at the University of Rochester (Rochester, New York) and Children’s Hospital of Philadelphia (Philadelphia, Pennsylvania). He has designed the text to be a stand-alone reference for anesthesia residents during their core rotation in pediatric anesthesia, as well as an aid in preparation for written, oral, and recertification examinations.
The book is 361 pages in length, with 38 chapters, in eight sections, covering essential topics in pediatric anesthesia. Section I focuses on the physiology of healthy pediatric patients. There is particular attention paid to fetal and infant development, underscoring their unique differences from older children and adults. Section II focuses on pediatric diseases and is organized by organ system. The congenital heart disease chapter offers helpful diagrams for visualizing some important lesions, as well as a useful case discussion regarding the care of an emergency patient with a single ventricle. The respiratory chapter discusses the contentious topic of anesthetizing a child with an upper respiratory infection both by reviewing a frequently cited article on the topic and by providing a case discussion. The chapter also necessarily covers lower respiratory tract diseases. There is special focus on asthma, and further coverage of status asthmaticus in section VIII, the critical care chapter. The oncology chapter provides a clear outline of the principles for anesthetizing a child with an anterior mediastinal mass, in addition to reviewing key articles and providing a case discussion. Rounding out section II are well-written chapters on diseases affecting premature and formerly premature infants. Section III reviews preoperative assessment and preparation. It was curious that the discussion on premedication with midazolam included every route except intramuscular. Although no one really likes to give shots, it can be the most reliable route for premedicating a spirited toddler coming from home.
Section IV covers intraoperative management. There is a wonderfully clear discussion of the dreaded topic of pediatric breathing circuits. There are two chapters on pediatric airway management. The difficult airway chapter, one of the longer chapters in the book, reviews strategies for managing children with either an anticipated or an unanticipated difficult intubation or ventilation. It is well organized and stresses the importance of having multiple backup plans with experienced personnel on hand. In addition to algorithms, there is a clear step-by-step protocol for epiglottitis management, which will aid both practitioners and those preparing for oral examinations. The malignant hyperthermia chapter similarly offers a clear step-by-step protocol for managing suspected malignant hyperthermia patients, as well as highlighting the indications for muscle biopsy testing. Section V briefly reviews a few postoperative considerations. These include: discharge criteria, postoperative nausea and vomiting, stridor, and emergence delirium. In section VI, Drs. Logan and Rose cover the evolving field of pediatric pain management in five chapters of varying depth. Each chapter includes an interesting case discussion, as well as a review of a historically relevant article. The chapters cover pain assessment, analgesia pharmacology, local anesthetics, and adjuvant analgesics, as well as acute pain management and diagnosis and a brief chapter on treatment of complex regional pain syndrome type I in children. The final sections (VII and VIII) cover pediatric surgical procedures, critical care topics, and pediatric anesthesia in nonoperating room locations.
As a whole, the book offers a number of unique features. Most of the chapters have not only an illustrative case discussion for the chapter, but also a review of an “Article to Know” that has shaped pediatric anesthetic practice. Those preparing for oral board examinations will find these features valuable. Visually, these sections are set aside in shadowed boxes to highlight their importance and enhance readability. In addition, the text offers sections titled “Additional Articles to Know.” These are not so-called suggested readings; rather, the authors provide a brief listing of articles that have shaped pediatric anesthesia practice. Interestingly, the text itself is not heavily referenced. This seems to be clearly a stylistic choice, but perhaps future editions might make a complete bibliography available at least on-line.
Like all first editions, Pediatric Anesthesia: The Requisites in Anesthesiology is a work in progress. Dr. Litman’s authorship of a number of the chapters gives the book stylistic consistency and enhances its readability. The text succeeds in being a concise, tightly focused overview of the field of pediatric anesthesia. As such, not all topics receive in-depth discussion. For example, the chapter entitled chronic pediatric pain discusses only one pathology, complex regional pain syndrome type I. This is not so much a criticism as an acknowledgment that challenging pathology and procedures always require deeper investigation from other sources. Still, the reader should walk away with a sense of what is a reasonable standard of care for a variety of pediatric patients undergoing routine procedures.
This Requisites text is a good starting point for those who desire an overview of pediatric anesthesia. It should be extremely helpful to residents doing their core rotation in pediatric anesthesia, as well as those preparing for their oral board examinations. The book is readable, informative, and well written. I highly recommend it.
Northwestern University’s McGaw Medical Center & Children’s Memorial Hospital, Chicago, Illinois. lkbonasera@yahoo.com
