Pediatric Cardiac Anesthesia, 4th Edition.  Edited by Carol L. Lake, M.D., M.B.A., M.P.H., and Peter D. Booker, M.B., B.S., M.D., F.R.C.A. Philadelphia, Lippincott Williams & Wilkins, 2005. Pages: 808. Price: $129.00.

This is Carol Lake's fourth edition of Pediatric Cardiac Anesthesia  but the first edition for which she has partnered with Peter D. Booker from the United Kingdom as coeditor, which gives the textbook a fresh, new appeal compared with the 1998 third edition. In addition to a new editor from across the Atlantic, multiple new authors have been added, many from outside the United States, which provides a more international flavor to the book. This includes authors from children's hospitals in the United Kingdom, Ireland, Canada, and Australia.

Carol Lake, M.D., M.B.A., M.P.H. (Former Professor and Chair, Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky), and Peter D. Booker, M.B., B.S., M.D., F.R.C.A. (Senior Lecturer in Pediatric Anesthesia, University of Liverpool, Honorary Consultant Pediatric Anesthetist, Royal Liverpool Children's Hospital, Liverpool, United Kingdom), have also dramatically changed the format and broadened the scope of the book. The text is now logically organized into sections for easier reference. Also, as the field of pediatric cardiac anesthesia rapidly changes, new topics have accordingly been added to the book to address these changes. These new elements include Pediatric Heart Disease in the Developing World (Introduction section); chapters on Intrauterine and Extrauterine Development of the Cardiovascular System (in the Developmental Issues section); a new chapter on Pediatric Electrocardiography and Cardiac Electrophysiology (in the Preoperative Evaluation section); a greatly expanded section of Peroperative Management; an entire multichapter section on Postoperative Care; and a section on Practice Management, which includes chapters on quality improvement and teaching issues.

The opening chapter, although not new, is interesting in that it not only discusses the history of pediatric cardiac anesthesiology, but also looks into the future, which will include the increasing use of cardiac magnetic resonance imaging, the expansion of minimally invasive and video-assisted surgery, new and innovative interventional procedures, new monitoring techniques such as near-infrared spectroscopy, and fetal surgery, and with each of these comes new anesthetic challenges.

I especially appreciated the new chapter on Pediatric Heart Disease in the Developing World, because I have participated in numerous trips to assist emerging pediatric cardiac surgical programs in developing countries. Traveling to these sites to provide safe anesthesia care is such an enormous challenge, and there is so little information about how to prepare, so this chapter is a welcome addition for those readers who wish to help where resources are limited. This is an area of tremendous growth potential, and I hope that this chapter will be expanded in future editions.

Past the introductory section, there are clearly elements of each chapter that have remained the same, although the majority of the chapters have been significantly updated and reorganized. Some organizational changes are confusing: The format of the subheadings in the Pediatric Anesthesia Pharmacology chapter makes for more difficult reading, and some topics are covered in multiple chapters, whereas the subject matter would be more concise if consolidated. Updates seem to be hit or miss in the book: Some chapters seem very current, whereas others seem to be missing information on new technologies.

In section V, Anesthesia for Cardiac Surgical Procedures, most sections have been updated substantially. Some chapters now include genetics information, where applicable. The unique combination photograph/cartoon illustrations in the chapter on Septal and Endocardial Cushions Defects give the reader a better idea of what the lesions are. New chapters on anomalies of the pulmonary valve and right ventricular outflow tract, the tricuspid atresia, the double outlet right ventricle, the truncus arteriosus, pulmonary hypertension and Eisenmenger syndrome, and vascular anomalies and cardiac tumors are all welcome additions. The descriptions of new techniques for treating patients with hypoplastic left heart syndrome are also valuable. As more children with palliated and corrected congenital cardiac anomalies live into adulthood, there will be a growing need to understand more about their special anesthetic requirements, and another new chapter, entitled “Anesthesia for Noncardiac Surgery in Children and Adults with Congenital Heart Disease,” will help all anesthesia providers to care for that unique patient population.

A nice feature that is borrowed from the third edition is the one-page synopses of intraoperative management for the individual lesions at the end of each chapter, which serve as chapter summaries as well as quick reminders/refreshers. These seem virtually unchanged from the last edition but are easier to read because of the different font.

The book is definitely bigger and better than the last edition. The book has nearly 90 additional pages and more references, pictures, tables, and figures. Previous chapters have been split, and expanded in terms of both depth and breadth of content. One minor complaint about the new edition is that it still has the color inserts at the front of the book. The color inserts are of better quality and higher resolution than those in the last edition but correspond to differing chapters and would be more suitable in their respective chapters. Also, one glaring omission in the book is how little information is provided about extracorporeal membrane oxygenation, which is such an integral part of a pediatric cardiac anesthesia practice.

As pediatric cardiac anesthesiologists expand their role outside of the operating room, acquisition of a new set of skills is required. This book addresses that concern, reflected in an added emphasis on perioperative management of these children and management in the catheterization and electrophysiology laboratory, the magnetic resonance imaging suite, and postoperatively in the intensive care unit. Overall, the transformation of the textbook has improved it significantly and provided a valuable resource to anyone caring for patients with congenital heart disease.

Mayo Clinic, Rochester, Minnesota.