James C. Eisenach, M.D., Editor

Handbook of Neonatal Anaesthesia. Edited by D. Hughes, S. Mathes, and A. Wolfe. Philadelphia, WB Saunders, 1996. Pages: 387. Price:$22.50.

This first-edition handbook is designed to provide a comprehensive overview of scientific principles in providing anesthesia to newborns for routine and complex conditions. The editors anticipate that the text will be useful to trainee and practicing anaesthetists.

The first six chapters highlight neonatal physiology, pharmacology, equipment, and monitoring. The authors succinctly distilled practical, up-to-date knowledge regarding unique considerations of the newborn. Without rewriting the standard knowledge base presented in complete textbooks of anaesthesia, the authors take the already familiar reader from general principles to focus on specifics regarding care of newborns. Physiologic review of principles, practical management, and administration of fluids in the operating room are nicely presented. The chapter regarding the very premature infant contains information duplicated in some other chapters, but is a wonderful discussion of all aspects of concern in management of these extremely challenging infants and can be read multiple times, with new insight to be gained at each reading. Although traditional pediatric/neonatal anesthesia equipment are well covered, the short sections covering high frequency ventilation and nitric oxide administration only mention the existence of this equipment and provide insufficient information to allow an anaesthetist unfamiliar with this equipment to become more comfortable with its use. The discussion of postoperative respiratory management is lengthy and may not be of great interest to anaesthetists not involved in intensive care unit care postoperatively. Discussion of basic principles and performance of regional anesthesia (spinal and caudal) are concise and informative, but descriptions of other regional techniques are sparse. Precautions regarding risks of EMLA are well presented, without being judgmental.

Chapters on specific neonatal surgical conditions and neonatal cardiac surgery are necessarily short, due to the handbook presentation, but offer a wealth of practical information. Multiple methods of anaesthetic induction and maintenance of anesthesia are presented. These are particularly welcome chapters for new trainees, to obtain an overview of a very large field in a short time.

For the experienced clinician, the chapter on problematic intubations is worthwhile, with logical assessment of management and experiential advice. Complementary photographs of challenging situations add nicely to the text.

Pediatric anaesthetists are not frequently involved in interhospital transport of sick neonates in the United States, but this is practiced in other regions of the world. The transport chapter is practical, but does not address dangers that commonly occur during intrahospital transport. This issue, along with the following chapter (a view from developing countries), initiates my only criticism of a conspicuously absent presentation: provision of anesthesia in the neonatal intensive care unit or out of the operating room environment. Anaesthetists have such a large armamentarium of agents now available to them that they need not rely on inhalational anaesthetics. Some mention of provision of anesthesia in neonatal intensive care units, magnetic resonance imaging, or radiology suites, etc., would be welcome.

Overall, although the editors' intentions were to create a handbook, they provided a volume greater than the sum of its parts. The book has easy readability, moderately extensive references, and presents most important topics in care of the sick and routine neonatal patient. All trainees can easily read the text cover-to-cover and be knowledgeable of most issues in their challenging field. Experienced clinicians will be pleased to have a quick synopsis of important points in care of neonates. The text is a welcome addition to most anesthetizing locations, libraries, and practitioners' private references. The value of the book clearly exceeds its stated price.

Joseph Tobin, MD; Associate Professor of Anesthesia, The Bowman Gray School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina 27157.