James C. Eisenach, M.D., Editor
Pediatric Cardiac Anesthesia, 3rd Edition. Edited by Carol L. Lake. Stamford, Connecticut, Appleton and Lange, 1998. Pages: 698. Price:$145.00.
This is the third edition of the multiple-authored text edited by Carol Lake, M.D., concerning anesthesia and postoperative care of pediatric patients with congenital heart disease. In the 5 years since the second edition, pediatric congenital heart surgery and anesthesia have continued to advance rapidly, which makes a new edition of this text beneficial and timely. The textbook contains 27 chapters contributed by many distinguished faculty with clinical and research expertise in pediatric patients with congenital heart disease. By having a variety of authors from different institutions, one avoids the tendency of some textbooks to become a manual of institutional preferences for care of patients. This textbook provides the reader with a well-balanced, readily available source describing perioperative care of a diverse and complex group of patients and an extensive collection of references for additional reading. The textbook may be separated into three parts: introduction to the general aspects of anesthesia for pediatric congenital heart patients, defects of congenital heart disease, and postoperative care of pediatric patients after congenital heart repair.
After a brief history of congenital heart surgery from its inception until the present by the editor Carol Lake, M.D., the next three chapters review basic pathophysiology of congenital heart disease and fetal and neonatal development and function. Chapter 4, by Kathleen Chance, M.D., F.A.A.P., is an excellent description of fetal and neonatal circulation and cardiac function, electrophysiology, and ultrastructure of the myocardial cell. It provides a good foundation of the basic principles of perioperative care of the pediatric congenital heart patient. A valuable addition to the textbook is a chapter by Jeanny K. Park, M.D., on pediatric cardiac electrophysiology, which reviews basic electrophysiology. A later chapter describes electrophysiologic procedures performed in the catheterization laboratory to treat certain arrhythmias, such as Wolff-Parkinson-White syndrome, in more detail.
Chapter 8, by Roger A. Moore, M.D., on the preoperative evaluation and preparation of the pediatric congenital heart patient, appears earlier in the textbook compared with the second edition, which is an example of the third edition's improved organization. I highly recommend this chapter to any anesthesia student who will be exposed to pediatric patients with congenital heart disease. It describes the basic principles that are important to understand the anesthetic considerations of these patients. The next chapter, pediatric pharmacology, is a very thorough and well-organized review of the most recent volatile and intravenous anesthetic agents and muscle relaxants most often used for anesthesia of these children. Although the next chapter in the textbook, anesthesia for cardiac catheterization and electrophysiologic studies, is excellent, perhaps it could have been more closely aligned with an earlier chapter on cardiac electrophysiology. The appearance of this chapter seems to interrupt the flow of the book. The chapter on monitoring of the pediatric cardiac patient now includes a small section on hemostasis monitoring, which nicely leads into one of the best chapters in the book-extracorporeal circulation and circulatory assist devices. This chapter is another “must read” for the anesthesia student. An array of complicated topics involving cardiopulmonary bypass are succinctly described, including management of coagulation, transfusion therapy, and modified ultrafiltration. The section on modified ultrafiltration is particularly welcome because it has proven to be a real advancement in the care of the infants after congenital heart repair. A section of this chapter outlining future trends in pediatric cardiac surgery helps create additional interest in the subspecialty. The final chapter, related to general topics of pediatric cardiac anesthesia, is myocardial preservation. It is a detailed chapter, which may be more suitable for someone with a special interest in pediatric cardiac anesthesia but may be too involved for the general anesthesia student rotating through cardiac anesthesia.
After the introductory chapters, the remaining 250 pages of the textbook are devoted to specific congenital anomalies. They are presented in a similar manner as in the second edition. Each topic concerning a congenital cardiac defect is divided into subsections: anatomy, pathophysiology, natural history, diagnosis, anesthesia and perioperative management, and surgical technique. These chapters are informative but are not intended to be an exhaustive description of the congenital defect. The focus is more clinically oriented. The chapter on transposition of the great vessels is outstanding. The chapter on pulmonary valve and circulation includes an excellent section on pulmonary hypertension with an update on nitric oxide. The anesthetic management of patients for Fontan surgery is particularly informative. The chapter on aortic valve and arch disorders presents interrupted aortic arch and truncus arteriosus in superb fashion. The chapter on pediatric transplant will be useful to review before a transplantation or a non-cardiac procedure in a previously transplanted patient. A new feature at the end of the congenital cardiac defect chapters is a brief summary of important aspects of the specific defect just described. These summaries are good reviews for the anesthesia student or a ready resource for the practicing clinician. Further, these summaries are quick, organized reviews of congenital heart disease for written or oral board examinations.
Another strong part of this third edition involves the chapters on postoperative care of the pediatric congenital heart patient, which have been expanded to three chapters. The first chapter of the three, by Jeffrey Holz, M.D., is a generalized overview of the intensive care unit particularly related to identification of problems. The next chapter deals more specifically with the pathophysiology processes within the intensive care unit, such as low cardiac output tamponade. The final chapter focuses on respiratory management. Although there is some overlap, all three chapters are excellent with extensive references.
This textbook will be an excellent addition to the library of any anesthesia student or practicing clinician who may care for a pediatric patient with congenital heart disease either in a cardiac or, more importantly, in a non-cardiac situation. A strong point of the book is that it is written without such great complexity and detail that the reader without an extensive background in pediatric cardiac surgery can benefit from the text. It should be required reading for anyone participating in a cardiac fellowship or rotating in the pediatric cardiac intensive care unit; however, only selective chapters are necessary for anesthesia students with greater interests elsewhere.
William C. Oliver, Jr., M.D.
Mayo Clinic; Department of Anesthesiology; 200 First Street SW; Rochester, Minnesota 55905
(Accepted for publication September 23, 1998.)