Pediatric Procedural Sedation and Analgesia.By Baruch Krauss, M.D., Ed.M., Robert M. Brustowicz, M.D.Philadelphia, Lippincott Williams & Wilkins, 1999. Pages: 321. Price: $37.95.
For most non–anesthesiology-trained healthcare providers, developing expertise in the use of sedatives and analgesics can be difficult. Unless one is in a training program (i.e. , critical care medicine, emergency medicine) that regularly provides the supervision and education necessary, the trainee’s experience is often limited by infrequent encounters, minimal versatility, and a less-than-comprehensive understanding of the issues. Sedation protocols attempt to deal with this by providing dosing and monitoring guidelines to make the process safer, although usually intellectually unsatisfying.
Given these facts and the increasing attention paid to “conscious” sedation, Krause and Brustowicz’s book is timely. Written predominantly by emergency medicine physicians and anesthesiologists, this collaboration provides a concise, easy-to-read overview of procedural sedation and analgesia (PSA) from a pediatric perspective. It is divided into three sections, which discuss basic science (Scientific Foundation), practical sedation and analgesia issues (Principles and Management Strategies), and procedure scenarios (Nonelective Procedures). The Scientific Foundation section devotes two chapters to physiology and nine to pharmacology. These chapters contain the core information necessary to understand the medications used for PSA and their impact. The Principles and Management Strategies section delineates the practical issues that are key to safe and effective PSA. Topics such as presedation and postsedation evaluation, medicolegal aspects, and specific situations (i.e. , trauma patients, transport, and emergency department) are included. The last section, Nonelective Procedures, presents a wide variety of potential PSA situations, divided by region of the body. For example, there are chapters devoted to procedures of the head and neck, chest, abdomen, musculoskelatal tissues, and soft tissues, which also are practically presented, with special considerations identified for each region and procedure. Many of the chapters make good use of flow diagrams and algorithms to offer medication options or to delineate clinical implications.
The book is an attractive azure with a pastel insert, fitting for a sedation text. It has a reinforced soft cover that fits easily in a lab coat side pocket. The binding seems durable, and the print is easy to read on low-glare paper. The chapters are well-referenced and organized in a logical fashion. The index is extensive, with good cross-referencing. The authors and editors have done an excellent job in proofing the material.
No review is complete without a few suggestions for future editions. Uniform summary tables in the pharmacology section would be helpful. Though it would give some redundancy to other parts of the text, it would speed up information retrieval when checking a dose or interaction. Opinions about the book were sought from 10 pediatric residents and critical care fellows. Uniformly, they thought the material would be helpful as they develop PSA expertise. However, they thought that the size of the book would prevent them from carrying it around. One solution is further condensation and smaller print. A better approach might be making a version available for hand-held personal information devices (i.e. , palm pilot) so one could easily pull up an algorithm or checklist.
In summary, this book is a winner. It helps fill a void by combining physiology, pharmacology, and clinical experience in PSA in one neat package. Healthcare providers, particularly those developing patient care expertise, would benefit greatly. More senior individuals could incorporate the text as an educational tool. The $37.95 price tag is more than worth it.