Anesthesia and Pain Management for the Pediatrician. (2001)

Wake Forest University School of Medicine, Winston-Salem, North Carolina. dririe@wfubmc.eduAnesthesia and Pain Management for the Pediatrician. Edited by Lynne R. Ferrari.Baltimore, The Johns Hopkins University Press, 1999. Pages: 224. Price: hardcover, $55.00; paperback, $22.50.Douglas G. Ririe, M.D., Wake Forest University School of Medicine, Winston-Salem, North Carolina. dririe@wfubmc.eduThis book provides a broad spectrum of information related to the issues facing providers, families, and patients with respect to understanding of and preparation for surgical procedures. As such, this book is a powerful resource for integration of the family, the child, and the primary care provider into the surgical process. The editor, Lynne Ferrari, M.D., is from Boston Children’s Hospital. All contributors are from the United States and are considered experts in the field of perioperative health care for children.Initially, a fair amount of discussion about the primary care provider “clearing the child for surgery” is presented. This has been used for quite some time, and it probably should be abandoned because it should be the job of the anesthesiologist, as a perioperative physician, to “clear” the patient for surgery. However, it is important to provide information to our colleagues about understanding what it takes to “clear” a patient. This goal is accomplished by this book. Specifically, this entails information to provide an understanding of when and what laboratory tests are required; NPO status, guidelines, and rationale; help in discussing information and risks; potential identification of appropriateness of particular procedures, such as parent-present inductions; and providing old records and insight into chronic problems. As such, this book provides an excellent treasure for care providers who are not directly involved with patient care during the surgical procedure.The trends and practices in the anesthesia section provide a cursory overview of anesthetic agents, including inhalation anesthetics, intravenous anesthetics, muscle relaxants, local anesthetics, and analgesics. A discussion of monitoring is provided also. Although brief discussions of rare but significant anesthesia-specific events, such as malignant hyperthermia and halothane hepatitis, are offered, a more extensive discussion would be beneficial because the nonanesthesiologist may see these sequelae in consultation or follow-up visits. Unfortunately, this book gives little attention to the airway. Greater coverage of perioperative airway management and considerations would help the main care provider to recognize airway concerns that may have a major impact on the care of the child.The special consideration section provides insight into the perioperative care of children with both acute and chronic illnesses. This section is well-written and includes problems such as upper respiratory illnesses, asthma, chronic upper airway obstruction, murmurs, formerly premature infants, and others. I believe this section emphasizes understanding of these problems and their impact on anesthetic and surgical management. Integrating the principal care provider into the evaluation of these illnesses and the patient’s physical status before surgery can play a beneficial role in improving care for children. In particular, this emphasizes that although a note of clearance from the pediatrician is beneficial, the availability of old records or notes defining the scope and course of the patient’s illnesses helps the anesthesiologist to understand the full spectrum of the child’s illnesses during a brief period.If every pediatrician were to read this book, I believe care of the child in the perioperative period would be improved vastly. Furthermore, I believe that the value of this book is such that an adult complement should be written, and every internist should read it and understand it as well.