Pediatric Pain Management and Sedation Handbook (1998)

Pediatric Pain Management and Sedation Handbook., M. Yaster. St. Louis, MO: Mosby-Year Book, 1997. ISBN 0-8151-9516-8. 600 pp., $36.95. The Pediatric Pain Management and Sedation Handbook is a paperback reference book intended for a broad audience, i.e., all clinicians responsible for the management of painful conditions or sedation for painful procedures in children. The editors' objective was to consolidate the vast knowledge acquired over the last decade on the subject and to present it in a concise, practical, and portable format. The editors are recognized experts in this field and have sought the expertise of 33 contributors from diverse pediatric subspecialties to assemble this comprehensive work. Although the editors may have pushed the concept of portability to the limit (the handbook's dimensions are 4[prime] x 6 3/8[prime] x 1 3/8[prime] and it weighs 15.5 oz), they have successfully achieved their goal of producing a useful handbook. The book is divided into six sections and 31 chapters and is written in an outline format. The chapters overlap somewhat (e.g., Figures 3-1 and 15-5 and Figures 5-3 and 13-4 are identical) but are otherwise well written. Some of this overlap may be unavoidable, allowing the reader to pick up the book and check the authors' recommendations on a topic without having to flip through multiple sections. The authors have made liberal use of figures and tables to emphasize and summarize important information. Numerous algorithms that depict a logical approach to the management of various problems that may be encountered by clinicians caring for pediatric patients in pain are provided. The management of dysesthetic pain Figure 5-1), the management of opioid-induced side effects Figure 6-4), and the management of drug-induced respiratory depression Figure 23-2) are superb examples of the effective use of algorithms. The quality of these visual aids is uniformly excellent. Section 1, the management of acute pain, is the largest section, with chapters on pain assessment, the pharmacology of analgesic agents (including nonsteroidal antiinflammatory drugs, opioids, opioid antagonists, local anesthetics, and adjuvant analgesics), techniques for providing analgesia (IV patient-controlled analgesia, epidural analgesia, and peripheral nerve blockade), and techniques for transitioning patients from one therapy to another. Unfortunately, the pain assessment chapter does not discuss how to incorporate disparate pain evaluations from different caretakers into a cohesive treatment plan or how to move from a place on a pain scale to effective therapy. Section 2 addresses the management of a variety of challenging problems. Neonatal pain management is outlined especially well in this section. Also included in this section are recommendations for the management of pain in neurologically impaired children; the management of pain secondary to pancreatitis, mucositis, and burns; and entire chapters devoted to headache, recurrent abdominal pain, neuropathic pain, and pain management for the terminally ill child. Some would question the use of bretyllium Bier block to confirm the diagnosis of complex regional pain syndrome, but this is probably a reflection of the authors' personal practices. Sections 3 and 4 are devoted to the sedation of children for a variety of procedures. The discussion of NPO status for procedures in the emergency room is vague, perhaps because of the lack of data about the actual risk of aspiration in the emergency room setting and the wide range of actual practice. Section 5 is a formulary of the drugs described in the earlier sections of the book for the management of pediatric pain and sedation and is complete, except for the absence of clonidine. Section 6 is a compilation of appendices, including samples of pain assessment forms, a variety of sedation documentation forms, and Current Procedural Terminology codes for common procedures performed in caring for children with painful conditions. In summary, this handbook contains a wealth of information for physicians who frequently or occasionally manage painful conditions in children or who provide sedation to children for a variety of procedures, and it would be a useful addition to their reference library. The information is provided concisely, in an outline format, and is reinforced with numerous well designed figures, algorithms, and tables to facilitate understanding. Unfortunately, this book will increase laundry bills, as pain management rounds will have to be made wearing lab coats so that this book can be readily available. John B. Rose, MD David E. Cohen, MD Department of Anesthesiology and Critical Care Medicine; Children's Hospital of Philadelphia; University of Pennsylvania; Philadelphia, PA 19104