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Manual of Pediatric Anesthesia: With an Index of Pediatric Syndromes 6th edn J.Lerman, D. J.Steward & C. J.Coté . Churchill Livingstone , Philadelphia , 2009 , ISBN 978-1437709889 , 544 pp . , Price £47.99

The sixth edition of the Manual of Pediatric Anesthesia, over 30 years after the first edition was published, has been developed to be a comprehensive, yet concise, pocket-sized handbook of paediatric anaesthetic practice. The current edition has been extensively expanded and updated, encompassing the latest research and references as well as advances in surgical techniques and recently introduced drugs. Some new chapters have been added: Anesthetic Implications of Syndromes and Unusual Disorders; and Cardiopulmonary and Neonatal Resuscitation, while others have been extensively rewritten.

The manual is divided into two main sections, Foundations of Pediatric Anesthesia and Anesthesia for Specific Procedures, followed by three appendices.

The first section provides extremely readable chapters covering basic anatomy, physiology and pharmacology, specifically geared to paediatric patients. There is also a very interesting and thought-provoking section on the psychology of the parent/child/anaesthetist relationship. There follow two detailed chapters concerning practical procedures and regional techniques, describing basic techniques as well as useful practical tips based on over 100 years of combined experience from the authors. The final chapter in this section, Medical Conditions Influencing Anesthetic Management, covers everything from how to deal with a child with an upper respiratory tract infection to special considerations for children after organ transplant. This chapter is extremely well written, and provides invaluable advice to anyone anaesthetising children in any setting.

The second section deals with anaesthesia for specific operations and is divided into chapters by surgical speciality. This section covers a huge range of procedures, from grommet insertion to Fontan’s procedure, in a practical and straightforward manner. Each condition or procedure is presented with some background information, followed by specific anaesthetic problems that may be encountered and finally a step-by-step guide to managing these cases. The procedures described are very specific, representing what, in the authors’ extensive experience, they consider works best for them.

The main sections are followed by three appendices: Anesthesia Implications of Syndromes and Unusual Disorders gives a brief description and anaesthetic implications of over 300 conditions; Cardiopulmonary Resuscitation, including Neonatal Resuscitation, provides a summary of prevention and treatment of paediatric cardiac arrest, interestingly without the use of any algorithms that are typically seen in such sections; and Drug Doses gives recommended doses for many drugs used in the pre-, peri- and postoperative periods. Unusually for a North American text, these drugs are referred to mainly by their generic names.

The text would definitely have benefited from the inclusion of more diagrams. Apart from a few illustrations in the Regional Anesthesia Techniques chapter, there are almost no diagrams to complement the written descriptions. Generally, the book does not suffer excessively from this due to the excellent and comprehensive nature of the text. However, several sections, especially the Cardiovascular Surgery and Cardiologic Procedures chapter, would definitely benefit from a picture or two to help grasp some of the complex anatomy involved. The layout of the text can also be excessively ‘uniform’, with long blocks of text and few subheadings. It can be difficult to find specific references in these sections, especially those relating to emergency procedures, that should be easy to locate. Treatment of a pulmonary hypertensive crisis, for example, is lost under point 8 of the ‘special problems’ section of the Cardiovascular Surgery chapter.

Overall, this is an extremely well written book that I would recommend highly to anyone involved in anaesthetising children. It is comprehensive enough to provide an excellent reference for trainees and general anaesthetists who occasionally deal with paediatric cases, while at the same time giving valuable supplemental information for paediatric anaesthetists encountering an unusual procedure or condition. In short, this is a book that would make a welcome addition to any anaesthetist’s mobile library.