Pediatric Sedation Outside of the Operating Room: A Multispecialty International Collaboration K. P. Mason ( ed.) Springer, September 2011, ISBN 978-0387097138, 518pp., Price £67.99
Sedation is a subject that most anaesthetists feel they should know about but few are practised in. It is an art form no better exemplified than in the challenges of the paediatric population. This book is therefore a welcome addition to the literature as it provides a thorough summary, in a little over 500 pages, of the challenges and solutions available to us.
We start with a well-illustrated history chapter that describes the surprisingly (to me!) deep and long history of sedation practices going back more than 4500 years. This is followed by a physician’s perspective of procedural sedation that is a little brief. A very much US-based summary of safe sedation policies is rounded off by only a brief paragraph alluding to international standards.
Scales and discharge criteria are dealt with thoroughly. The ensuing chapters on anatomy, physiology and pharmacology will be second nature to most anaesthetists but are worthy of recall. In particular, there are a couple of worked examples on children with OSA and a mediastinal mass that are very useful. This is followed by a highly detailed and challenging pharmacology section.
The chapter on billing and reimbursement is very much relevant to the US market but not as pertinent to other health care systems. However, as the public purse is squeezed tighter, these may gain more relevance to the UK. Running a sedation service in a paediatric hospital, based on the editor’s own experiences in Boston, is interesting and well written but again relies heavily on an American model of nurse anaesthetists.
Different areas of the hospital (intensive care, gastroenterology, emergency department) are dealt with in separate chapters with that on intensive care being particularly well and comprehensively described and referenced. Again, worked examples are the jewel in the crown in the emergency department section. There is some repetition in these chapters, particularly in the descriptions of pharmacological agents.
The claim in the title of the book to be international is largely justified by chapters 17 and 18 that tell of the European and developing world experiences.
We end with chapters on such wide-ranging subjects as drug development and acupuncture and an infusions chapter that I can’t help but feel would have sat better with the earlier pharmacology section. Of great interest is the chapter on benchmarking of adverse events that is the future of excellent service development.
In summary, this is a thorough and well informed text, largely from a US perspective, that allows novice and experienced anaesthetists alike to develop and help form a safe and effective paediatric sedation service.