Smith's Anesthesia for Infants and Children, 8th ed.

The eighth edition of the classic pediatric anesthesiology textbook edited by Davis, Cladis, and Motoyama bears little resemblance to Dr. Robert M. Smith's original version of this text, which was published in 1959. The differences testify to the vast technological chasm that opened over the 50+ years since the original version of this classic textbook appeared. Even the young children that pediatric anesthesiologists frequently care for are different now compared with 50 years ago (e.g., micropremies, conjoined twins, and congenital heart disease). Furthermore, the scope of problems in which pediatric anesthesiologists are currently involved is far broader (e.g., chronic pain in children, palliative care, critical care, and anesthesia outside the operating room and outside the hospital). Additionally, the techniques available to 21st century pediatric anesthesiologists to enhance patient safety and comfort (e.g., transesophageal echocardiography, ultrasound-guided nerve blocks, and new hypnosedative drugs for total IV anesthesia) represent major advances over what was available to Dr. Smith and his colleagues in the mid-20th century. Only a textbook that is broad in scope would be capable of capturing the important developments in pediatric anesthesia practice over the last 50 years. Peter Davis and his coeditors sought to maintain Dr. Smith's original emphasis on the “personal approach to patients,” as they stated in their preface, and on the primacy of patient safety considerations, while presenting new and updated information in both a highly accessible hardcopy format and in a digital format managed by Expert Consult (a division of Elsevier Ltd.). The editors have organized a large body of information into a cohesive textbook containing 42 chapters by 91 expert contributors covering more than 1300 pages, as well as extensive supplemental digital material found on the Expert Consult website. The textbook material is extremely detailed—even more detailed than a general anesthesiologist or a resident (who is not considering a career as a pediatric anesthesiologist) might consider necessary. The textbook is written as an authoritative, encyclopedic resource book on pediatric anesthesiology. As a result, its content and utility seem directed more toward pediatric anesthesiologists and pediatric anesthesia fellows who are preparing for a subspecialty qualifying examination, as well as for senior anesthesia residents rotating through a pediatric anesthesia service in a large tertiary (or quaternary) medical center. The major disadvantage of this method of presentation is that much of the more general material, such as pharmacology principles and fundamentals, cardiac and respiratory physiology, and neurophysiology, found in this volume can also be found in the many general anesthesiology textbooks available to anesthesia trainees and practitioners. Some of the unique features of the textbook include a very detailed and copiously illustrated chapter (and accompanying digital material) on pediatric anesthesia equipment by J.E. Fladjoe, J.M. Feldman, and D.E. Cohen; a chapter on regional anesthesia by A. Kinder Ross and R.B. Bryskin with still photos and videos of many frequently used peripheral nerve blocks archived in the online digital resource; and chapters specifically on anesthesia for fetal surgery, pediatric dentistry, procedures outside the operating room, same-day (ambulatory) surgery, and office-based surgery. In addition, review questions and an answer key are provided for most chapters in the online content. In other respects, the book provides a standard presentation of material relevant to the practice of pediatric anesthesia. For example, the authors applied approaches used in other large, general texts such as Miller's Anesthesia and Nelson's Pediatrics, to the task of describing the field of pediatric anesthesiology. As might be expected in a discipline with a limited pool of recognized experts, several authors contributed chapters to both this textbook and to A Practice of Anesthesia for Infants and Children, the other recently published major pediatric anesthesia textbook (edited by Coté, Lerman, and Todres), including Drs. Keira Mason, David Polaner, Allison Kinder Ross, Gregory Hammer, and Myron Yaster. The online material consists of the text itself; still photos, drawings, and graphs; and video material to supplement the descriptions found in the text. Videos are available depicting airway management including fiberoptic intubation and insertion of a bronchial blocker, interesting surgical procedures (including laparoscopic pyloromyotomy, laparoscopic gastric volvulus reduction, and liver and small bowel transplantation), management of pediatric trauma cases, congenital heart disease syndromes, and pediatric regional anesthesia. The functioning of the video image library was temperamental; some videos downloaded, others did not, and for some, only the audio portion played. This is a problem with the Expert Consult site itself, and does not detract from the overall quality of the textbook. The videos that were available were of good quality and instructive. The question that arises with the availability of 2 major comprehensive pediatric anesthesia textbooks is: If the practitioner wants to purchase only 1 textbook on pediatric anesthesia (given the high price tag on both), which would be the better choice, Smith's Anesthesia for Infants and Children or A Practice of Anesthesia? Overall, the former is less smooth in style and a bit choppier in presentation than the latter, but the quality of the writing is high in both textbooks. Smith's Anesthesia is list priced at $229.00 and A Practice of Anesthesia is listed for $189.00. They are published by different divisions of the same publisher, Elsevier (Mosby/Elsevier for Smith's Anesthesia and Saunders/Elsevier for A Practice of Anesthesia). Smith's textbook has several chapters unique to pediatric anesthesia textbooks that are well written and very detailed. The emphasis on tertiary care pediatric anesthesia is evident from, for example, chapters on cardiac anesthesia that are long enough to warrant a separate volume themselves (>100 pages), but a single, far shorter chapter (25 pages) on anesthesia for otolaryngologic surgery, for example (which anesthesiologists may encounter more frequently in all practice settings), and only 19 pages on ambulatory (same-day) surgery, which covers the bulk of the typical pediatric surgical caseload in most centers. Because both textbooks are available in digital format for easy carry-along access via an e-book reader, the bulky textbook presentation is not an issue. In summary, this reviewer would recommend the new edition of Smith's Anesthesia for Infants and Children for career pediatric anesthesiologists (and general anesthesiologists with a large pediatric component) and for pediatric anesthesia trainees and fellows studying for a specialty qualifying examination. However, A Practice of Anesthesia for Infants and Children would be recommended for anesthesiologists who do not manage children or infants on a regular basis and for anesthesiology residents assigned to basic pediatric anesthesia rotations. Finally, Smith's Anesthesia for Infants and Children should be available to staff and residents in the anesthesia libraries of all major medical centers and training programs. Jay R. Shayevitz, MD, MS Department of Anesthesiology University of Rochester School of Medicine and Dentistry Rochester, New York [email protected]