James C. Eisenach, M.D., Editor.

Smith's Anesthesia for Infants and Children, 6th ed. Edited by Peter J. Davis and Etsuro K. Motoyama. New York, Mosby Year Book, 1996. Pages: 999. Price:$125.00.

The 6th edition of Smith's Anesthesia for Infants and Children represents the 2nd edition since the switch to a multi-authored format in 1990. The resuscitative effort of this classic text was carried out in the 5th edition by Peter J. Davis and Etsuro Motoyama, who received the baton from Robert M. Smith. Representing one of only two comprehensive multi-authored texts on the subject of pediatric anesthesia, this text, in my opinion, had become the text preferred by most pediatric anesthesiologists. The arduous efforts by Motoyana and Davis have, once again, payed off in the 6th edition, providing an important resource to all anesthesiologists who practice pediatric anesthesia. The text maintains a handsome academic physical appearance. However, the blue background on the faceplate and side of the text peels rather easily, in a manner similar to a teflon frying pan. The list of authors continues to be impressive, and the mix does not overweight the editor's home institution, minimizing the problem of institutional bias. Updating is extensive: I was surprised several times by the referencing of very recent works. The referencing is thorough, and I am particularly fond of the inclusion in the text of both the author and date for each reference.

The organization of the text continues to be in the same four parts as in previous editions. The first section on “Basic Principles in Pediatric Anesthesia” has the same six chapter titles, dealing largely with pediatric physiology and pharmacology. The chapter on cardiovascular physiology has been skillfully rewritten and expanded by Maureen Strafford in a manner that reflects her training in pediatric cardiology and her extensive experience in cardiac anesthesiology. The chapter on pharmacology remains one of my favorites, and has been improved through contributions by Jerrold Lerman. The second section, titled “General Approach to Pediatric Anesthesia,” has undergone organizational changes and has added a new chapter on pediatric pain management. Chapters from the 5th edition, titled “Induction of Anesthesia” and “Endotracheal Intubation,” have appropriately been lumped together into one chapter, as have the chapters titled “Maintenance of Anesthesia” and “Normal Recovery from Anesthesia.” A chapter on pediatric pain has been added, authored by Charles Berde and Zeev Kain. This chapter is outstanding, but bears a striking resemblance in content (but not in wording) to the pediatric pain chapter that Berde co-authored for George Gregory's Pediatric Anesthesia. The similarity is easily overlooked, because I can think of nobody better to write a chapter on pediatric pain than Berde. A cursory chapter on fluid and blood therapy has been disbanded, but one can still find most of this information in other sections of the new edition. The chapter on hypotensive anesthesia has appropriately been integrated into the chapter on blood conservation. The third section of the text deals with anesthesia for particular medical and surgical subgroups. The chapter titles are the same as in the previous edition, with the exception of the addition of a chapter on “Anesthesia & Sedation for Procedures Outside the Operating Room.” Five of the thirteen chapters have been redone by new authors. The chapters in this section are uniformly strong. There is considerable repetition, but this is understandable, because these chapters are clearly meant to stand alone. Of note is one apparent error, which pertained to an unusually low dose of morphine recommended in the chapter on anesthesia for dentistry. The fourth section is labeled “Associated Problems in Pediatric Anesthesia,” and represents a potpourri of subjects that do not fit well anywhere else. Because there is a new chapter on the history of pediatric anesthesia written by Robert Smith, the title of the section might need to be changed. I would prefer not to think of history as a problem. I thoroughly enjoyed Smith's chapter and was immediately enchanted by the inclusion of some of the accomplishments of John Snow (one of my personal heroes). The remainder of the chapters in this section are titled as in the previous edition, with some revisions and lots of updates. The chapter on systemic disorders is well written and very useful, but does have a few errors in transcription (i.e., adenoid process instead of odontoid). Such errors were rare occurrences in this text. Lastly, this volume continues to include an appendix on syndromes and their anesthetic implications. This appendix is a real bonus, which has great value in the clinical setting. Many practitioners, myself included, find that, even with years of pediatric experience, it is nearly impossible to keep the syndromes straight.

In summary, this comprehensive textbook is outstanding and is well worth the price. It can be recommended to anesthesia practitioners at all levels who wish to improve their skills in pediatric anesthesia, or who simply need a strong reference text.

George D. Politis, M.D., M.P.H., Assistant Professor, Department of Anesthesia, Bowman Gray School of Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina 27157–1009.