A Practice of Anesthesia for Infants and Children, 4th Edition.  By Charles Cote, M.D., F.A.A.P., M.A.(Hon), Jerrold Lerman, M.D., F.R.C.P., F.A.N.Z.C.A., I. David Todres, M.D. Philadelphia, Saunders-Elsevier, 2009. Pages: 1,126. Price: $149.00.

The mark of a seasoned physician, according to my childhood understanding, involved the weathered individual sitting in front of a mahogany desk, surrounded by an imposing library of large tomes of medical knowledge. Although once glorious, the paradigm has clearly shifted to a more practical and dynamic niche for medical textbooks. The new fourth edition of A Practice of Anesthesia for Infants and Children  by Cote et al.  provides a state-of-the-art hybrid between traditional textbook and online multimedia library.

The textbook is an assembly of chapters written by well-known and geographically diverse academicians, adding a particular strength to the textbook by justifying its opinions as a collective voice and not just the methods practiced at the editors' home institutions. The book itself is beautifully presented with clear and crisp color photos and well-reproduced tables. The sections are well divided into a color-coded, systems-based organization, with additional sections dedicated to pain management and “special topics.” All subjects are evenly covered, ranging from “bread and butter” focuses suitable for community-based practitioners to complex syndromes encountered at referral centers. Importantly, this range of topics is covered with equal diligence and attention to evidence, placing the textbook as a good resource for anesthesiologists of many different stripes.

Beginning the book, the first section focuses on general topics of pediatric anesthesia, including pediatric physiology, preoperative evaluation, and medicolegal and ethical issues. The second section, “Drug and Fluid Therapy,” provides an excellent, detailed look at the special pharmacologic and hematologic needs of the pediatric patient. Of note, the 1500 reference-strong chapter on pharmacology serves as an achievement, citing its breadth and contribution by authors from different disciplines. Sections dedicated to the chest and heart detail both physiology and complex disease management and include chapters dedicated to interventional cardiology, ventricular assist devices, and anesthesia for noncardiac surgery in children with congenital heart disease. These serve as excellent guides for increasingly prevalent situations. Perusing sections dedicated to the brain, glands, and abdomen will nicely explain difficult physiology and highlight up-to-date management of solid-organ transplantation.

Succinct and well-written chapters detail the management of specific surgical procedures, including orthopedic, otolaryngologic, ophthalmologic, and plastic surgeries, as well as burns. The section titled “emergencies” features an impressive and informative chapter dedicated to the management of the micropremie. In addition, the chapter dedicated to the ex utero  intrapartum treatment procedure and fetal interventions is an interesting guide to an emerging, still limited, area. The pain management section features acute and chronic pain discussions as well as a chapter dedicated to regional anesthesia. Regarding the chapter entitled “Ultrasound Guided Regional Anesthesia,” the recreations of the ultrasound images are of excellent quality and truly stand out when compared with other texts. The special topics addressed include emerging areas of concern for today's anesthesiologist, including off-site anesthesia, sedation, and special procedures for vascular access.

Of note, the text's readability is generally excellent, providing an easier read than other standard textbooks that sacrifice flow for technical description. The color-coded organization also allows the textbook to serve as a quick reference guide, especially in light of the useful and well-reproduced tables. My first critique of the book would cite the overuse of plot graphs from basic science literature, which are difficult to interpret and probably more easily summarized in words. Second, the book would also be enhanced by printed Web addresses such as in the chapter dedicated to cardiopulmonary resuscitation, and a link to updated pediatric advanced life support and advanced cardiac life support protocols would be useful.

The Internet-based portion that accompanies the textbook on purchase is provided through Elsevier Expert Consult. The textbook includes an activation code along with easy-to-follow instructions to navigate the Web site. Once opened, the Web-based portion is a wonderful new addition, adding a multimedia component that is easy to use and well designed. The bulk of the Web-based component is dedicated to online text corresponding to sections and chapters in the textbook. In particular, well-edited clips and images accompany the chapters concerning regional anesthesia, providing clear examples of techniques that can often be difficult to describe in text alone. Although the Web-based portion of the textbook is a timely addition to the text, I do believe that it could benefit from the addition of more integrative Web use, specifically the inclusion of hyperlinked Web addresses. In addition, a video portion detailing ultrasound-guided vascular access is not included and would nicely supplement the existing chapter.

In the era of quick accessibility to online journals, this textbook strongly justifies its existence by merging a well-written standard textbook supported by up-to-date references with an evolving multimedia component. The overall strength of this textbook lies in a combination of traditional, time-tested knowledge and up-to-date evidence-based practice suggestions. These provide excellent insights into a changing landscape of pediatric anesthetic practice.

University of Colorado Health Sciences Center and The Children's Hospital, Aurora, Colorado. alan.bielsky@ucdenver.edu.