Anesthesia for Genetic, Metabolic, & Dysmorphic Syndromes of Childhood. Edited by Victor C. Baum, Jennifer E. O’Flaherty. Philadelphia, Lippincott Williams & Wilkins, 1999. Pages: 352. Price: $99.00.
Both editors of this slim, hardcover book are not only pediatric anesthesiologists, but also pediatricians. The text is intended for those who have occasion to care for children (and adults) with rare conditions or syndromes that develop during childhood and who, like me, cannot remember all the important anesthetic implications of each. All of us in pediatric anesthesia are presented not infrequently with the scenario described by the authors in their preface—having a patient with “some bizarre syndrome” in need of a quick curbside consult. This text provides that consult in a well-organized and efficient manner. Previously, this information was not available or was available only in texts not directed toward anesthesiologists. Typically, standard pediatric anesthesiology texts omit information about the multitude of syndromes and conditions encountered in children, or the information is abbreviated greatly and included only as a table or glossary. This text, however, is devoted entirely to the myriad syndromes, many of which we never see in our day-to-day practice. However, because there are so many syndromes, even if we see a small fraction of them, it may constitute an almost weekly problem.
The text is arranged alphabetically by the most common name of the syndrome or condition, providing a quick and easy way to find information. Information is provided in a standardized format, also facilitating a quick topic review. It is clear, concise, and practical. Clearly, the authors did not intend to provide a comprehensive review of the syndromes or their anesthetic managements. There is an assumption of knowledge on the part of the authors that allows the sections to be necessarily brief. Information is provided about the syndrome in general and the anesthetic implications specifically. However, the authors presume, for example, that the reader knows what malignant hyperthermia is and how it is managed.
Because the book is arranged alphabetically, there is no need for the usual index. Unfortunately, the authors chose not to include an index that would allow the clinician to discern the name of a syndrome based on its features, which is common in many or most standard texts of dysmorphology. For example, it is not uncommon to be presented with a child who has a constellation of conditions, such as cleft palate, mid-face hypoplasia, craniosynostosis, and so forth, and the question, what is this and what should I worry about? An index organized by clinical presentation would allow the clinician to decide what syndrome the child has and care for him or her accordingly.
Black and white photographs of some of the syndromes are included and are extremely helpful. One wonders if more photographs would allow the anesthesiologist to visualize better the descriptions in the text. Frequently, we plan the anesthetic management of patients we will not see for hours or days. Several of the photographs do not name the syndrome in the accompanying caption, creating the possibility of confusion as to the appearance of one syndrome versus another whose text is adjacent (e.g. , Hurler vs. Hunter). It is recognized that the addition of more photographs or the use of color plates almost certainly would make this relatively modestly priced text prohibitively expensive.
This is a book that should be in the library of all those involved in the anesthetic care of children with complex problems. More appropriate may be two copies, one in the library and one in close proximity to the operating area.
