Smith's Anesthesia for Infants and Children PDF
Preview Smith's Anesthesia for Infants and Children
A02647_FM 9/20/05 05:04 PM Page vii Contributors Ann G.Bailey,M.D. Bruno Bissonnette,M.D.,F.R.C.P.C. Professor of Anesthesiology and Pediatrics Professor of Anesthesiology University of North Carolina at Chapel Hill University of Toronto Faculty of Medicine School of Medicine Director of Neuroanesthesiology Chapel Hill, North Carolina Department of Anaesthesia Anesthesia for Pediatric Ophthalmic Surgery Hospital for Sick Children Toronto, Ontario Matthew B.Baker,M.D.,Ph.D. Thermoregulation: Physiology and Perioperative Disturbances Chief Resident Department of Anesthesiology Barbara W.Brandom,M.D.,M.P.H. Vanderbilt University School of Medicine Professor of Anesthesiology Nashville, Tennessee University of Pittsburgh School of Medicine Anesthesia for Pediatric Plastic Surgery Attending Anesthesiologist Department of Anesthesiology Victor C.Baum,M.D. Children’s Hospital of Pittsburgh Professor of Anesthesiology and Pediatrics Director, North American Malignant Hyperthermia Executive Vice-Chair, Cardiac Anesthesia Registry Department of Anesthesiology Pittsburgh, Pennsylvania University of Virginia School of Medicine Malignant Hyperthermia Charlottesville, Virginia Systemic Disorders in Infants and Children Claire M.Brett,M.D. Professor of Clinical Anesthesia and Pediatrics David S.Beebe,M.D. University of California, San Francisco, School of Medicine Professor San Francisco, California Department of Anesthesiology Anesthesia for Neonates and Premature Infants University of Minnesota Medical School-Minneapolis Fairview University Medical Center Franklyn P.Cladis,M.D. Minneapolis, Minnesota Assistant Professor of Anesthesiology Anesthesia for Pediatric Organ Transplantation University of Pittsburgh School of Medicine Childern’s Hospital of Pittsburgh Kumar G.Belani,M.D. Pittsburgh, Pennsylvania Professor of Anesthesiology and Pediatrics Pediatric Drug Dosages University of Minnesota Medical School–Minneapolis Index of Syndromes and Their Pediatric Anesthetic Minneapolis, Minnesota Implications Anesthesia for Pediatric Organ Transplantation David E.Cohen,M.D. Richard A.Berkowitz,M.D. Associate Professor of Anesthesiology and Pediatrics Associate Professor Departments of Anesthesiology and Pediatrics Department of Anesthesiolgy University of Pennsylvania School of Medicine University of Illinois at Chicago College of Medicine Perioperative Medical Director Chicago, Illinois Department of Anesthesiology and Critical Care Medicine Chairman and Medical Director Children’s Hospital of Philadelphia Department of Anesthesiology and Pain Medicine Philadelphia, Pennsylvania Community Hospital Pediatric Anesthesia Equipment and Monitoring Munster, Indiana Office-Based Pediatric Anesthesia Ira T.Cohen,M.D. Associate Professor of Anesthesiology and Pediatrics George B.Bikhazi,M.D. George Washington University School of Medicine and Professor of Anesthesiology Health Sciences University of Tennessee, Memphis, College of Medicine Attending Anesthesiologist St. Jude Children’s Research Hospital Children’s National Medical Center Memphis, Tennessee Washington, D.C. Anesthesia for Neonates and Premature Infants Pediatric Intraoperative and Postoperative Management vii A02647_FM 9/20/05 05:04 PM Page viii ■ ■ ■ D.Ryan Cook,M.D. Dallas, Texas C O Professor of Anesthesiology Attending Anesthesiologist NT Duke University School of Medicine Cook’s Children’s Hospital R IB Durham, North Carolina FortWorth, Texas U Pharmacology of Pediatric Anesthesia Induction of Anesthesia and Maintenance of T O the Airway in Infants and Children R S Peter J.Davis,M.D. Professor Carl G.Fischer,M.D. Department of Anesthesiology Professor of Anesthesiology Department of Pediatrics University of Cincinnati College University of Pittsburgh School of Medicine of Medicine Anesthesiologist-in-Chief Anesthesiologist Children’s Hospital of Pittsburgh Shriners Hospital for Children Pittsburgh, Pennsylvania Cincinnati, Ohio Special Characteristics of Pediatric Anesthesia Anesthesia for Children with Burns Thermoregulation: Physiology and Perioperative Disturbances Pharmacology of Pediatric Anesthesia Jeffrey L.Galinkin,M.D. Preoperative Preparation for Infants and Children Associate Professor Anesthesia for Neonates and Premature Infants University of Colorado School of Medicine Anesthesia for General Abdominal, Thoracic, Urologic, and University of Colorado Health Science Bariatric Surgery in Pediatric Patients Center Perioperative Management of the Pediatric Trauma Patient Director of Research Systemic Disorders in Infants and Children Department of Anesthesia Children’s Hospital Jayant K.Deshpande,M.D.,F.A.A.P. Denver, Colorado Associate Professor of Pediatrics and Anesthesia Anesthesia for Fetal Surgery Vanderbilt University School of Medicine Director, Division of Pediatric Critical Care and Anesthesia Salvatore R.Goodwin,M.D. Vanderbilt Children’s Hospital Associate Professor of Anesthesiology Nashville, Tennessee MayoClinic Chairman Anesthesia for Pediatric Plastic Surgery Department of Anesthesiology Nemours Children’s Clinic Karen B.Domino,M.D.,M.P.H. Jacksonville, Florida Professor of Anesthesiology Systemic Disorders in Infants and Children Adjunct Professor of Neurological Surgery University of Washington School William J.Greeley,M.D. Seattle, Washington Professor Anesthesia for Pediatric Neurosurgery Departments of Anesthesia and Pediatrics University of Pennsylvania School of Medicine R.Blaine Easley,M.D. Anesthesiologist-in-Chief Assistant Professor Children’s Hospital of Philadelphia Departments of Anesthesiology and Critical Care Philadelphia, Pennsylvania Medicine and Pediatrics Anesthesia for Pediatric Cardiovascular Surgery Johns Hopkins School of Medicine Johns Hopkins Hospital Brian J.Gronert,M.D. Baltimore, Maryland Anesthesia Associates of New Mexico Pediatric Cardiopulmonary Resuscitation Attending Anesthesiologist Presbyterian Hospital Albuquerque, New Mexico Demetrius Ellis,M.D. Induction of Anesthesia and Maintenance of the Professor of Pediatrics Airway in Infants and Children University of Pittsburgh School of Medicine Director of Pediatric Nephrology Steven C.Hall,M.D. Children’s Hospital of Pittsburgh Anesthesiologist-in-Chief Pittsburgh, Pennsylvania Department of Pediatric Anesthesiology Regulation of Fluids and Electrolytes in Infants and Children Children’s Memorial Hospital Arthur C. King Professor of Anesthesiology Gavin F.Fine,M.D.,M.B.B.Ch. Northwestern University Medical School Clinical Assistant Professor Chicago, Illinois University of Texas Southwestern Medical Center at Anesthesia for General Abdominal, Thoracic, Urologic, and Dallas Southwestern Medical School Bariatric Surgery in Pediatric Patients viii A02647_FM 9/20/05 05:04 PM Page ix ■ ■ ■ Gregory B.Hammer,M.D. Nashville, Tennessee C Professor of Anesthesiology and Pediatrics Anesthesia for Pediatric Plastic Surgery O Stanford University School of Medicine N T Stanford University Hospital Frank H.Kern,M.D.,F.C.C.M. RIB Stanford, California Professor of Anesthesiology and Pediatrics U T Anesthesia for General Abdominal, Thoracic, Urologic, and Chief of Pediatric Anesthesia and Critical Care Medicine O R Bariatric Surgery in Pediatric Patients Duke University Medical Center S Durham, North Carolina Michael Winn Hauser,M.D. Anesthesia for Pediatric Cardiovascular Surgery Assistant Professor University of North Carolina at Chapel Hill School of Elliot J.Krane,M.D. Medicine Professor of Anesthesia and Pediatrics Chapel Hill, North Carolina Stanford University School of Medicine Anesthesia for Pediatric Ophthalmic Surgery Stanford, California Chief, Pain Management Andrew Herlich,D.M.D.,M.D. Lucile Salter Packard Children’s Hospital at Stanford Professor of Anesthesiology, Otolaryngology, and Pediatrics Palo Alto, California Medical Director, Human Simulation Center Preoperative Preparation for Infants and Children Temple University School of Medicine Anesthesia for Pediatric Neurosurgery Staff Anesthesiologist Temple University Children’s Medical Center and Shriners Ira S.Landsman,M.D. Hospital for Children of Philadelphia Associate Professor Philadelphia, Pennsylvania Departments of Pediatrics and Anesthesiology Anesthesia for Pediatric Dentistry Vanderbilt University School of Medicine Director, Division of Pediatric Anesthesiology Robert S.Holzman,M.D. Vanderbilt Children’s Hospital Associate Professor of Anesthesia Vanderbilt University Medical Center Harvard Medical School Nashville, Tennessee Children’s Hospital Anesthesia for Pediatric Otorhinolaryngologic Surgery Boston, Massachusetts Anesthesia and Sedation for Pediatric Procedures Outside the Jerrold Lerman,M.D.,F.R.C.P.C.,F.A.N.Z.C.A. Operating Room Clinical Professor of Anesthesia Women and Children’s Hospital of Buffalo, SUNY at Richard J.Ing,M.B.B.Ch.,F.C.A.(S.A.) Buffalo Strong Memorial Hospital Department of Anesthesia University of Rochester Duke University School of Medicine Rochester, New York Durham, North Carolina Pharmacology of Pediatric Anesthesia Anesthesia for Pediatric Cardiovascular Surgery Ronald S.Litman,D.O. Jodi Innocent,J.D. Associate Professor of Anesthesiology and Pediatrics Associate Counsel, Corporate Compliance and University of Pennsylvania School of Medicine Privacy Officer Attending Anesthesiologist Children’s Hospital of Pittsburgh Children’s Hospital of Philadelphia Pittsburgh, Pennsylvania Philadelphia, Pennsylvania Medicolegal and Ethical Aspects of Pediatric Anesthesia Pediatric Anesthesia Equipment and Monitoring Zeev N.Kain,M.D.,M.B.A. Igor Luginbuehl,M.D. Professor of Anesthesiology, Pediatrics, and Assistant Professor Child Psychology Department of Anesthesiology Executive Vice-Chair University of Toronto Faculty of Medicine Department of Anesthesiology Staff Anesthesiologist Yale University School of Medicine Hospital for Sick Children Anesthesiologist-in-Chief Toronto, Ontario, Canada Yale–New Haven Children’s Hospital Thermoregulation: Physiology and Perioperative Disturbances New Haven, Connecticut Psychological Aspects of Pediatric Anesthesia Shobha Malviya,M.D. Associate Professor of Anesthesiology Kevin J.Kelly,M.D.,D.D.S. Section of Pediatric Anesthesiology Associate Professor University of Michigan Medical School Department of Plastic Surgery C. S. Mott Children’s Hospital Vanderbilt Medical Center Ann Arbor, Michigan Medical Center South Perioperative Management of the Pediatric Trauma Patient ix A02647_FM 9/20/05 05:04 PM Page x ■ ■ ■ Thomas J.Mancuso,M.D. Respiratory Physiology in Infants and Children C O Assistant Professor of Anesthesia Induction of Anesthesia and Maintenance of the Airway in NT Harvard Medical School Infants and Children R IB Director, Acute Pain Treatment Services Pediatric Intraoperative and Postoperative Management U Children’s Hospital Anesthesia for Fetal Surgery T O Boston, Massachusetts Anesthesia for Pediatric Otorhinolaryngologic Surgery R S Systemic Disorders in Infants and Children Systemic Disorders in Infants and Children Safety and Outcome in Pediatric Anesthesia Keira P.Mason,M.D. Assistant Professor of Anesthesia (Radiology) Bridget M.Philip,M.D. Harvard Medical School Pediatric Anesthesia Fellow Associate in Perioperative Anesthesia Department of Anesthesia Director of Radiology Anesthesia Stanford University School of Medicine Children’s Hospital Stanford, California Boston, Massachusetts Attending Anesthesiologist Anesthesia and Sedation for Pediatric Procedures Outside the Santa Clara Valley Medical Center Operating Room San Jose, California Anesthesia for Pediatric Neurosurgery Lynne Maxwell,M.D.,F.A.A.P. Associate Professor David M.Polaner,M.D.,F.A.A.P. Department of Anesthesia Associate Professor of Anesthesiology University of Pennsylvania School of Medicine Department of Anesthesiology Director, General Anesthesia Division University of Colorado School of Medicine Department of Anesthesiology and Critical Care Medicine Attending Pediatric Anesthesiologist Children’s Hospital of Philadelphia Chief, Acute Pain Service Philadelphia, Pennsylvania Children’s Hospital Systemic Disorders in Infants and Children Denver, Colorado Anesthesia for Pediatric Same-Day Surgical Procedures John E.McCall,M.D. Professor of Anesthesiology Paul I.Reynolds,M.D. University of Cincinnati College of Medicine Uma and Sujit Pandit Professor and Chief of Pediatric Director of Anesthesiology Anesthesiology Shriners Hospital for Children University of Michigan Medical School Cincinnati, Ohio University of Michigan Health System Anesthesia for Children with Burns Ann Arbor, Michigan Perioperative Management of the Pediatric Trauma Patient Francis X.McGowan,Jr.,M.D. Professor of Anesthesiolgy Kerri M.Robertson,M.D.,F.R.C.P.(C.) Harvard Medical School Associate Clinical Professor Cardiac Anesthesia Service Department of Anesthesiology Children’s Hospital Duke University School of Medicine Boston, Massachusetts Chief, Transplantation Services Anesthesia for Pediatric Organ Transplantation Duke University Medical Center Durham, North Carolina Philip G.Morgan M.D. Anesthesia for Pediatric Organ Transplantation Professor Department of Anesthesiology, Genetics and Pharmacology Mark A.Rockoff,M.D. University Hospitals of Cleveland Professor of Anesthesiology Case Western Reserve University Harvard Medical School Cleveland, Ohio Vice Chairman Systemic Disorders in Infants and Children Department of Anesthesiology Children’s Hospital Etsuro K.Motoyama,M.D. Boston, Massachusetts Professor History of Pediatric Anesthesia Department of Anesthesiology Department of Pediatrics (Pulmonology) Allison Kinder Ross,M.D. University of Pittsburgh School of Medicine Associate Professor of Anesthesiology Attending Anesthesiologist and Pulmonologist Duke University School of Medicine Director, Pediatric Pulmonology Laboratory Associate Chief, Division of Pediatric Anesthesia Children’s Hospital of Pittsburgh Duke University Medical Center Pittsburgh, Pennsylvania Durham, North Carolina Special Characteristics of Pediatric Anesthesia Pediatric Regional Anesthesia x A02647_FM 9/20/05 05:04 PM Page xi ■ ■ ■ Lynn M.Rusy,M.D. Donald H.Shaffner,M.D. C Associate Professor Associate Professor O Department of Anesthesia Department of Anesthesiology and Critical Care Medicine N T R Medical College of Wisconsin Johns Hopkins University School of Medicine IB Staff Anesthesiologist Johns Hopkins Hospital U T Medical Acupuncturist Baltimore, Maryland O R Children’s Hospital of Wisconsin Pediatric Cardiopulmonary Resuscitation S Milwaukee, Wisconsin Pain Management in Infants and Children Avinash C.Shukla,M.B.B.S.,F.R.C.A. Associate in Cardiac Anesthesia M.Ramez Salem,M.D. Department of Anesthesia Chairman Harvard Medical School Department of Anesthesiology Children’s Hospital Illinois Masonic Medical Center Boston, Massachusetts Clinical Professor of Anesthesiology Anesthesia for Pediatric Organ Transplantation University of Illinois College of Medicine Robert M.Smith,M.D.,F.R.A.R.C.S.,Ireland (Hon.) Attending Anesthesiologist Clinical Professor of Anesthesia, Emeritus Shriners Hospital for Crippled Children Harvard Medical School Chicago, Illinois Chief of Anesthesia (1946–1980) Blood Conservation in Children Children’s Hospital Charles L.Schleien,M.D. Boston Massachusetts History of Pediatric Anesthesia Professor of Pediatrics and Anesthesia Director, Pediatric Intensive Care Unit Oliver S.Soldes,M.D. Columbia University Medical Center Clinical Assistant Professor New York, New York Section of Pediatric Surgery Professor of Pediatrics and Anesthesiology University of Michigan Medical School Coloumbia University College of Physicians University of Michigan Health System and Surgeons Ann Arbor, Michigan Medical Director, Pediatric Critical Care Medicine Perioperative Management of the Pediatric Trauma Patient Morgan Stanley Children’s Hospitals-Presbyterian New York, New York Maureen A.Strafford,M.D. Pediatric Cardiopulmonary Resuscitation Associate Professor of Anesthesiology and Pediatrics Tufts University School of Medicine Uwe Schwarz,M.D. Associate Anesthesiologist Research Fellow Department of Anesthesiology University of Pennsylvania School of Medicine New England Medical Center Hospitals Children’s Hospital of Philadelphia Boston, Massachusetts Philadelphia, Pennsylvania Cardiovascular Physiology in Infants and Children Anesthesia for Fetal Surgery Stevan P.Tofovic,M.D.,D.Sc. Robert J.Sclabassi,M.D.,Ph.D. Assistant Professor Professor Medicine/Clinical Pharmacology Departments of Neurosurgery, Neuroscience, Center for Clinical Pharmacology Electrical Engineering, and Biomedical Engineering University of Pittsburgh School of Medicine University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Attending Clinical Neurophysiologist Pharmacology for Pediatric Anesthesia Department of Neurosurgery, Center for Clinical Neurophysiology Robert D.Valley,M.D. Children’s Hospital of Pittsburgh, University of Pittsburgh Professor of Anesthesiology and Pediatrics Medical Center University of North Carolina at Chapel Hill School of Medicine Pittsburgh, Pennsylvania Director of Pediatric Anesthesia Pediatric Anesthesia Equipment and North Carolina Children’s Hospital Monitoring Chapel Hill, North Carolina Anesthesia for Pediatric Ophthalmic Surgery Victor L.Scott,M.D. Clinical Professor of Anesthesiology Jay A.Werkhaven,M.D. University of Pittsburgh School of Medicine Associate Professor Attending Anesthesiologist Department of Otolaryngology Children’s Hospital of Pittsburgh Vanderbilt University School of Medicine Pittsburgh, Pennsylvania Nashville, Tennessee Anesthesia for Pediatric Organ Transplantation Anesthesia for Pediatric Otorhinolaryngologic Surgery xi A02647_FM 9/20/05 05:04 PM Page xii ■ ■ ■ Eva Vogeley,M.D.,J.D.,Mdiv. Kelly K.Yeh,M.D. C O Assistant Professor of Pediatrics Pediatric Anesthesia Fellow N Division of Pediatric Emergency Medicine Department of Anesthesia T R IB University of Pittsburgh School of Medicine Stanford University School of Medicine U Attending Physician Stanford, California T O Children’s Hospital of Pittsburgh Pediatric Anesthesiologist R S Pittsburgh, Pennsylvania Department of Anesthesia Medicolegal and Ethical Aspects of Pediatric Santa Clara Valley Medical Center Anesthesia San Jose, California Anesthesia for Pediatric Neurosurgery Steven J.Weisman,M.D. Steven E.Zgleszewski,M.D. Professor of Anesthesiology and Pediatrics Instructor in Anesthesia Medical College of Wisconsin Harvard Medical School Medical Director, Jane B. Pettit Pain and Associate in Perioperative Anesthesia Palliative Care Center Director, Endoscopy Unit Anesthesia Services Associate Director, Pediatric Anesthesiology Children’s Hospital Children’s Hospital of Wisconsin Boston, Massachusetts Milwaukee, Wisconsin Anesthesia and Sedation for Pediatric Procedures Pain Management in Infants and Children Outside the Operating Room Myron Yaster,M.D. Aaron L.Zuckerberg,M.D. Richard J. Traystman Professor of Pediatric Anesthesiology, Assistant Professor Critical Care Medicine, and Pediatric Pain Departments of Pediatrics Anesthesia and Critical Care Management Medicine Department of Anesthesia and Critical Care University of Maryland School of Medicine Medicine Director, Pediatric Anesthesiology, Critical Care Medicine Johns Hopkins University School of Medicine Director, Children’s Diagnostic Center Attending Anesthesiologist Sinai Hospital of Baltimore Johns Hopkins Hospital Baltimore, Maryland Baltimore, Maryland Anesthesia for Pediatric Orthopedic Surgery Anesthesia for Pediatric Orthopedic Surgery Systemic Disorders in Infants and Children xii A02647_FM 9/20/05 05:04 PM Page xiv Foreword to the Fifth Edition When the first edition of the book was published in 1959, the accomplishment, educational programs have burgeoned, and essentials of pediatric anesthesia were barely taking form. Teaching the research approaches previously limited to older patients have was limited to a few centers, literature was scanty, and research been developed for even the smallest infants, resulting in a was virtually nonexistent. Anesthesia for Infants and Childrenwas deluge of new and important information. The situation clearly offered as a practical text presenting the fundamental differences demands a multiauthored text. I am delighted to pass the respon- in pediatric patients as related to older persons, with safety and sibility on to my former associate Etsuro K. Motoyama, who has simplicity as the main underlying principles. authored an outstanding chapter on respiratory physiology in all During the following 20 years, pediatric anesthesia expanded earlier editions, and to his associate, Peter Davis. The chapters along with the rapid development of pediatric surgery. Standards are written by experts in each area, adding much authority to the of clinical management became established and refined, training presentation. While benefiting greatly from scientific advances, facilities were organized, and pediatric anesthesiology became a our text still retains emphasis on the human approach to the recognized and respected field of medicine. The three editions whole patient. published during this period kept pace with the growing specialty I am greatly indebted to the editors and the collaborators for while retaining the same general format as the first edition. In the their painstaking efforts and for prolonging the existence of fourth edition all but 6 of the 29 chapters were written by the Anesthesia for Infants and Children. principal author. During the past 10 years clinical management has advanced Robert M. Smith, M.D. to a highly developed science with unpredicted levels of xiv A02647_FM 9/20/05 05:04 PM Page xv Preface Dr. Robert M. Smith’s legacy is as a pioneer and a great educa- bispectral electroencephalographic index monitoring. Increased tor in pediatric anesthesia. Long before the terminology became awareness and improvement in perioperative pain management fashionable—before it even existed—Dr. Smith advocated patient over the last decade have led to the establishment of pain monitoring and safety. In the 1950s, when pediatric anesthesia services by anesthesiologists. Though much has changed since was still in its infancy, he made the use of the precordial stetho- Dr. Smith last edited the book, its underlying focus is still on scope and the pediatric blood pressure cuff (Smith cuff) a stan- patients and their families. dard of care. In 1959, he wrote a major comprehensive anesthesia The seventh edition has been prepared with the same inten- textbook,Anesthesia for Infants and Children, which was specifi- tion as the previous six editions: to give anesthesia care providers cally dedicated to the anesthetic management and the care of the comprehensive coverage of the physiology, pharmacology, and children. clinical anesthetic management of infants and children of all The first four editions of this book were written almost entirely ages. This edition remains organized into four sections. The first by Dr. Smith himself. The scope of Dr. Smith’s scholarship was section, Basic Principles in Pediatric Anesthesia, has been reflected in the breadth of his firsthand clinical experience, his updated by major revisions of the chapters on respiratory physiol- keen sense of observation, and his ability to apply scientific and ogy, cardiovascular physiology, fluid and electrolyte regulation, technical developments in medicine and anesthesia to the field of thermal regulation, and pharmacology in infants and children. In pediatric anesthesia. In 1988, Dr. Smith became the first pediatric the second section, General Approach to Pediatric Anesthesia, anesthesiologist to receive the Distinguished Service Award from a new chapter on the psychological aspects of pediatric anesthesia the American Society of Anesthesiologists. has been created, reflecting anesthesiologists’ increased awareness In1980, with Dr. Smith’s retirement from the Harvard Medical of the subject. New chapters on pain management and pediatric School faculty and the anesthesia directorship of Children’s regional anesthesia have been added by new contributors. All Hospital, Boston, the task of updating this classic textbook was other chapters in this section have been updated by the same bestowed upon the current editors. The fifth edition, published in group of contributors as in the sixth edition. The third section, 1990, was multiauthored and was reorganized to include new sub- Clinical Management of Special Surgical Problems,contains jects of importance in the ever expanding field of anesthesiology newly added chapters on anesthesia for fetal surgery, in response and pediatric anesthesiology in particular. In the fifth edition, to the development of fetal surgical procedures, and office-based the editors tried to maintain Dr. Smith’s compassion, philosophy, pediatric anesthesia. This section also contains newly reorganized and emphasis on the personal approach to patients. To honor his chapters on anesthesia for general, thoracic, urologic, and bariatric pioneering work and leadership (and against Dr. Smith’s initial surgery and for plastic surgery in infants and children. New chap- strong resistance), the title of the fifth edition of the textbook was ters by new contributors are included on anesthesia for pediatric modified to read Smith’s Anesthesia for Infants and Children. ophthalmic surgery, anesthesia for pediatric same-day surgical In 1996, the sixth edition of the textbook was published. procedures, anesthesia for children with burns, and perioperative New developments with inhaled anesthetic agents (sevoflurane management of pediatric trauma patients. All other chapters in this and desflurane), intravenous agents (propofol), neuromuscular section have been updated by the same group of contributors. The blocking agents, and anesthetic adjuncts, coupled with changes fourth section, Associated Problems in Pediatric Anesthesia, in the approach to pediatric pain management and airway contains new chapters on pediatric cardiopulmonary resuscitation management, were highlights. and ethical and medicolegal aspects of pediatric anesthesia. The Today, the seventh edition further expands these areas of devel- remainder of the chapters went through major revisions and opment. The roles of airway management, regional anesthesia, updates by the corresponding contributors. Of note, the chapter new local anesthetic agents, and innovative regional anesthetic on the history of pediatric anesthesia has been updated by techniques have been further developed. Newer intravenous Dr. Mark A. Rockoff with direct consultation with Dr. Robert anesthetic agents and adjuncts have also been included in this M. Smith—who, we are happy to report, still enjoys good health edition, while patient safety and compassion remain integral in his advancing age, at the time of this writing. The aspects of Smith’s Anesthesia for Infants and Children. Extensive Appendicesinclude an updated list of drugs and their dosages, experience with the newer inhaled anesthetics has brought up normal growth curves, normal values for pulmonary function hitherto unrecognized problems. In the case of sevoflurane, its tests in children, and an expanded list of common and breakdown products (i.e., compound A) in carbon dioxide uncommon syndromes of clinical importance for pediatric absorbers and exothermic reactions led to the development anesthesiologists. of inert, calcium chloride-based absorbers. Consequently, Inkeeping with the advancement in technology, this edition sevoflurane anesthesia using a low-flow or even a closed-circle contains a DVD with video segments to provide visual and system is becoming a reality with lower cost and less environ- verbal descriptions to improve the understanding of some techni- mental air pollution in the operating room. Development of an cally more demanding procedures. They include techniques of ultra-short-acting synthetic opioid (remifentanil) together with regional anesthesia, single-lung ventilation, and fiberoptic intu- propofol has made the total intravenous anesthesia for young bation. Video and still images of surgical procedures as well as infants a reality. The assessment of anesthetic depth is aided by the color images of syndromes of clinical importance for pediatric xv A02647_FM 9/20/05 05:04 PM Page xvi ■ ■ ■ anesthesia are included. They are intended to help pediatric of our young patients during the perianesthetic period remains P R anesthesiologists for preoperative assessments and preparations. unchanged. E F In summary, considerable developments and progress in the A Etsuro K. Motoyama, M.D. C practice of pediatric anesthesia over the last decade are reflected E in this new edition. The emphasis on the safety and well-being Peter J. Davis, M.D. xvi A02647_FM 9/20/05 05:04 PM Page xvii Acknowledgements The project of revising a classic medical textbook presents many We wish to thank the staff members of the Department of opportunities and challenges. The chance to review the many Anesthesiology at the Children’s Hospital of Pittsburgh and the new developments that have emerged in pediatric anesthesia University of Pittsburgh Medical Center for their support and since the publication of the last edition of Smith’sAnesthesia for tolerance. Infants and Children in 1996 and to evaluate their effects on Our special thanks go to David Chasey, Editorial Assistant, as clinical practice have indeed been exciting. As always, we are well as Susan Danfelt and Patty Klein, Administrative Assistants, deeply indebted to the extraordinary work done and commit- of the Department of Anesthesiology, Children’s Hospital of ment made by Dr. Robert M. Smith. Beginning shortly after Pittsburgh, for their many hours of diligent work on the book. We World War II, Dr. Smith pioneered pediatric anesthesia in the are appreciative of the photographic material supplied to us by United States. Between 1959 and 1980, he published the first various current and former members of the Children’s Hospital of four editions of his book, Anesthesia for Infants and Children. His Pittsburgh staff. The credits for photography go to Dr. Brian work made this textbook a classic, establishing a quality and Gronert; Ellen Kretchman, CRNA; David Wagner, CRNA record of longevity. Editions 1st through 4th were written (Anesthesiology); Drs. Charles Bluestone, Sylvan Stool, Robert almost exclusively by Dr. Smith, with the exception of the chap- Yellon (Otolaryngology), and Basil Zitelli (Pediatrics). The cover ter on respiratory physiology by E.K. Motoyama. Since the late for this edition was created by Kaoru Kawasaki, graphic designer. 1980s, when Dr. Smith passed the book to the current editors, the Our special thanks also go to Elsevier’s Natasha Andjelkovic, subsequent 5th and 6theditions and now the new 7th edition Publisher; Ann Ruzycka Anderson, Senior Developmental Editor; have utilized the talents and expertise of many renowned pediatric and Mary Anne Folcher, Senior Project Manager, for their editorial anesthesiologists throughout North America. The 7th edition has assistance. been expanded further by the addition of new chapters and new Finally, as with the previous two editions, we are deeply contributors. The new edition has added DVD capabilities to indebted to our family members, Yoko, Eugene, and Ray further enhance the book’s educational potential. These addi- Motoyama and Katie, Evan, Julie, and Zava Davis, for remaining tions reflect the continual growth and complexity of the spe- loyal, for being understanding, and for providing moral support cialty of pediatric anesthesia. throughout the lengthy and, at times, seemingly endless project. Our ability to maintain this book’s standard of excellence is not Etsuro K. Motoyama, M.D. just a reflection of the many gifted contributors but is also a result of the level of support that we have received at work and athome. Peter J. Davis, M.D. xvii
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