Portal de Periódicos da CAPES

Pediatric Trauma Anesthesia and Critical Care

1997; Lippincott Williams & Wilkins; Volume: 85; Issue: 1 Linguagem: Inglês

10.1097/00000539-199707000-00055

1526-7598

Gregory J. Schears,

Anesthesia and Pain Management

Pediatric Trauma Anesthesia and Critical Care, J. K. Hall and J. M. Berman, eds. Armonk, NY: Futura Publishing Co., 1996, ISBN 0-87993-624-X, 507 pp, $98.00. Pediatric Trauma Anesthesia and Critical Care is the only textbook currently available devoted exclusively to pediatric trauma anesthesia. As a provider of care to pediatric trauma victims, this reviewer decided what was needed before opening the pages; namely, a reference focused on the specific issues of pediatric trauma relevant to anesthesiologists and critical care physicians, and in particular, a discussion of trauma pertaining to the airway, thorax, and abdomen that could lead to cardiopulmonary instability and their resuscitation. Information on outcome, predictors of morbidity and mortality, and efforts of prevention was also sought. Finally, does the current literature support a textbook on this new subspecialty? Fortunately, my fears were laid to rest with review of the text. The content is logically organized in a way similar to how a clinician might approach a trauma victim's problems. The 20 chapters are well written and adequately referenced. Chapter 1 is particularly good in that it emphasizes the importance of the mechanism of injury to the evaluation process. This is often not practiced in the trauma bay. The resource that the first responders can provide is often overlooked. Chapters 2, 3, and 4 deal with initial ABC issues of resuscitation. There is the right mix of basic and trauma specific information in these chapters to make the reading enjoyable. Chapters 5, 6, and 7 present issues related to the transport of patients. Chapter 5 gives an overview of the emergency medical system, which includes a historical perspective of its development. Chapter 6 focuses on the time interval from trauma scene management to the hospital. Chapter 7 deals with intrahospital transport issues. The six chapters that focus on disease-specific topics were particularly useful. These chapters include head injury, thoracoabdominal trauma, maxillofacial trauma, spinal cord injury, near drowning, and burns; they are the core of the text as well as its biggest asset. These sections give a flavor of the surgical concerns and relevant anesthetic issues. Again, the information is concisely presented and relevant. Chapter 17, on pain management, provides a practical overview of pain management options in the traumatized child. Chapters 18 deals with host response to trauma and its treatment. A brief presentation on the impact of nutrition and transfusion on immunity is given. Also, the effect of trauma and ventilation on lung injury is included. Chapter 19 discusses rehabilitation and outcome. What are the limitations of the text? The big issue is whether a textbook on pediatric trauma anesthesia is necessary. Some would say that the information presented is largely overlap with that available in pediatric critical care or anesthesia texts and that there is not enough research in the area or cohorting of pediatric trauma to support the development of this as a subspecialty of anesthesia. This reviewer believes such a text is necessary. Pediatric trauma information relevant to the intensivist or anesthesiologist can now be located in one convenient place. Also, as anesthesiologists establish an increasing role in perioperative management, traumatology could be a logical direction. There are a few smaller concerns, as well. Would the chapter (20) on the trauma team be better placed after the introduction? Are chapters on poisonings and envenomization necessary? There are some areas for which more information would be helpful, i.e., a larger section be devoted to cardiopulmonary resuscitation, information on optimizing resuscitation techniques and monitoring quality, and inclusion of a chapter on general principles of anesthesia as they relate to the trauma victim. Overall, Pediatric Trauma Anesthesia and Critical Care is a quality product that incorporates the current information on the topic in a very readable form and will serve as a useful reference for anesthesiologists involved in the care of pediatric trauma patients, particularly if pediatrics is not the primary focus of their practice. Gregory J. Schears, MD Department of Anesthesia and Critical Care Medicine; University of Pennsylvania School of Medicine; Philadelphia, PA 19104