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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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.
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