This text is designed as a ready reference for anesthesiologists caring for children. It expresses the practical opinions and reflects the experience of the authors as practicing pediatric anesthesiologists.
Because a child's job is growth and development, it made sense to us to organize our book around this point philosophically. One might wonder at the wisdom of this departure from traditional pharmacology and physiology approaches to anesthesia for various subspecialties, and fear that it would reflect a leaning toward embryology rather than anesthesiology. We wanted, therefore, to set the record straight that while pediatric anesthesia is not just “anesthesia for little people,” the reality is that much of anesthesia for children is just that. Only when one actually looks at the evolution of pediatric medicine, surgery, and anesthesia together is an appreciation gained that what makes “pediatric” anesthesia distinct are the unique developmental aspects—physiologically, pharmacologically, anatomically and surgically—that require special attention and thought. Other than technical aspects of size adjustment and equipment as well as personnel, diseases of adults occurring in children are not terribly different. However, there are many diseases of children (including older children) that are not within the broad realm of the generalist anesthesiologist, and more than any other overall approach, developmental normalities and abnormalities made the most sense to us.
Preparation for a pediatric anesthetic, therefore, must begin, in the most practical sense, by understanding the reason for the abnormality in the first place. Anyone can memorize the steps of what to do, but an understanding, even if brief, of the reason for an anomaly, will inform decisions about anesthetic and further medical care and will help to sort out evolving problems and influence anesthetic technique choices. At the same time, a methodical approach, once the underlying embryology, anatomy and surgery is understood, will help the anesthesiologist prepare for the best induction, maintenance, and emergence technique as well as specific monitoring and equipment readiness. All of this information should be rapidly and easily retrievable from the formatting and layout of the text.