Pediatric procedural sedation and analgesia
B Krauss, R M Brustowicz, editors. (PP 327; $39.95). Lippincott Williams and Wilkins, 1999. ISBN 0-683-30558-1.
As all who deal with children are well aware, over the past 10 years it has become unacceptable practice to physically restrain children for painful and non-painful procedures. There have been changes to the law with the Children's Act and the recent Human Right's Act to further constrain us and tie our own hands, alongside a growing demand from parents and children that a more humane approach is needed. This means we have to replace physical with pharmacological restraint.
This book is an American multi-authored text edited by an anaesthetist and an emergency physician from Boston Children's Hospital. It claims to contain everything you wanted to know about sedation in children but were afraid to ask—and it does. It is well written and easy to read. It gives tons of information on drugs and techniques, occasionally dropping into the text real life horror stories of sedation mismanagement, just to make sure we treat these techniques with the respect they deserve. The book is divided into three sections looking at scientific foundations, general management principles, and finally sedation for non-elective procedures.
The first two sections of the book are excellent. They extensively cover the physiology and pharmacology of sedatives and analgesics and discuss issues of consent, assessment, how to monitor these patients for adverse events and how to determine adequate recovery. The last section of the book advocates using sedation for many procedures that in the UK would automatically be done under general anaesthesia. This probably reflects a difference in culture and financial constraints on the two sides of the Atlantic. My main criticisms of the book are that like all multi-authored texts it is a little repetitive (but not excessively). Some of the drugs recommended are not available in this country (cetacaine, sufentanil), and some may be unavailable in the United States (Ametop) and so their role is not discussed. It occasionally advocates use of anaesthetic induction agents in doses that would produce anaesthesia, and as an anaesthetist this puts shivers up my spine.
Although this text is firmly aimed at American medical practice, it has much to recommend itself to anyone who has to perform procedures on children. Its aim is to advance the overall safety of sedation in children, which it goes a long way towards. Although distraction and relaxation are mentioned as techniques of enhancing or avoiding pharmacological restraint, it has little of the theory or description of their use. The differing backgrounds of the two editors has created a book that has a wider appeal, and should not be regarded as just for anaesthetists or accident and emergency physicians. It fills an important gap in the market and is eminently affordable.