Dr. Robert M. Smith's legacy is as a pioneer and a great educator in pediatric anesthesia. Long before the terminology became fashionable'before it even existed'Dr. Smith advocated patient monitoring and safety. In the 1950s, when pediatric anesthesia was still in its infancy, he made the use of the precordial stethoscope and the pediatric blood pressure cuff (Smith cuff) a standard of care. In 1959, he wrote a major comprehensive anesthesia textbook, Anesthesia for Infants and Children, which was specifically dedicated to the anesthetic management and the care of the children.
The first four editions of this book were written almost entirely by Dr. Smith himself. The scope of Dr. Smith's scholarship was reflected in the breadth of his firsthand clinical experience, his keen sense of observation, and his ability to apply scientific and technical developments in medicine and anesthesia to the field of pediatric anesthesia. In 1988, Dr. Smith became the first pediatric anesthesiologist to receive the Distinguished Service Award from the American Society of Anesthesiologists.
In 1980, with Dr. Smith's retirement from the Harvard Medical School faculty and the anesthesia directorship of Children's Hospital, Boston, the task of updating this classic textbook was bestowed upon the current editors. The fifth edition, published in 1990, was multiauthored and was reorganized to include new subjects of importance in the ever expanding field of anesthesiology and pediatric anesthesiology in particular. In the fifth edition, the editors tried to maintain Dr. Smith's compassion, philosophy, and emphasis on the personal approach to patients. To honor his pioneering work and leadership (and against Dr. Smith's initial strong resistance), the title of the fifth edition of the textbook was modified to read Smith's Anesthesia for Infants and Children.
In 1996, the sixth edition of the textbook was published. New developments with inhaled anesthetic agents (sevoflurane and desflurane), intravenous agents (propofol), neuromuscular blocking agents, and anesthetic adjuncts, coupled with changes in the approach to pediatric pain management and airway management, were highlights.
Today, the seventh edition further expands these areas of development. The roles of airway management, regional anesthesia, new local anesthetic agents, and innovative regional anesthetic techniques have been further developed. Newer intravenous anesthetic agents and adjuncts have also been included in this edition, while patient safety and compassion remain integral aspects of Smith's Anesthesia for Infants and Children. Extensive experience with the newer inhaled anesthetics has brought up hitherto unrecognized problems. In the case of sevoflurane, its breakdown products (i.e., compound A) in carbon dioxide absorbers and exothermic reactions led to the development of inert, calcium chloride-based absorbers. Consequently, sevoflurane anesthesia using a low-flow or even a closed-circle system is becoming a reality with lower cost and less environmental air pollution in the operating room. Development of an ultra-short-acting synthetic opioid (remifentanil) together with propofol has made the total intravenous anesthesia for young infants a reality. The assessment of anesthetic depth is aided by bispectral electroencephalographic index monitoring. Increased awareness and improvement in perioperative pain management over the last decade have led to the establishment of pain services by anesthesiologists. Though much has changed since Dr. Smith last edited the book, its underlying focus is still on patients and their families.
The seventh edition has been prepared with the same intention as the previous six editions: to give anesthesia care providers comprehensive coverage of the physiology, pharmacology, and clinical anesthetic management of infants and children of all ages. This edition remains organized into four sections. The first section, Basic Principles in Pediatric Anesthesia, has been updated by major revisions of the chapters on respiratory physiology, cardiovascular physiology, fluid and electrolyte regulation, thermal regulation, and pharmacology in infants and children. In the second section, General Approach to Pediatric Anesthesia, a new chapter on the psychological aspects of pediatric anesthesia has been created, reflecting anesthesiologists' increased awareness of the subject. New chapters on pain management and pediatric regional anesthesia have been added by new contributors. All other chapters in this section have been updated by the same group of contributors as in the sixth edition. The third section, Clinical Management of Special Surgical Problems, contains newly added chapters on anesthesia for fetal surgery, in response to the development of fetal surgical procedures, and office-based pediatric anesthesia. This section also contains newly reorganized chapters on anesthesia for general, thoracic, urologic, and bariatric surgery and for plastic surgery in infants and children. New chapters by new contributors are included on anesthesia for pediatric ophthalmic surgery, anesthesia for pediatric same-day surgical procedures, anesthesia for children with burns, and perioperative management of pediatric trauma patients. All other chapters in this section have been updated by the same group of contributors. The fourth section, Associated Problems in Pediatric Anesthesia, contains new chapters on pediatric cardiopulmonary resuscitation and ethical and medicolegal aspects of pediatric anesthesia. The remainder of the chapters went through major revisions and updates by the corresponding contributors. Of note, the chapter on the history of pediatric anesthesia has been updated by Dr. Mark A. Rockoff with direct consultation with Dr. Robert M. Smith'who, we are happy to report, still enjoys good health in his advancing age, at the time of this writing. The Appendices include an updated list of drugs and their dosages, normal growth curves, normal values for pulmonary function tests in children, and an expanded list of common and uncommon syndromes of clinical importance for pediatric anesthesiologists.
In keeping with the advancement in technology, this edition contains a DVD with video segments to provide visual and verbal descriptions to improve the understanding of some technically more demanding procedures. They include techniques of regional anesthesia, single-lung ventilation, and fiberoptic intubation. Video and still images of surgical procedures as well as the color images of syndromes of clinical importance for pediatric anesthesia are included. They are intended to help pediatric anesthesiologists for preoperative assessments and preparations.
In summary, considerable developments and progress in the practice of pediatric anesthesia over the last decade are reflected in this new edition. The emphasis on the safety and well-being of our young patients during the perianesthetic period remains unchanged.