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When we, as professionals, peruse a new medical book, most of us pay particular attention to the foreword, on which we depend for an independent overview and assessment of that book.

I am honored to have been requested by Professor Bruno Bissonnette, the editor and primary author, to write a foreword for this remarkable book, entitled Syndromes: Rapid Recognition and Perioperative Implications. It is my privilege to have known Professor Bissonnette personally since 1987, that is, ever since he was appointed to the staff of the Department of Anesthesia of the Hospital for Sick Children, Toronto, Canada.

Syndromes is timely as well as unique. In the present era of “same-day admission” there is no longer adequate time for preoperative assessment by the anesthesiologist who may be seeing the infant or child for the first time only shortly before the operative procedure is scheduled to begin.

Imagine yourself as the anesthesiologist being faced with the patient under such circumstances and noticing that “there is more to this patient’s condition than meets the eye.” Yet, at that time you do not know the nature of the pre-existing disorder, let alone know how that disorder may impact your administration of the anesthesia or the specific postoperative management required.

In a perfect world the nature of the pre-existing disorder would—whenever feasible—be conveyed to the anesthesiologist by the surgeon days, or even longer, before the proposed date of the operative procedure. Furthermore, this information could be shared with the family in order that they may understand the situation and sign a truly informed consent.

Consequently, there is an enormous need for a “user-friendly” reference wherein both the surgeon and anesthesiologist can rapidly and accurately recognize a pre-existent disorder and learn about its significance to perioperative management. The immediate availability of such an encyclopedic book can also prevent the undesirable phenomenon of the last-minute cancellation of the surgical procedure, with its resultant distress and frustration for the patient, family, and hospital staff. More importantly, the data in this unique book could help to prevent potential complications associated with the presence of the pre-existing disorder. This book thereby does the anesthetic and surgical professions a remarkable service in providing such precise and exhaustive information.

This wonderful book should be an essential addition to the personal libraries of anesthesiologists and surgeons who care for infants, children, and adults affected with special medical conditions. It should also be available in hospital libraries as well as at the desks of all operating room suites. It represents a monumental contribution to the increasingly complex fields of anesthesia and surgery.

Robert B. Salter, CC, OOnt, FRSC, MD, MS, FRCSC, FACS
Professor Emeritus of Surgery
University of Toronto
Department of Surgery, Division of Orthopedic Surgery
Senior Scientist Emeritus
The Research Institute
The Hospital for Sick Children
Toronto, Ontario, Canada

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