Foreword 3: A Pediatrician’s Perspective

Because of advances in medical technology and improvement of care, pediatricians are more and more often faced with complex chronic conditions or diseases. This concerns all the pediatric subspecialists, including pediatric intensivists. In fact, children with chronic conditions, particularly infants, have a more than threefold increased rate of hospitalization compared with the general pediatric population. Furthermore, around 30 to 45% of children admitted to the pediatric intensive care units (PICU) suffer from such diseases. The syndromes that are described in this new textbook represent a large part of these diseases. Finally, chronic conditions of congenital origin account for 4% of total deaths and for 15% of unscheduled PICU admissions.

Syndromes: Rapid Recognition and Perioperative Implications is a well-illustrated, quick-consultation reference. Each syndrome, listed in alphabetic order, is described in nine sections, plus essential references: main features (“at a glance”) with their implication for anesthesia and intensive care, synonyms, historical facts when important, incidence, genetic inheritance, pathophysiology, diagnosis, precautions before anesthesia, anesthetic considerations, and pharmacological implications. Perhaps the most important sections of each entry are the last two, which summarize useful data often difficult to find rapidly: airway management, precautions to be taken for mobilization, fluid intake, and drug utilization (which drugs can be safely used and which must be avoided).

Why is this textbook useful? First, almost all these syndromes are orphan (or rare) diseases and thus are not well known by many pediatricians, who cannot be expected to memorize the 4,500 listed syndromes. Moreover, surveys have indicated a lack of physician confidence in caring for children with special health care needs. The very concise description presented by Professor Bissonnette and the authors will help pediatricians recognize the key features of each syndrome. Second, many children with these syndromes may need invasive investigations and surgical procedures performed under sedation or anesthesia. This book indicates all the precautions required to avoid a possible last-minute cancellation and delay and guarantee safe perioperative management. Last but not least, the reader will have access to a very detailed thesaurus of all the syndromes discussed, their synonyms, and other conditions to be considered, in addition to numerous overview tables.

All pediatricians and residents, and more generally all health care providers, will find in this excellent book a quick and useful reference to improve the care for children who present with these syndromes and who frequently have special anesthetic care needs. No doubt this book merits translation into many languages, in order to provide help for physicians and children worldwide.

The authors and publisher are to be congratulated for producing such a thorough work.