“The fact that A Practice of Anesthesia for Infants and Children, 5th Edition is going to be available on an e-reader with direct access to videos is going to be absolutely awesome.” – Charles Cote, MD
One incident that made me want to go into the field happened when I was a senior medical student. I was an acting intern in the newborn nursery and there was a baby who was dying from hyaline membrane disease. It was 1971 and there wasn’t much we could offer these children. An anesthesiologist from San Francisco, George Gregory, had just published a paper in the New England Journal of Medicine where he put a plastic box around the baby’s head and sealed it with some towels. By giving high enough fresh gas flow into that system, he was able to give positive end expiratory pressure, and demonstrated survival in babies who previously had all died. I wanted to try that on this baby that was headed for the grave. The attending neonatologist would not let me do it, but the baby was a patient of a private pediatrician, who let me try it. I got together with a respiratory therapist; we built it; it worked; and the baby survived. I think that’s really what got me interested in critical care.
The greatest area of expansion is the use of ultrasound for placing specific nerve blocks in children in a much safer and more precise manner than before. It’s particularly valuable because we put the children to sleep first and then we put the block in, unlike in adults where they put them in when the patient is awake. Some people feel that doing it when the patient is awake is a safer process because they can tell you if you’ve hit a nerve with the needle. You can’t do that with children, so having the ultrasound has allowed us to greatly minimize the potential for injury to a nerve and have a successful block for post-operative pain relief. The same is true for vascular access. We’re much more assured when inserting a central venus catheter that we’re not going to hit a vital structure.
The big controversy and concern in pediatric anesthesia now is the potential for neurotoxicity related to just about every drug we use to provide anesthesia to children. So we devoted a new chapter just to that topic — what’s known, what’s unknown, and where we need to go in the future.
A Practice of Anesthesia for Infants and Children has had a very nice history to it. It started when I was a junior faculty at Mass General and one of my colleagues had been approached to put together a pediatric book. Our chief of anesthesia asked me if I would take it on as a sub-editor. The first book was about 20 chapters long, maybe 250 pages, and was written entirely by people within our department. Five years later, we did the second edition, which we expanded with more chapters and more authors from other institutions. We expanded the book again for the third edition, which had more of an international flavor with international authors. The fourth edition, which is the current one available, has 120 authors from six continents, 52 chapters, color for the first time, and a web site that has additional tables, figures, video clips and the ability to search for references that can be directly downloaded from Pub Med. All of the artwork was redone and all the photography was reshot. The latest book is an enormous improvement.
We’re now working on the fifth edition, which will be greatly expanded in terms of web content. It will include videos of ultrasound-guided regional anesthesia, ultrasound-guided insertion of vascular catheters, and videos of specific operations. The fact that it’s going to be available on an e-reader with direct access to videos is going to be absolutely awesome. So, we’re delighted and we hope that our readers continue to enjoy it.
Biography
Charles J. Cote, MD is director of Clinical Pediatric Research at the Mass General Hospital for Children, Massachusetts General Hospital and Professor of Anesthesia at Harvard Medical School. His research focuses on clinical anesthesia of children. Dr. Cote has published broadly in this area, including the text, A Practice of Anesthesia for Infants and Children, 6th Edition.
Dr. Cote is board-certified in Anesthesiology, and Pediatrics, with a special certificate in Critical Care Medicine He holds a medical degree from Albany Medical School, and completed residencies in pediatrics at Boston Floating Hospital for Infants and Children at Tufts New England Medical Center and in anesthesiology at the Hospital of the University of Pennsylvania. He also completed a fellowship in pediatric anesthesiology and critical care at the Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania.
