Ground Rules

In the beginning, I titled this book Principia Pediatrica Anesthesiologica, but when it came time to call it something actually useful, I decided on Basics of Pediatric Anesthesia, mainly because no one else had taken that title. This book (or more precisely, e-book) is intended, and specifically written for, beginning students of pediatric anesthesia. It was purposely designed to accompany a lecture series for anesthesia residents, student nurse anesthetists, or student anesthesia assistants during their rotations in pediatric anesthesia. It assumes that the reader has already learned a sufficient amount of adult anesthesiology theory and practice, but now needs to learn the differences between adults and children, and how to conduct a proper anesthetic for pediatric surgical procedures.

There already exist too many authoritative texts on pediatric anesthesia; they are large and unwieldy, and are used mainly as reference texts for more advanced students of the field. You would not schlep (arduously carry with pained facial expression and contempt for the book’s authors) one of these behemoths to the hospital each day to read during a tympanomastoidectomy. Basics is published in an e-book format to be used on an e-reader. This platform is now sufficiently popular that a large enough proportion of learners have access to it, and because of their size and sleekness, all sorts of e-readers can easily be read in any anesthetizing location, without knowledge of the authorities. The other great advantage of digital publishing is that I’m able to keep the price about the same as the appetizer you will order for tonight’s dinner. (Isn’t this e-book better than soggy fried calamari?)

For those of you without an e-reader, a printed version is available, at the lowest possible cost for a printed book. To keep the cost that low, I had to omit most of the tables, figures, and pictures, but they are all here on the website, freely available.

Basics is a revision, of sorts, of the book that was originally published in the Requisites series, which no longer exists (check out how much it’s going for on Amazon!). Residents and students appreciated the Requisites book for its short chapters that could be easily read in an hour or two, with simple explanatory language. In this e-book, I have taken a similar approach for us plain folk; unnecessary or advanced details have been omitted, and big words have been left out (okay, that’s not entirely true, I love big words, especially when no one else knows what they mean, so see if you can find them). When the use of a complicated word is unavoidable, I’ll try to define it for you, but since this is an e-book, you can just hold your finger on it and… voila!… the definition appears. Important articles will be discussed within the text, with the ability to hyperlink to the article itself. That’s right, just touch the hyperlink, and…voila!… the article appears from the internet, like a miracle.

By self-publishing, I can do what I want without the constraint of the usual annoying publication rules set forth by large medical publishing companies that charge way too much for hardcover books that are outdated before they are ever released. For example, I don’t need to spell out commonly abbreviated terms. We all know what ECG stands for without having to write the actual word “electrocardiogram”. Just writing out the whole word here was quite painful, and if anyone reading this book doesn’t already know what ECG stands for, his or her future patients should be worried. Also, I removed as many gratuitous statements as possible. For example, my previous book had a sentence that read: “It is very common for head and neck position to change during pediatric surgical procedures.” No kidding.

I did not reference individual sentences in the text. This would have been too time-consuming. You will just have to trust me here that most of what the authors wrote is true. But even though you trust us, make sure you verify everything (Republicans will dream of their savior Ronald Reagan). Because I care so much about your education, I tried to hyperlink as many interesting or important references for each chapter as possible, and I strongly advise you to read them. Anything in blue and underlined is a hyperlink that leads somewhere, perhaps to a website or the actual PDF of the article, and sometimes the link leads somewhere unexpected, so be adventurous and click on them all. Some of these hyperlinks lead to websites where you may need to pay for access. If you are unable to view any article for free, email me at (that’s a real email address) and I will send you the article. For free.

I did not include any material on drugs that are no longer used (e.g., halothane, droperidol, mivacurium, etc.) or drugs that don’t work (e.g., metoclopramide, melatonin, etc.) or drugs that you dream about but aren’t yet available (e.g., sugammadex). If you are interested in learning about the use of those drugs in pediatric anesthesia, go read an anesthesia history textbook or a European journal. On the other hand, if you have expertise on drugs that are commonly used outside the U.S. (e.g., sugammadex) feel free to volunteer to write that section by emailing me at:

The e-book you are about to read is divided into several sections, each of which is divided into specific chapters. None of the chapters builds on any others, so each chapter can be read without prior knowledge of any other. It’s quite useful for reviewing pertinent material the night before your cases. In the initial Requisites book, I included a chapter on the different types of pediatric breathing circuits. Since most of these are now primarily of historical interest (except on board exams), I omitted that chapter.

There is no chapter on the “basics” of pediatric cardiac surgery, because there are no “basics” in this field. This e-book is aimed at residents, student CRNAs and student AAs. I did, however, include a chapter on anesthetizing children with various forms of congenital heart disease, so you should be grateful for that.

At various points throughout the book, I refer to the anesthesia practitioner as an anesthesiologist and at other times I call that person an anesthetist. I do not in any way intend this as a slight to any one group. As long as they show up to lectures on time and read my books, I love my residents and student CRNAs equally. If the Commonwealth of Pennsylvania allowed Anesthesia Assistants, I would love you too.

I anticipate that there will be mistakes, such as typos, dead links, or just plain wrong information. Please find them for me, and email them to If you are correct, your name will be included in a special acknowledgements section in future editions called “Really Smart ReadersTM”. However, if you are not correct, your name will appear in another section for dodos (only kidding). If you have any suggestions for future editions, or if you just need to talk, email me at, and, respectively. If you really like this book, please do me a great favor and let all your friends and colleagues know, and give it a great review and blurb on the book’s Amazon page here.

Although I have taken a jocose approach to the writing in this book, which the mirthless booboisie among you may not appreciate, I never want to convey that administering anesthesia to children (okay, to adults too) isn’t a serious matter. Every single day, many thousands of parents entrust their children’s lives in our hands. I frequently review legal cases where anesthesia providers have harmed children. This harm usually does not occur from lack of knowledge or skills, but lack of focus, which is often difficult to sustain in the often-mundane OR environment. Therefore, I urge you to be meticulous, down to the seemingly most inconsequential detail of care. Attention to minute details does not come naturally for most of us, so it needs to be practiced. The very first recorded anesthetic death in 1848 was a child. Hannah Greener was a 15-year old that succumbed during a procedure to remove an ingrown toenail. Dedicate your life and career to making sure this never happens again.

While we are on the subject of safety, make a pledge to yourself that you will never, ever again, for the rest of your life administer a medication without: 1) triple-checking that it is indeed the medicine you intended to draw up from the vial; and 2) triple-checking that it is indeed the correct syringe you think it is. Vials and syringes often look alike, and it’s difficult to maintain perfect focus every day on every case. Click here to see what happens if you don’t.

For this endeavor, I have taken on a team of expert collaborators. Two of my outstanding residents (and future pediatric anesthesiologists), Greg Dodson and Jim Quint, served as Associate Editors. They combed through the recent pediatric anesthesia literature (about 10 years worth!) to make sure I didn’t miss anything important that should be included in the book. It was a lot of work, and they will be handsomely rewarded with a free copy of this e-book.

My production team consists of two very talented individuals. Rob Fedirko is a world-class medical illustrator. One of the most important aspects of teaching pediatric anesthesia is conveying visual information that cannot be otherwise conveyed by text or photos. From a pool of hundreds of applicants, Rob was chosen because his wife Mary Beth is really attractive. Finally, I was lucky enough to find Penn architecture student Will Korchek as my Director of Product Design. Will is a credit to his nation (California) and will be a highly successful product designer in the future.

The last crucial member of the team is my wife Daphne, my soul-mate and love of my life, who keeps me healthy and fit, intellectually and physically, and lets me know in no uncertain terms (she goes upstairs and tells me she will be asleep soon) when I have been typing too long.

Ron Litman

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