It has been four years since the fourth edition of the premiere textbook of pediatric anesthesia was published. At first glance, the fifth edition distinguishes itself from previous editions in both form and content. The ten well-organized sections of this text of 1,142 pages and 53 chapters are colour coded for easy and efficient searching, and the pages are printed on a tactile appealing glossy paper. The text contains in excess of 1,000 well-placed high-quality figures and images that add greatly to the content of the text. Additionally, the extensive online content enhances this already excellent book.

Brian Anderson replaces David Todres as a co-author in this edition. Dr. Anderson is recognized for his expertise and contributes additional international flavour and know-how to this publication. With close to 2,000 references, Dr. Anderson’s chapter, “Pharmacokinetics and Pharmacology of Drugs Used in Children”, is an impressive example of his world-class knowledge of the subject matter. Drs. Coté and Lerman continue to impact this edition with their expertise, their extensive contribution to content, and their editorial oversight. In addition to the editors, the more than 100 contributors are the “Who’s Who” of pediatric anesthesia. These contributors represent ten countries and six continents, giving the book an extensive multinational viewpoint.

This edition retains most of its familiar section and chapter arrangement; furthermore, all chapters have been significantly revised and updated and feature many new contributors. Andreas Loepke and Andrew Davidson, two world experts in the field, write a notable new chapter, “Surgery, Anesthesia, and the Immature Brain”. This is a very timely addition, as the possible deleterious effects of anesthetic agents on the developing brain are gaining prominence not only in the medical literature but also in the lay news. The chapter offers an excellent discussion on the background of the topic, a synthesis of the available literature, and a frank discussion on the limitations of the science. Given the growing emphasis on simulation as an integral part of medical training, the chapter, “Simulation in Pediatric Anesthesia”, written by simulation researchers and educators, Drs. Christine Mai, Demian Szyld, and Jeffrey Cooper, is also an opportune addition. These authors provide an excellent overview of medical simulation with emphasis on its role in pediatric anesthesia. The other chapters continue to offer well-organized, in depth, current, and well-referenced discussions on all aspects of pediatric anesthesia from basic science to cutting-edge practice. Except for the obvious focus on pediatrics, the ten sections are organized in a sequence similar to most other standard textbooks on anesthesia.

The written word has provided effective information transfer for millennia. Sophisticated online technology and the near ubiquitous access to the internet with its availability and platforms make this medium vastly superior to the traditional textbook. In addition to the already improved printed content, this edition embraces online content with superb results. Easy access to the content is provided via www.expertconsult.com, an online application used for many medical textbooks. The website states, “Access Expert Consult from any device via the internet: desktop, laptop, tablet, or smartphone”. The author was able to access the content seamlessly through one manufacturer’s smartphone, tablet, and laptop and did not require Adobe Flash Player to view. The entire printed text is available online with the added advantage of a search feature with user-defined keywords. In addition, all references are available in the online text (not all references are included in the printed text) and hyperlinked to a PubMed reference, allowing the user to review most abstracts and many complete manuscripts as well as the standard reference contents. All figures and images in the printed text are available online, and additional figures are also available to enhance the online experience. Furthermore, numerous videos accompanying the online text provide content which is simply irreproducible in printed text or still picture. For example, there are videos of the expected echocardiogram loops, ultrasound-guided nerve blocks, and central vein access, as well as many others, including inhalation induction with and without parental accompaniment. The videos are high quality and annotated to enhance their educational impact even further. These online features truly allow most users to carry this resource easily in their pocket for real-time access in a way that would have been inconceivable even a decade ago.

The shortcomings of this textbook are few. It is regrettable that the chapter, “Thermal Regulation”, has been removed from this edition. The topic is covered in several other chapters, but given the prominence of the clinical problem, the topic continues to justify its own chapter. A second criticism relates to the access to online video content. The icons indicating a related video are well placed within the online content, but viewing the video is not simply a matter of clicking the icon; it requires accessing a separate section of the website.

It is difficult to envision that a new addition of A Practice of Anesthesia for Infants and Children could offer more than an update, but this is precisely what this fifth edition accomplishes. The new online content offers so much additional rich subject matter to an already superb text, and its ease of access and multi-platform compatibility make this book a must have for anyone providing pediatric anesthesia.