A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study.

Background: Pediatric anesthesiology fellowship education has necessarily evolved since Accreditation Council for Graduate Medical Education (ACGME) accreditation in 1997. Advancements in perioperative and surgical practices, emerging roles in leadership, increasing mandates by accreditation and certification bodies, and progression toward competency-based education-among other things-have created pressure to enrich the current pediatric anesthesiology training system. The Society for Pediatric Anesthesia (SPA) formed a Task Force for Pediatric Anesthesiology Graduate Medical Education that included key leaders and subject matter experts from the society.

Acupuncture as an Adjunctive Treatment for Pain in Hospitalized Children With Sickle Cell Disease.

Context: Acute episodes of pain associated with sickle cell disease (SCD) account for over 100,000 hospitalizations and expenses of nearly one billion dollars annually in the U.S. New treatment approaches are needed as the current opioid based therapy is often inadequate in controlling pain, resulting in prolonged inpatient stays, and high rates of readmission.

Are Prior Experience and Subspecialty Training Time Predictive of Pediatric Anesthesia Exit Exam Scores for Rotating CA-2 Residents?

Background: Anesthesiology residency programs commonly have rotations at free-standing children's hospitals to provide and/or supplement their residents' training in pediatric anesthesia. Length and timing of these rotations differ from program to program as can their residents' existing medical knowledge and clinical skills. We predicted that residents with prior pediatric anesthesia experience, who rotate at our pediatric institution for two consecutive months, will score higher on an exit exam compared to residents without prior pediatric experience or those that only rotate for one month.

Pediatric fasting times before surgical and radiologic procedures: benchmarking institutional practices against national standards.

Prolonged preoperative fasting can be associated with adverse outcomes, particularly in children. Our aims were to assess the time pediatric patients fasted prior to surgical or radiologic procedures and evaluate whether fasting (NPO) orders complied with national guidelines. We measured NPO start time, time of last intake, and time test or surgery was scheduled, took place, or was cancelled in 219 pediatric patients.

An overview of the clinical use of ondansetron in preschool age children.

The introduction of 5-HT(3) receptor antagonist has revolutionized the prevention and treatment of nausea and vomiting in preschool aged children. These distressing symptoms, arising from multiple etiologies such as anesthesia, chemotherapy, and viral infection, are a major concern of patients and their families. Clinical research has demonstrated the antiemetic effectiveness of ondansetron in children.

Repeat episodes of severe muscle rigidity in a child receiving sevoflurane.

We report on a patient who developed two episodes of severe muscle rigidity, increased endtidal CO2 and increased creatine phosphate kinase associated with sevoflurane anesthesia. Dysrhythmias and hyperthermia were not observed and dantrolene was not administered. Genetic testing for the 17 known mutations associated with malignant hyperthermia (MH) was negative.

Peer review interrater concordance of scientific abstracts: a study of anesthesiology subspecialty and component societies.

Abstracts presented at anesthesiology subspeciality and component society meetings are chosen by peer review. We assessed this process by examining selection criteria and determining interrater concordance. For the societies studied, the level of reviewer agreement ranged from poor to moderate, i.

Caudal block complication in a patient with trisomy 13.

In this report we describe a complication of a caudal block in a 4-year-old child with trisomy 13. The patient's history was remarkable for microcephaly, developmental delay, seizures, apnea, and prolonged emergence times. Induction of anesthesia and tracheal intubation were uneventful.

A double-blind comparison of intravenous ondansetron and placebo for preventing postoperative emesis in 1- to 24-month-old pediatric patients after surgery under general anesthesia.

Unlabelled: We assessed the efficacy and safety of ondansetron (0.1 mg/kg IV) prophylactically administered before surgery for prevention of postoperative vomiting (POV) in a double-blind, placebo-controlled study of 670 pediatric patients, 1- to 24-mo-old, undergoing elective surgery under general anesthesia. The study enrolled 335 children in each treatment group (ondansetron versus placebo).

Systems-Based Practice and Anesthesiology Residency: Report from the SEA Task Force on the ACGME Core Competencies.

Background: The Accreditation Council for Graduate Medical Education requires that residents be educated in six general core competencies, but has relied on individual specialties to develop their own definitions, teaching methods and evaluative tools. The Society for Education in Anesthesia took the initiative by organizing a two-day conference to accomplish these goals.

Methods: Facilitated by four anesthesia educators, anesthesiologists from diverse programs and backgrounds employed open systems theory to better define System-Based Practice and outline key examples specific for anesthesiology.

Peer Review Interrater Reliability of Scientific Abstracts: A Study of an Anesthesia Subspecialty Society.

Background: Presentation of scientific abstracts is an important function of medical specialty and subspecialty societies. Selection is typically performed by the means of a peer review process. The validity and reliability of the peer review is under examination.

Ondansetron oral disintegrating tablets: acceptability and efficacy in children undergoing adenotonsillectomy.

Postoperative nausea and vomiting (PONV), a major complication in children, is responsive to IV and oral ondansetron. Because these routes are not always available, we studied the acceptability and efficacy of ondansetron oral disintegrating tablets (ODT). In this double-blind, randomized, placebo-controlled study, 62 patients undergoing adenotonsillectomy, aged 5 to 11 years, preoperatively received ODT (4 mg) or placebo.

Clinical and biochemical effects of propofol EDTA vs sevoflurane in healthy infants and young children.

Background: Propofol is frequently used for the induction and maintenance of anaesthesia in children aged 3 years and older. The present study compared the clinical and chemical effects of propofol containing disodium edetate (Diprivan) with that of sevoflurane in children younger than 3 years of age.

Methods: This was an open-label, comparative, parallel-group study.

Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol.

Background: Emergence agitation in children is frequently associated with the use of the new highly insoluble volatile anaesthetics. Rapid emergence has been cited as one of the possible causes. Propofol also permits rapid emergence from general anaesthesia but is not associated with agitation.

Propofol or midazolam do not reduce the incidence of emergence agitation associated with desflurane anaesthesia in children undergoing adenotonsillectomy.

Background: The aim of the study was to determine if concurrent use of short-acting sedatives would decrease the incidence of emergence agitation associated with desflurane while preserving rapid recovery.

Methods: Sixty-nine children, aged 2-9 years, who were undergoing adenotonsillectomy, were randomly assigned to three groups: (i) intravenous midazolam 0.1 mg.

The effect of fentanyl on the emergence characteristics after desflurane or sevoflurane anesthesia in children.

Unlabelled: Desflurane and sevoflurane anesthesia are associated with emergence agitation in children. In this study, we examined the effect of a single intraoperative dose of fentanyl on emergence characteristics in children undergoing adenoidectomy. One hundred children, 2-7 yr old, were randomly assigned to receive desflurane or sevoflurane for maintenance of general anesthesia after an inhaled induction with sevoflurane and a 2.

A comparison of three doses of a commercially prepared oral midazolam syrup in children.

Unlabelled: Midazolam is widely used as a preanesthetic medication for children. Prior studies have used extemporaneous formulations to disguise the bitter taste of IV midazolam and to improve patient acceptance, but with unknown bioavailability. In this prospective, randomized, double-blinded study we examined the efficacy, safety, and taste acceptability of three doses (0.