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SPA Newsletter.
Out and About the ASAPediatric Clinical Forum at ASAModerated by: Joseph R. Tobin, MD, FAAP, FCCMReviewed by: Allison Kinder Ross, MD This was a well-attended forum under the direction of Joe Tobin, MD, Professor of Anesthesiology, Wake Forest University. The panel members were Rita Agarwal, MD, Associate Professor of Anesthesiology, University of Colorado and The Children's Hospital, Denver, Allison Ross, MD, Clinical Associate Professor of Anesthesiology, Duke University., and Carlos Archilla, MD, Staff Anesthesiologist, Arnold Palmer Hospital for Children and Women, Orlando. Case 1: The first case was of a 7-year old presenting for an emergency appendectomy. His father had an episode consistent with Malignant Hyperthermia (MH) during a previous anesthetic. The child had no previous anesthetics. The panel members and audience were in agreement with using a non-triggering anesthetic technique. There was also general agreement that premedication with dantrolene was not indicated. However there was great discussion regarding the management of intraoperative fever and tachycardia. Suggestions ranged from getting blood gases, treating with dantrolene to simply treating the fever. Case 2: The second presented case, a 15-month old with trisomy 21 for removal of a coin from the esophagus, was similarly challenging for all. There was great discussion involving the issues of whether preoperative neck films are needed (and if they are, who is going to interpret them), whether an IV is required prior to induction and whether a rapid sequence induction is required. Some institutions and individuals always treat patients with foreign body aspiration as if though they have a full stomach and therefore will use a rapid sequence induction, others do not. The scenario of not being able to start an IV in this child brought further discussions as to alternative techniques of induction. Of more importance was the realization that since these children may be at risk for atlanto-occipital instability and removal of a foreign body can be done either with flexible or rigid esophagoscopy. As child advocates we should promote the use of flexible esophagoscopy whenever it is appropriate. Case 3: The third case entailed a 43-week ex premature infant, hospitalized with respiratory syntial virus (RSV) who requires a herniorrhaphy. The discussions centered around, whether the procedure should be postponed (if possible) to allow the resolution of the baby's RSV and/or decrease the anesthetic risk due to his prematurity. Assuming that postponement was not possible the risks and complications of RSV were discussed. As expected, the audience was split between offering a general versus a regional technique. The majority did agree that postoperative monitoring would still be required either way. Table of Contents
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