Updates in Pediatric Anesthesia

51 Pages·2017·2.46 MB·English

Updates in Pediatric
Anesthesia
MAY 12, 2017
BRIAN GILLISS MD
PEDIATRIC ANESTHESIA
KAISER SAN FRANCISCO
SELECTED SLIDES DRAFTED BY
KAREN BOCKLI MD
NEONATOLOGY, KAISER SAN FRANCISCO
Disclosure
Kaiser Permanente South San Francisco has
determined that the speaker (Dr. Gilliss, Dr. Bockli)
and the planning committee (Dr. Becker, Dr. Yap, Dr.
Ginsberg, Rebecca Bayrer, Heather Miller) for this
activity do not have any relevant financial
relationships. Kaiser Permanente South San Francisco
takes responsibility for the content, quality, and
scientific integrity of this CME Activity.
Kaiser Permanente does not endorse any brand-name
products.
Objectives
 Review new literature on pediatric anesthesia and
discuss implications to current practice.
 Address new concern of FDA release statement on
exposure to anesthesia for our pediatric population.
 Manage pediatric emergencies according to latest
guidelines.
 Diagnose pediatric emergence delirium and apply latest
treatment recommendations.
Recent Literature
 Not much to say . . .
 Implementation of Cognitive Aids
SPA Pedi Crisis Cards

 Sugammadex in children
 . . . except about neurotoxicity
Recent Literature
 http://www.pedsanesthesia.org/wp-content/uploads/2017/03/Critical_Event_Checklists.pdf
Clebone. Anesth Analg. 2017 Mar;124(3):900-907

Recent Literature
Volume 27 (2)
 Roughly 6 trials have been done (n~20-80), all with
rocuronium
 Mixed surgical, oncology, CHD, neonates
 Case reports in myasthenia, myotonic dystrophy, and
Duchenne’s
 Typical time to reversal 30s-90s
 Anaphylaxis rate 0.3%, almost entirely within 4min
 What about emergent reintubation?
Discussion of KP SSF practice
 What cases do you do/transfer?
ENT: myringotomy, T&A, sleep endoscopy, hearing tests

ortho/podiatry: elbow CRPP, club foot

Urology: circumcision, orchiopexy

Gen Surg: appy

IR: line revisions

ED: intubation, difficult PIV, LP assistance

 How do you do your T&A?
Premed, decadron, tylenol, precedex, zofran, opiate
