Editor's Picks for the Pediatric Anesthesia Article of the Day: November 2024
Melissa Brooks Peterson MD, Justin L Lockman MD MSEd, Myron Yaster MD
Ron Litman’s Pediatric Anesthesia Article of the Day has over 7,200 daily readers. I know that many of you simply do not have the bandwidth to read even our 5-6 minute reads of the current literature or joined the PAAD community only recently. Working in conjunction with the journal Pediatric Anesthesia, Drs. Melissa Brooks Peterson, Justin Lockman and I pick the most opened and read articles of the month for the journal. Once published in Pediatric Anesthesia I reprint these summaries in place of the Friday reader response. Myron Yaster MD
Original Article
Brooks Peterson, M., Lockman, J.L. and Yaster, M. (2025), Editor's Picks for the Pediatric Anesthesia Article of the Day: November 2024. Pediatr Anesth, 35: 481-482. https://doi-org.proxy.hsl.ucdenver.edu/10.1111/pan.15107
Title: You did an Allen test, did not you!? Rethinking pre-procedural assessment for arterial line placement.
Link: https://ronlitman.substack.com/p/you-did-an-allen-test-didnt-you-rethinking.
Original article:
Gleich SJ, Wong AV, Handlogten KS, Thum DE, Nemergut ME. Major Short-Term Complications of Arterial Cannulation for Monitoring in Children. Anesthesiology. 2021 Jan 1;134(1):26–34. doi: 10.1097/ALN.0000000000003594. PMID: 33079134.
Original article:
Abbasi RK, Packiasabapathy S, Hamilton M, Walker SG, Mazurek M, Dierdorf S. Ipsilateral Double Arterial Puncture in Children. Paediatr Anaesth. 2022 Apr;32(4):581–582. doi: 10.1111/pan.14413. Epub 2022 Feb 18. PMID: 35150182.
What do we know regarding safe cannulation strategies for pediatric arterial lines? First and foremost, it is remarkably safe. In this article, data from 5142 arterial cannulations were analyzed, and the authors found an overall low risk of complications (0.2%). An Allen test was not a study requirement. While several major health organizations (including the WHO) still advocate for the continued use of the Allen test, many clinicians no longer consider this part of their routine practice; the AHA no longer recommends it during trans-radial coronary procedures, and the increased use of ultrasound during arterial cannulation further reduces the need for the Allen test.
Title: External ventricular drains: What the pediatric anesthesiologist should know.
Link: https://ronlitman.substack.com/p/external-ventricular-drains-what.
Original article:
Lele AV, Bebawy JF, Takala R. The External Ventricular Drain Safety Campaign: A Global Patient Safety Initiative of the Society for Neuroscience in Anesthesiology and Critical Care. J Neurosurg Anesthesiol. 2024 Jul 24. doi: 10.1097/ANA.0000000000000982. Epub ahead of print. PMID: 39051910.
Many patients with hydrocephalous require diversion of cerebrospinal fluid (CSF) with external ventricular drains (EVDs) to reduce the risk of life-threatening increases in intracranial pressure (ICP) or to relieve existing intracranial hypertension and impending cerebral herniation. Others have EVDs placed temporarily while being treated for infection of their permanent ventriculoperitoneal shunts. Most pediatric anesthesiologists have received little to no education about the prevention of under- or over-drainage of CSF, accidental disconnection or dislodgement, or infectious complications. Further, during intrahospital transfers, these drains are sometimes clamped (potentially causing dramatic increases in ICP) – but how is the anesthesiologist to know when this is a risk and when it is not? The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) has launched a global patient safety initiative “The EVD Safety Campaign” (https://snacc.org/external-ventricular-drain-campaign/) to help bridge this gap.
Title: Postoperative analgesia for the Nuss procedure.
Link: https://ronlitman.substack.com/p/postoperative-analgesia-for-the-nuss.
Original article:
Coppens S, Dewinter G, Hoogma DF, Raudsepp M, Vogelaerts R, Brullot L, Neyrinck A, Van Veer H, Dreelinck R, Rex S. Safety and efficacy of high thoracic epidural analgesia for chest wall surgery in young adolescents: A retrospective cohort analysis and a new standardized definition for success rate. Eur J Anaesthesiol. 2024 Dec 1;41(12):873–880. doi: 10.1097/EJA.0000000000002064. Epub 2024 Oct 3. PMID: 39363622.
The Nuss procedure, in which bars or struts are placed under the chest wall, has become the most common operation for the correction of pectus excavatum. Although it can be considered “minimally invasive” from a surgical standpoint when compared to previous approaches, it is accompanied by considerable postoperative pain. When first introduced, thoracic epidural analgesia became the predominant modality for analgesia, although in most centers in the US, alternative methods are dominant—especially cryoablation. Cryoablation uses precisely controlled subzero temperatures to selectively cause axonal injury and resultant downstream nerve degeneration. However, because the perineural structures are preserved, axonal regeneration has been shown to occur post-ablation, with the full postoperative return of nerve function by 1–4 months. Although high quality, large “n” studies are lacking, the data here show significant reductions in length of stay and overall costs and reduced systemic analgesic requirements. Compared to thoracic epidural analgesia, cryoablation offers prolonged analgesia for this procedure.
Title: Working conditions during pregnancy: European perspective.
Link: https://ronlitman.substack.com/p/working-conditions-during-pregnancy.
Original article:
Zdravkovic M, Kabon B, Dow O, Klincová M, Bilotta F, Berger-Estilita J; Collaborators. Working conditions during pregnancy: a survey of 3590 European anaesthesiologists and intensivists. Br J Anaesth. 2024 Nov;133(5):1062–1072. doi: 10.1016/j.bja.2024.08.002. Epub 2024 Sep 10. PMID: 39256092.
This survey-based study sought to describe the working conditions and experiences associated with pregnancy for both women and men working as anaesthesiologists and intensivists in European countries. Respondents' perception of safety and working conditions during pregnancy was the primary study outcome, while secondary outcomes included the impact of pregnancy on clinical practice, work and training demands on family planning, and awareness of national and institutional policies and regulations.
Although pregnancy is not a disease, particularly in surgery and anesthesia, we often treat it as if it were due to the known physical changes and limitations that exist in the pregnant state. It is fundamental to recognize that pregnant physicians may face significant barriers to advocating for their own protections in the workplace, such as the negative perception of requesting work schedule modifications or avoiding radiation exposure. The authors highlight the role of leadership in creating a more safe and supportive workplace, calling for proactive creation and enforcement of policies that support pregnant physicians, ensuring their safety and well-being while minimizing the impact on their professional responsibilities.