Editor's picks for the pediatric anesthesia article of the day: May 2024

Melissa Brooks Peterson MD, Justin L. Lockman MD, MSEd, Myron Yaster MD

As previously announced, the PAAD has entered into a partnership with the journal Pediatric Anesthesia in which we provide the journal with our top 4-5 PAADs of the month which the journal then posts with short summaries and a hyperlink on their website. Today’s PAAD are the highest opened articles with the most reader responses in the month of May (Peterson et al: Editor's picks for the pediatric anesthesia article of the day: May 2024. Paediatric anaesthesia 2024 (In eng). DOI: 10.1111/pan.14974).

TITLE: The quest for the holy grail of pain management May 2, 2024

LINK: https:// ronlitman. substack.com/p/the-quest-for-the-holy-grail-of-pain

Editorial:

Habib AS, Gadsden J, Carvalho B. Liposomal Bupivacaine for Abdominal Fascial Plane Blocks: No Evidence or Lack of Relevant Evidence? Anesthesiology. 2024;140(5):871–873.doi: 10.1097/ALN.0000000000004933. PMID: 38592357.

Original article:

 Hussain N, Speer J, Abdallah FW. Analgesic Effectiveness of Liposomal Bupivacaine versus Plain Local Anesthetics for Abdominal Fascial Plane Blocks: A Systematic Review and Meta-analysis of Randomized Trials. Anesthesiology. 2024;140(5):906–919.doi: 10.1097/ALN.0000000000004932. PMID: 38592360.

This systematic review and meta-analysis of randomized trials compared liposomal bupivacaine with plain local anesthetics for fascial plane blocks (primarily transversus abdominal plane, TAP, blocks) in adult patients undergoing a variety of abdominal surgeries. No difference was observed between the two groups for area under the curve (AUC) pain scores, with a standardized mean difference (95%CI) of −0.21 cm.h (−0.43 to 0.01; P = 0.058; I 2 = 48%). Furthermore, the two groups were not different for any of the Day 2 or Day 3secondary outcomes. Finally, Dr. Nihar Patel at a recent SPA meeting discussing liposomal bupivacaine concluded that “to date there have been NO randomized controlled trials of liposomal bupivacaine in pediatrics and its value remains speculative and unproven.

TITLE: Direct v Video laryngoscopy: Time to give up the ghost? May 7, 2024

LINK: https://ronlitman. substack.com/p/direct-v-video-laryngosco py-time

Original article:

Ruetzler K, Bustamante S, Schmidt MT, Almonacid-Cardenas F, Duncan A, Bauer A, Turan A, Skubas NJ, Sessler DI;  Collaborative VLS Trial Group. Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial. JAMA. 2024;331(15):1279–1286. doi: 10.1001/jama.2024.0762. PMID:38497992; PMCID: PMC10949146.

Today's PAAD compared video laryngoscopy with direct laryngoscopy on the number of intubation attempts required to correctly position a single- lumen tube. Specifically, the trial tested the primary hypothesis that fewer intubation attempts would be required when initial laryngoscopy was performed with a videolaryngoscope rather than a direct laryngoscope in patients being intubated in the operating room for cardiac, thoracic, or vascular surgical procedures. Secondarily, the trial tested the hypotheses that video laryngoscopy would reduce the number of intubation failures and a composite of airway and dental injuries. This study confirms AND strongly suggests that in ADULT patients, video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures. This study confirms previous pediatric studies from SPA's difficult airway registry. Our reviewers point out that not all video laryngoscopy is the same and in pediatrics hyperangulated video laryngoscopy blades have distinct dis -advantages compared with straight video laryngoscopy blades like the C-Mac Storz system.

TITLE: A game-changing way to better secure an IV catheter? May 9,2024

LINK: https:// ronlitman.substack.com/p/a-game-changing-way-to-better-secure

Original article:

Charters B, Foster K, Lawton B, Lee L, Byrnes J,Mihala G, Cassidy C, Schults J, Kleidon TM, McCaffery R, Van K, FunkV, Ullman A. Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction: A Randomized Clinical Trial. JAMA Pediatr. 2024:e240167. doi: 10.1001/jamape-diatrics.2024.0167. Epub ahead of print. PMID: 38558161; PMCID:PMC10985620.

Editorial:

Bettencourt A, Ruppel H, Bonafide CP. Advancing Evidence-Based Peripheral Intravenous Catheter Securement. JAMA Pediatr. 2024. doi: 10.1001/jamapediatrics.2024.0177. Epubahead of print. PMID: 38557797.

Charters et al. randomized patients to standard care, a bordered polyurethane dressing (Tegaderm [3 M]), an integrated securement dressing (ISD) (SorbaView SHIELD with sizes dependent on child (Nano[SV118UDT-6], Micro [SV226UDT-6], or Peripheral [SV233UDT-6(Medline)] and a ISD with tissue adhesive (TA) skin preparation. Peripheral IV catheter (PIVC) failure rate was highest with standard securement, and although not significantly lower with ISD alone, failure risk was significantly lower in the ISD with TA group compared with standard securement. Thus, this simple solution will dramatically increase PIVC survival time. Our review concluded in how to implement this into your practice using common change management principles.

TITLE: Preanesthesia pregnancy screening: an imperative or a bubbemeise (old wive's tale)? Ethical considerations May 14 and 15, 2024

LINKS: https:// ronlitman.substack.com/p/pre-anesthesia-pregnancy-screening  https://ronlitman. substack.com/p/preanesthesia-pregnancy-screening-41a

Original article:

Jackson S, Hunter J, Van Norman GA. Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review. Anesth Analg. 2024 May1;138(5):980–991. doi: 10.1213/ANE.0000000000006669. Epub2023 Oct 6. PMID: 37801601.

Many institutions and practices demand universal preoperative pregnancy testing. Today's PAAD makes the case that pregnancy testing should be offered to patients but should not be required by physicians unless there is a compelling medical reason to know whether the patient is pregnant. Furthermore, the authors provide evidence from multiple large studies that show that “despite wide-spread belief to the contrary, no anesthetic drug has been proven to be a human teratogen when used in standard concentrations at any gestational age.” Finally, the authors concluded that any policy requiring nonconsented, routine/mandated/screening pregnancy testing in patients with the capacity to consent is not ethically acceptable because it fails to recognize patient autonomy, and such policies should be modified.”