From Benjamin Walker, MD, Professor (CHS) and Division Chief - Pediatric Anesthesiology, Department of Anesthesiology - UWSMPH, Medical Director of Perioperative Services - American Family Children's Hospital
Thank you for the series on epidural test doses. I think that ultrasound (US) for peripheral blocks has shown us the value of a "visual" test dose. It is quite easy to visualize LA spread and be confident that you are not making an intravascular injection. Although using US to place a caudal block in real time takes some learning, and may not improve success rate for experienced anesthesiologists, using US to during LA injection (via a paramedian longitudinal view) to confirm caudal placement and rule out intravascular injection is an easy skill to acquire. It is far more reliable than the poor negative predictive value of an epinephrine test dose, and certainly more reliable for proper anatomic placement than "it felt good". The same goes for confirming epidural catheter placement (threading a caudal catheter or direct puncture at the desired vertebral level) in infants and small children. We should be using these techniques routinely.
From Sapna Kudchadkar MD PhD
I’d like to highlight a beautiful article that celebrates and honors our nurses. The last few weeks have been marked by intensely high acuity and deeply emotional stories across our clinical spaces. Please take a moment to read this mother’s reflection, a pediatric psychologist who cares for patients and families in the PICU, confronting end-of-life for her own daughter in that same space and expanding on the role of continuity nursing. As she perfectly puts “This is the kind of loving care that creates a sort of beauty from heartbreak. All of us who care for children and their families should seek to nurture the kind of care that lets such moments flourish”: https://www.statnews.com/2023/06/29/picu-love-compassion-continuity-nursing/
Each and every person on this email will immediately recognize that love and care that we see from our perioperative and critical care nursing colleagues every single day.
From Rebecca Lowery MD USAP commenting on single use OR waste
4 years ago at our pediatric hospital, single-use disposable EKG cables and leads began to appear without explanation for every surgical patient, and OR staff had been instructed by their superiors to dispose of them after every case. After a long investigation, it was discovered this edict had come from the hospital's quality committee, who in turn had come across an article quoted in many nursing journals. This article offered no legitimate scientific evidence or literature to support the claim that reusable EKG cables "might" contribute to infection. Interestingly, the article's author disclosure revealed that the author was a regional sales manager for a disposable EKG company. It took a literature search, a statistician's analysis to debunk the claims made in the article, and a presentation to the hospital's quality committee to eliminate this wasteful and unnecessary process.
Thank you for addressing this important topic,
From Sean Barnes, MD, MBA, The Society for Pediatric Anesthesia’s Communications Chair commenting on physician suicide
Thank you for addressing such an important topic and acknowledging the work done by The Society for Pediatric Anesthesia’s well-being committee chaired by Drs. Norah Janosy and Rebecca Margolis. Recently the SPA Communications Committee has worked with Norah and Rebecca to reach a broader audience by creating bite-sized well-being tips that are shared from the SPA Twitter account (@PediAnesthesia). We publish these well-being themed tweets every Wednesday. To easily find these tweets we include the hashtag #WellBeingWednesday.