From Vikas O'Reilly-Shah on the HAMSTER trial MD, PhD, FASA, Professor of Anesthesiology & Pain Medicine, University of Washington | Seattle Children's Hospital
Thanks for publicizing that very interesting and important article. 100% agree with the main take home is providing oxygen during airway cases. However, I don't think the trial endpoint or PAAD discussion covered two key points that should be made about high-low flow nasal cannula.
First, our surgical colleagues at Seattle Children's have advocated for use of HFNC specifically for the delivery of humidified fresh gas, something we cannot achieve with our standard setups. This may have an impact on surgical conditions, something I am certainly not in a position to evaluate (and perhaps merits another stuffie trial!)
A secondary point is simplified administration of lower than 100% oxygen fraction via the device for situations where airway fire is a risk (laser etc). Standard prongs can indeed be used to administer 30% or lower fraction of O2, but this of course can only be done with the use of that little piece of plastic in the nasal cannula kit that 99.9% of people take out of the package and put straightaway into the trash. (Pictured.)
From Myron Yaster MD
I found this article by Dr. Howard Zucker MD JD “Just A Heartbeat From Presidential History — Standing In Politics ‘On Deck’ Circle” (https://medium.com/@hazucker/just-a-heartbeat-from-presidential-history-standing-in-politics-on-deck-circle-6e4407cdcc31 ) and thought many of you might find it interesting 3 minute read, particularly in this election season.
Dr. Zucker is one of my former students/mentees and a dear friend and colleague. He is a polymath, Board certified in Pediatrics, Anesthesiology, Pediatric Critical Care Medicine, Pediatric Anesthesiology, and Pediatric cardiology. And in his spare time, while PICU director at the Morgan Stanley Children’s Hospital, got a law degree. Long interested in public health, he was the 16th commissioner of the New York State Department of Health (during Covid) and most recently served as the Deputy Director of Global Health at the Centers for Disease Control and Prevention.
One of the PAAD’s executive council members, Allan J. Schwartz MD MSEd, after reading the article, thought that it raised a lot of questions that are rarely discussed about our own practices, specifically, the role of “vice-chairs”. What are the roles of a vice-chair? What is their “succession” role in departments? Does it help or hinder in the promotion process? What skill sets are required? Food for thought…
From Robert Nassif, DMD, MS, Assistant Clinical Professor, University of Pittsburgh, School of Dental Medicine, Department of Dental Anesthesia
Dr. Schreiner and Dr. Yaster, thank you for your succinct and accurate history of the medical use of Nitrous Oxide and Ether. I appreciate the omission of He Who Must Not Be Named: Craw***d L**g. While Morton’s behavior was certainly less than magnanimous, it was at least true, and not “Ah, um, yes, well I have been using that for years but didn’t tell anyone.” I think it’s important that younger anesthesia providers know about the advent of a pioneering discovery in Medicine.