Reader response
Myron Yaster MD
From Samuel Vanderhoek MD and Sapna Kudchadkar MD PhD, Johns Hopkins
Thank you for reviewing our PACU Up! feasibility study in the PAAD on October 14. We appreciate the opportunity to clarify the objectives of our research. Our primary aim was to assess the safety and feasibility of implementing a standardized, evidence-based early mobilization program for children recovering from anesthesia. Notably, we observed no adverse events related to mobilization, such as falls, and we also identified some key barriers to programmatic implementation.
As is typical with feasibility and pilot studies, our research was not powered to evaluate clinical effectiveness outcomes (see Eldridge SM et al., 2016). However, we presented findings on differences in pain scores, PONV and oxygenation pre- and post-mobilization to demonstrate the feasibility of measuring these outcomes in future studies. We are currently engaged in larger studies to address these important questions and look forward to sharing our findings with the pediatric anesthesia community.
From John Hagen, MD, MBA, FAAP, FASA (Memorial Sloan Kettering Cancer Center) and Deepa Kattail MD MHS FAAP Hospital for Sick Kids Toronto
The Baby-blocks.com team has just launched a local anesthetic calculator for pediatric nerve blocks that is free to use. This app calculates local anesthetic with adjuvants if desired based on age and weight. We want everyone to know it is available and is a great tool for trainees. Please remember that this is work in progress, debugging, updating based on new evidence (either new to us or new to the world), etc. We tried to adhere to being perhaps overly conservative, especially where the literature is gray, and a couple of bugs have already been found since we launched yesterday, but we tried to cobble together as much is what is scattered through the literature into one place. I got tired of trying to remember at what age the spinal dosing dropped off? Or was it weight? (It’s weight).
Here is the link https://www.baby-blocks.com/technique-detail/calculator
PS From Myron: I’m always on the look out for anesthesia/med apps that can be useful to our readers…I’ve never used this calculator and put in some hypotheticals and it appeared to work. I am not endorsing this product and would urge any of you who may use it to be cautious. Let me know if you do use it and I will post your experiences as a consumer report.
From Proshad Efune on adenotonsillectomy v watchful waiting
There are some older studies out of Canada where they developed and validated a score that they call the McGill oximetry score to stratify the severity of OSA/SDB. The score seems to correlate well with the severity of disease and risk of postoperative complications and simply requires wearing a pulse oximeter overnight at home and having the data downloaded. Not sure why this never caught on and was incorporated into mainstream practice. Would be curious to know if any centers, particularly in Canada, are using this score.
Nixon GM, Kermack AS, Davis GM, Manoukian JJ, Brown KA, Brouillette RT. Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. Pediatrics. 2004;113(1 Pt 1):e19-e25. doi:10.1542/peds.113.1.e19