From Drs. Myron Yaster and John Fiadjoe
The Pediatric Anesthesia Article of the Day (PAAD) is a blog created by Dr. Ron Litman to share his perspectives on the published literature and his general opinions about pediatric anesthesia practice. After Dr. Litman's passing, Myron assumed the primary responsibility of authoring the PAADs, and in order to broaden the scope and editorial decision process of the reviews, an editorial council was formed. The Society for Pediatric Anesthesia (SPA) graciously agreed to include the PAAD on its website and in its weekly newsletter. Unfortunately, several SPA members have disagreed with the content presented in the PAAD.
Because of this and because the views shared in the PAAD are not peer-reviewed or endorsed by the SPA and are the personal opinions of the writers, the SPA Board of Directors has elected to no longer post the PAAD on the SPA website or in the weekly newsletter. From our perspective, this decision is understandable and will not affect the ongoing writing and distribution of the PAAD. Readers will continue to receive it and be able to comment on the articles reviewed. We’ve also made it easier to unsubscribe (at the bottom of each PAAD).
From John Skoog, MD on hydromorphone morphine conversions
I just wanted to add another point to the dosage information. If it is 5 times more potent than morphine, the dose should be 0.04mg/kg (not 0.05 mg/kg) vs the .2 mg/kg of morphine. Please let me know if I’m incorrect.
Response from Myron: John you are correct. The morphine to hydromorphone conversion that I and most people use is 5: 1. The authors in the recent PAAD use 4:1 and we quoted their conversion numbers.
From Anonymous
I couldn't agree more with our colleague who so eloquently stated we need to hold our meetings in locations that support our stated mission and colleagues. Period.
Maybe now we have an opportunity to visit the lovely state of Vermont? Perhaps Minnesota? I don't attend meetings for the location, but rather for the meeting. However, I will NOT travel to a meeting because of the location (not female, LGBT or minority friendly).
From Dr. Bob Spear
One of the most difficult aspects of navigating daily life for many people is—admitting that they are conservative. Fortunately 1/2 of Americans don’t struggle with this problem. In the most recent reader responses, an anonymous person expressed some opinions that I totally understand, totally am empathetic to and completely disagree with. I’m not going to belabor my points because despite having 100% of the facts on my side (conservatives say irritating things like this), I know I have no chance of converting him/her. But please, let me assure you that you are safer than you imagine. Dr. Charles Krauthammer noted than in general, conservatives see liberals as uninformed (he actually said stupid), liberals see conservatives as evil. That’s a fairly wide divide, if I might say so. Anyway, that was the vibe I got from the author’s letter. In recent years, racism (White Supremacy) and all forms of bigotry are fairly liberally {clears throat} assigned to conservatives. I know quite a few conservatives and can say categorically that racist crap isn’t tolerated, isn’t spoken and would be openly challenged if such behavior was observed by others. Seriously, you don’t need to hide from us, and I’m not hiding either. We are both looking at the same thing, using the same tools, but we are looking at these things through opposite ends of a telescope and we just don’t see the same thing. Amazing.
I do believe we have more in common than you think. I have friends (?) who think my views on vaccines are right-wing. They ignore the fact that I logged more hours as a vaccinator at our community clinic than anyone else. My “oh hell no” response to their query about my thoughts on vaccinating healthy teenagers got me the dreaded “anti-vax” label. Not much middle ground out there.
I did find a bit of irony in the idea to boycott upcoming SPA meetings in Florida and Texas citing safety as a concern. I searched upcoming SPA meetings and noted the next 2 “safe“ meetings would be in San Francisco Union Square and Philly. Holy s***.
I hope to join everyone in Anaheim in 2024. And to my conservative friends out there, are we still really boycotting Disneyland? Just kidding. Hopefully we can have a politically mixed pickleball doubles match to settle any unresolved issues or better yet, leave them unresolved.
From Russell Groener, Division of Pediatric Anesthesiology, Washington University In St. Louis
I am writing in strong support of your anonymous correspondent regarding venues for SPA meetings. Inclusivity demands that we select meeting venues where all SPA members feel safe and are not discriminated against. Texas and Florida fail this basic test.
From Paula Belson, PhD, CRNA, CRNA Manager, Children’s Hospital Los Angeles on obesity PAAD
I still remember Dr. Samuel’s lecture as well. It was one of the most informative, eye opening presentations I have had the pleasure to attend. Amazing the impact Dr Samuels made. But it’s also a testament to the importance of having a regular meeting and discussing what is done at different facilities. We are just now starting a bariatric surgery program at CHLA. Thank you for the PAAD and your dedication to pediatric anesthesia.
From Anonymous on obesity PAAD
This is a dangerously narrow viewpoint to take as a physician, especially in pediatrics. We have a duty to see the whole picture, not just the one fed to us. Have you read any of the below issue? Researched any recent data, treatment, or paradigms surrounding fat phobia in the medical community? Are you aware of the number of children and teens (not to mention adults) that we see suffering from eating disorders who are praised for their behavior because of society's warped view of a "healthy" body.
Are you really practicing medicine if your patients don't want to see you?
From Scott Cook-Sather MD on obesity PAAD
I was happy to see that in the discussion of anesthetic considerations for obese patients, there was no mention of gastric fluid volume. I located and reread a paper that I was a co-author on from 2009 which looked at the prevalence of obesity and compared GFV in those with and without obesity in 2 - 12 year olds.(1) To my surprise, Ron Litman was a co-author, something I had totally forgotten. At that time 13% of 2 -12 year olds were obese and 14% were overweight. According to the CDC, 12.7% of 2-5 year olds were now obese in the interval 2017-2020, and 20.7% of 6 - 11 year olds.(2) And as far as GFV goes, when corrected for lean body weight, there were no differences in GFV between obese, overweight and lean/normal weight children. (Can we append the term “normal” anymore, now that so many children are overweight or obese?) In my view, if obese children are at risk for aspiration, it has to do with airway issues rather than GFV.
(1) , Gallagher PR, Kruge LE, Beus JM, Ciampa BP, Welch KC, Shah-Hosseini S, Choi JS, Pachikara R, Minger K, Litman RS, Schreiner MS. Overweight/obesity and gastric fluid characteristics in pediatric day surgery: implications for fasting guidelines and pulmonary aspiration risk. Anesth Analg. 2009;109(3):727-36.PMID: 19690239.