Reader response and celebrating the distinguished career of Elliot Krane, MD

Myron Yaster MD

From Kyle Kramer on fasting guidelines

Loved today’s PAAD. This continues to be a topic of interest in our (dental/OMS) world. One of the items that I discussed in a recent editorial was the difficulties with certain patients/families in failing to understand NPO guidelines. Working in non-OR settings, we have to be quite careful and follow the ASA fasting guidelines strictly. I realize that recent data supports some of the benefits of altered fasting; however, these still are not really practical in our world for many of our patients. I try to assess each patient/family to get a sense of how compliant they are likely to be with preop/post op instructions and often tailor some aspects of my care accordingly. For example, I’ll occasionally have a parent that I have major concerns with being able to differentiate ibuprofen from tylenol. I might omit the use of ketorolac for immediate postop analgesia in that patient and simply have mom/dad start oral ibuprofen/tylenol asap upon awakening. Similarly, I tend to adjust NPO instructions accordingly too. I’ve even had to adjust my language to include specifics like “and remember, candy is still food, so none of that.” In short, while I get what the science is starting/continuing to show us, I still am reluctant to move away from mainstream NPO guidelines at this time. Our surgical procedures are “minor” certainly compared to many of the other major ones included in many of the recent fasting studies. As such, we don’t have to deal with many of the negative issues often mentioned in supporting more aggressive NPO guidelines. Another item that should be mentioned is the lack of ample emergent support in non-OR setttings. There is no code team who can rush in during an emergency: It is my nurse, the treating dentist, their assistant, and me. That’s it. A conservative approach given all these factors trumps more liberal approaches.

From Genevieve D’Souza, MD and Rita Agarwal MD

At the annual meeting of International Symposium on Pediatric Pain, Dr. Elliot Krane, MD was honored with the Distinguished Career Award and gave a Plenary Lecture at the end of the Conference.

Dr. Krane was born in Philadelphia, and grew up in Tucson. He was the son of a watchmaker and a bookkeeper.  He trained in pediatrics and anesthesiology at Massachusetts General Hospital and completed a fellowship in pediatric anesthesiology and critical care medicine at the Boston Children's Hospital.

He recently retired from Stanford University after a long and productive career in both pediatric anesthesia and pediatric pain medicine.  He spent 11 years at the University of Washington where he opened the first pediatric pain clinic in North America and co-founded the Pediatric Regional Anesthesia Network (PRAN). He spent 30 years at Stanford University, where he was the Chief of Pediatric Pain Management, and for the first decade the Chief of Pediatric Anesthesiology.  While in Seattle, he and his colleague Donald Tyler founded the 1st Symposium on Pediatric Pain, which took place in 1988.  This year he received a distinguished career award at its 14th meeting in Halifax.

He has published extensively in the fields of anesthesiology, juvenile diabetes, anesthetic induced myocardial depression, patient safety, and of course pediatric pain.

In addition to Pain Management, he holds specialty certification in Pediatrics, Anesthesiology, Pediatric Anesthesiology and Critical Care Medicine and is a Fellow of the American Academy of Pediatrics. 

He has received the Physician’s Recognition Award in both Anesthesiology and Pediatric Critical Care from the American Medical Association, the Jeffrey Lawson Award for Advocacy in Children’s Pain Relief from the American Pain Society, the Ellis N. Cohen Achievement Award from the Stanford University Department of Anesthesiology, Perioperative and Pain Medicine, and grant support from the Mayday Fund, NIH, American Medical Association, Washington State Society of Anesthesiologists, Diabetes Research and Education Foundation, and American Society of Anesthesiologists as well as various small and large pharma companies for drug development for the treatment of  pain in children.

Dr Krane gave a Ted Talk in March 2011 which currently has over 2 million views on YouTube.

https://www.ted.com/talks/elliot_krane_the_mystery_of_chronic_pain?language=en

He was one of the founding members and President-Elect of the Pediatric Research Network for Pain (PRN-Pain).

He was on the International Association for the Study of Pain Presidential Task Force on Cannabis and Cannabinoid Analgesia to formulate the IASP Position Statement on the Use of Cannabinoids to Treat Pain.

During his plenary lecture, Dr. Krane highlighted the achievements in his career at Stanford Children’s including a first of its kind program evaluation and treating patients with spontaneous CSF leaks, that includes epidural blood and or fibrin glue patches under fluoroscopy., the use of lidocaine and ketamine infusions for CRPS, creation of an intensive outpatient  Pediatric Rehabilitation Program, research on CRPS, and research on Sigma -1 Receptor and its role in Pain Receptors.

Now in his retirement, Dr. Krane is tutoring first generation High School underprivileged Children and giving them career counseling to keep busy.