Week in review February 13-17
Myron Yaster MD
What a Tangled Web We Weave- ASRA Guidelines on the Management of the Perioperative Patient on Cannabis and Cannabinoids.
Genevieve D’souza, MD, FASA, Rita Agarwal, MD, FAAP, and Myron Yaster MD
Original article
Shah S, Schwenk ES, Sondekoppam RV, Clarke H, Zakowski M, Rzasa-Lynn RS, Yeung B, Nicholson K, Schwartz G, Hooten WM, Wallace M, Viscusi ER, Narouze S. ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids. Reg Anesth Pain Med. 2023 Mar;48(3):97-117. PMID: 36596580.
With the rising prevalence of both medical and recreational cannabis use in adults, adolescents and children, anesthesiologists, surgeons, pain and perioperative physicians must have an understanding of the effects of cannabis on physiology in order to provide safe perioperative care.
Perioperative Care of Pediatric Patients with Congenital Heart Disease Undergoing Non-Cardiac Procedures: A Survival Guide
Susan Nicolson MD, Viviane Nasr MD, James DiNardo MD, Lindsey Loveland Baptist MD
Original article
Nasr VG, Markham LW, Clay M et al. on behalf of the AHA Council on Lifelong Congenital Heart Disease and Heart Health in the Young and Council on Cardiovascular Radiology and Intervention. Perioperative Considerations for Pediatric Patients with Congenital Heart Disease Presenting for Noncardiac Procedure: A Scientific Statement From the American Heart Association. epub 21 january 2023 Circulation: Cardiovascular Quality and Outcomes PMID: 36519439
More than 90% of children born with CHD are surviving to adulthood. Improved survival superimposed on an increased incidence of indications for non-cardiac procedures results in more pediatric patients with CHD presenting for non-cardiac surgery, diagnostic and interventional procedures.
Hypotension on sevoflurane induction in Down syndrome patients
Myron Yaster MD and Sean Barnes MD
Original article
Adler AC, Nguyen HY, Nathanson BH, Chandrakantan A. Incidence of hypotension during sevoflurane induction in children with down syndrome; a prospective observational study. Paediatr Anaesth. 2023 Mar;33(3):259-262. PMID: 36398429
There was no association between bradycardia and hypotension and there was no association between bradycardia and sevoflurane concentration.
Ultrasound guided dorsal penile vs pudendal nerve blocks for circumcision
Myron Yaster MD, Rita Agarwal MD, Fabian Okonski MDI
Original article
Frédérique Boisvert-Moreau , Bruno Turcotte, Natalie Albert, Narcisse Singbo, Katherine Moore, Ariane Boivin. Randomized controlled trial (RCT) comparing ultrasound-guided pudendal nerve block with ultrasound-guided penile nerve block for analgesia during pediatric circumcision. Reg Anesth Pain Med. 2023 Mar;48(3):127-133. PMID: 36396298
Both techniques work and provide equal post operative analgesia
Reader response
Jerry Parness MD, retired comments on Methadone
Gil Gavel NHS Consultant Anaesthetist,Aberdeen Children's Hospital comments on bradycardia and hypotension in Down children during the induction of anesthesia