Week in review July 24-28, 2023
Myron Yaster MD
Are You Green Enough? Embracing Sustainability in Anesthesia
Veronica Zoghbi, MD and Germana Silva, MD and the SPA SIG for Sustainability
Original Article
Ahn, J; Bennici, L; Costa, A. “The Gas Looks Greener on the Other Side: Using Novel Tech to Minimize Anesthesia Greenhouse Emissions.” ASA Monitor. June 2023. 24.
One method of helping save the environment is remember that volatile anesthetics are more potent as greenhouse gases than CO2 and they contribute to global warming. Get rid of desflurane, lower your fresh gas flows and consider eliminating nitrous oxide or using nitrous from anesthesia machine E cylinder tanks and not walled nitrous.
Sugammadex Vial Wastage: Implications for the Cost of Anesthesia Care in Children
Myron Yaster MD and Lynn Martin MD, MBA
Original article
Mpody, C. , Beltran, R. , Hayes, S. , Nafiu, O. & Tobias, J. (2023). Sugammadex Vial Wastage: Implications for the Cost of Anesthesia Care in Children: Research Letter. Anesthesiology, 139 (1), 108-109. doi: 10.1097/ALN.0000000000004551.
Unadministered drugs account for more than 25% of the anesthesia medication budget. Because the ampules of sugammadex are designed for adults drug wastage occurs in almost 3 out 5 doses. Consider having your pharmacy break down sugammadex vials to smaller more pediatric favorable doses
Physician Suicide: We can’t fix a problem we don’t talk about
Adam Was, MD & Rebecca Margolis, DO, FAOCA
Approximately 120 physicians die by suicide each year. This is essentially an entire medical school class. Anesthesiologists (M>F) are particularly hard hit. The authors provide a detailed list or resources to help.
Management of inguinal hernias in children
Myron Yaster MD and Lynne G. Maxwell MD
Original article
Faraz A. Khan, Tim Jancelewicz, Kathleen Kieran, Saleem Islam, COMMITTEE ON FETUS AND NEWBORN, SECTION ON SURGERY, SECTION ON UROLOGY; Assessment and Management of Inguinal Hernias in Children. Pediatrics July 2023; 152 (1): e2023062510. 10.1542/peds.2023-062510
An excellent review of the anatomy, embryology, pathophysiology, and methods and timing of surgical repair of the patent processus vaginalis (PPV) and of the anesthetic issues involved in management of these mostly very young patients.
Reader response
Benjamin Walker, MD comments on the epidural test dose and makes the case that using ultrasound guidance is a much better of “seeing” intravascular injection. Dr. Sapn Kudchadkar shares a beautiful article that celebrates PICU nurses from a parents perspective. Dr. Rebecca Lowery comments on OR waste and tells the tale of disposable ECG leads.