This is a spot for discussions by professionals who are all about kids' anaesthesia.
Episode 7: Making New Boxes
A podcast on kids with challenging perioperative behaviours with particular reference to kid with autism. With Dr Andrew Weatherall.
The Tough Talk
This episode is a recorded version of a talk for the Don't Forget the Bubbles Conference. It's about the parent's perspective in those conversations where they are receiving bad news. With Dr Andrew Weatherall.
The Songs or Stories Podcast Episode 5 - The ABC of Ts and As
Time for another podcast and a chance to introduce a new guest. Dr David Kinchington has things to share about bread and butter paeds anaesthesia - Ts and As. Dr Andrew Weatherall took the chance to pick his brains.
Ts and As represent the sort of work that can challenge paediatric anaesthetists working in a variety of settings. David Kinchington has spent more than a bit of time thinking about this stuff and this conversation is a quick run through things that should be useful to any anaesthetist.
It's not even pretending to be the end of the story. Did you notice this whole site is set up so you can provide comments and clever thoughts? We'd love it if people took the chance to share their clever thoughts with the rest of us. Go hit that comment thing.
Of course any quick chat is the very start of wrestling with this topic. Following is a bunch of links for further reading for the anaesthetist finding the way to deliver periop care for these patients that works best in their hands.
Walker P, whitehead B, Rowley M. Role of paediatric intensive care following adenotonsillectomy for severe obstructive sleep apnoea: criteria for elective admission. J Laryngology Otology. 2013;127(suppl 1): S26-9.
Theilhaber M, Arachchi S, Armstrong DS, Davey MJ, Nixon GM. Routin post-operative intensive care is not necessary for children with obstructive sleep apnea at high risk after adenotonsillectomy. Int J Pediatr Otorhinolaryngology. 2014;78:744-7.
Tweedie DJ, Bajaj Y, Ifeacho SN, et al. Peri-operative complications after adenotonsillectomy in a UK pediatric tertiary referral centre. Int J Pediatr Otorhinolaryngology. 2012;65:809-15.
Hill CA, Litvak A, Canapari C, et al. A pilot study to identify pre- and peri-operatic risk factors for airway complications following adenotonsillectomy for treatment of severe pediatric OSA. Int J Pediatr Otorhinolaryngology. 2011;75:1385-90.
Waters KA, McBrien F, Stewart P, et al. Effects of OSA, inhalational anaesthesia, and fentanyl on the airway and ventilation of children. J Appl Physiol. 2002;92:1987-94.
Hullet B, Salman S, O'Halloran SJ, et al. Development of a Population Pharmacokinetic Model for Parecoxib and Its Active Metabolite Valdecoxib After Parenteral Parecoxib Administration in Children. 2012;116:1124-33.
Li X, Zhou M, Via Q, Li J. Parecoxib sodium reduces the need for opioids after tonsillectomy in children: a double-blind placebo-controlled randomised clinical trial. Can J Anesth. 2016;63:268-74.
Carroll JL, McColley SA, Marcus CL, et al. Inability of Clinical History to Distinguish Primary Snoring from Obstructive Sleep Apnea Syndrome in Children. Chest. 1995;108:610-8.
Leong AC, Davis JP. Morbidity after adenotonsillectomy for paediatric obstructive sleep apnoea syndrome: waking up to a pragmatic approach. J Laryng Otol. 2007;121:809-17.
Brouillette RT, Morielli A, Leimanis A, et al. Nocturnal pulse oximetry as an abbreviated testing modality for pediatric obstructive sleep apnea. Pediatr. 2000;105:405-12.
Wilson K, Lakheeram I, Morielli A, et al. Can Assessment for Obstructive Sleep Apnea Help Predict Postadenotonsillecotmy Respiratory Complications? Anesthesiol. 2002;96:313-22.
De Oliveira GS, Almeida MD, Benzon H, McCarthy RJ. Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain: A Meta-Analysisis of Randomised Controlled Trials. Anesthesiol. 2011;115:575-88.
Riggin L, Ramakrishna J, Sommer DD, Karen G. A 2013 updated systematic review and meta-analysis of 36 randomised controlled trials; no apparent effects of non-steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy. Clinical Otol. 2013;38:115-29.
Dorkham MC, Chalkiadis GA, von Ungern Sternberg BS, Davidson AJ. Effective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: barriers and possible solutions. Ped
A Real World Update on MPS - Podcast #4
This time there is a brand new guest, the very excellent Dr Gail Wong. Gail works at The Children's Hospital at Westmead but also spent a number of years at Sick Kids' in Toronto. Starting with the sort of case none of us relish, the chat covers the mucopolysaccharidoses, management of tricky airways and the ways modern treatments have made the old descriptions of kids with these conditions less relevant.
Gail kicks off with a case she's had prior clearance to discuss.
The intro mix is by Blank & Kytt and the outro bit is by Breakmaster Cylinder and is provided under an Attribution Licence/Creative Commons set up on the Free Music Archive.
There is plenty of extra reading to check out to get a more comprehensive story about kids with these conditions than we could cover in a quick chat.
Here's the one by Walker and crew mentioned in the conversation:
Kirkpatrick K, Ellwood J, Walker RWM. Mucopolysaccharidosis type I (Hurler syndrome) and anaesthesia: the impact of bone marrow transplantation, enzyme replacement therapy, and fiberoptic intubation on airway management. Pediatr Anesth. 2012;22:745-51.
Here's a couple of reviews:
Hack HA, Walker R, Gardiner P. Anaesthetic implications of the changing management of patients with mucopolysaccharidoses. Anaesthesia Intensive Care. 2016;44:660-8.
Walker R, Belani KH, Braunlin EA, et al. Anaesthesia and airway management in mucopolysaccharidosis. J Inherit Metab Dis. 2013;36:211-9.
Here are a couple covering longer-term outcomes:
Aldenhoven M, Wynn RF, Orchard PJ, et al. Long-term outcome of Hurler syndrome patients after hematopoietic cell transplantation: an international multi-centre study. Blood. 2015;2164-72.
Lum SH, Stephen KM, Ghosh A, et al. Long term survival and cardiopulmonary outcome in children with Hurler syndrome after haematopoietic stem cell transplantation. J Inherit Metab Disease. 2017;40:455-60.
Songs or Stories Podcast #3 - IARS 2017 Review
Dr Andrew Weatherall sits down to record a few stand out points from the recent IARS 2017 meeting in Washington, DC. This is mostly stuff relevant to paediatric anaesthesia. There's a bit on neurotoxicity, a little on neurodevelopment and a bit of virtual reality thrown in for good measure.
Episode 2 - The Line on Lines
Returning for Episode 2, the Songs or Stories Podcast takes on Peripherally Inserted Central Catheters (PICCs). Dr Hillel Hope joins Andrew Weatherall to talk about these sometimes pesky things - why we're asked to put them in, choosing a line, complications, insertion practice and troubleshooting.
As always all thoughts, comments and tips from your own practice will be gratefully received.