Carol A. Hirshman, M.D., Editor.
Pediatric Anesthesiology. Tampa, Florida, February 15–18, 1996.
The second annual meeting jointly sponsored by the Society for Pediatric Anesthesia (SPA) and the Section on Anesthesiology of the American Academy of Pediatrics (AAP) was attended by more than 300 physicians. Welcoming remarks were delivered by William Greeley, M.D. (Duke University), SPA president, and J. Michael Badgwell, M.D. (Texas Tech University), Chairman, AAP Section on Anesthesiology. The opening session was moderated by Dr. Badgwell and addressed the issue of Trauma in Children. This is a major public health concern, because trauma is the leading cause of death in children. It results in more than 22,000 deaths annually in the United States in children younger than 19 yr and more than half of all deaths for those aged 1–15 yr. In addition, an estimated 600,000 children are hospitalized, and there are more than 30,000 survivors annually with permanent disabilities. Clearly, anesthesiologists will be involved in the management of many of these patients, and the topic Trauma in Children was presented from many perspectives. Joseph Weinberg, M.D. (LeBonheur Children's Hospital, Memphis), the Chairman of the AAP's Committee on Pediatric Emergency Medicine, began with Pre-Hospital and Emergency Room Care. J.J. Tepas III, M.D. (University of Florida, Jacksonville) discussed OR Care from the Surgeon's Perspective, and Steven Hall, M.D. (Children's Memorial Hospital, Chicago) discussed OR Care from the Anesthesiologist's Perspective. ICU Care and Outcome were reviewed by David Nichols, M.D. (Johns Hopkins University). Karen Slay (Lubbock, Texas) then discussed her grassroots campaign to seek legislative action to ban children from riding unrestrained in the back of open pick-up trucks. This is in response to the large number of pediatric injuries and fatalities that have occurred in Texas and throughout the country because of this activity.
Another scientific session was devoted to Advances in Pediatrics/Anesthesia and was moderated by Frank McGowan, M.D. (Children's Hospital, Boston). This consisted of three separate presentations, each with a state-of-the-art review of a clinical problem by a pediatric specialist, followed by comments regarding the anesthetic implications by a pediatric anesthesiologist. Pamela Zeitlin, M.D., Ph.D. (Johns Hopkins University) and (her husband) Myron Yaster, M.D. (Johns Hopkins University) discussed Pulmonary Advances in Cystic Fibrosis. Ernest Turner, M.D. (Meharry Medical College) and Brenda McClain, M.D. (Vanderbilt University) discussed Hematologic Advances in Sickle-Cell Anemia. J. Geoffrey Stevenson, M.D., and Anne Lynn, M.D. (both from the Children's Hospital, Seattle) discussed The Role of Echocardiography in the OR. Finally, a superb update was given by Diane Wara, M.D. (University of California, San Francisco) on Pediatric AIDS.
Presentation of research and work-in-progress was an important part of the meeting as well. A number of sessions were devoted to oral abstracts. Moderators included Paul Hickey, M.D. (Children's Hospital, Boston), Randall Wetzel, M.B.B.S. (Johns Hopkins University), and Charles Cote, M.D. (Children's Memorial Hospital, Chicago). A separate session highlighted the many abstracts displayed throughout the meeting in poster format. This was moderated by Jeffrey Morray, M.D. (Children's Hospital, Seattle) and included discussions related to Pain Control (Charles Berde, M.D., Ph.D., Children's Hospital, Boston), Drugs in Anesthesia Practice (Barbara Brandom, M.D., Children's Hospital, Pittsburgh), and Other Interesting Clinical Observations (Frederic Berry, M.D., University of Virginia).
A number of prizes were given at a special awards session moderated by Patty Davidson, M.D. (Ohio State University). John J. Downes, M.D., Chairman of the Department of Anesthesia at the Children's Hospital of Philadelphia, received the AAP's Robert M. Smith Award, presented by one of his colleagues, Eugene Betts, M.D. Ronald Litman, M.D. (University of Rochester) presented his paper entitled Levels of Consciousness and Ventilatory Parameters in Young Children during Sedation with Oral Midazolam and Increasing Concentrations of Nitrous Oxide, which was supported by a grant last year from SPA and the Foundation for Anesthesia Education and Research (FAER). It was also announced that Robert Wilder, M.D., Ph.D. (Children's Hospital, Boston) has been awarded the 1996 SPA/FAER Grant and will present his research on Mechanisms of Tachyphylaxis to Local Anesthetics at next year's meeting.
Three awards were presented by the AAP for best papers by residents/fellows-in-training. First prize went to Andrew Zimmerman, M.D., for his paper entitled The Threshold for Low-Flow Cardiopulmonary Bypass as Assessed by Transcranial Doppler Sonography in Infants Undergoing Cardiac Surgery (collaborators were P. Hickey and F. Burrows). Second prize went to Shoichi Uezono, M.D., for his paper entitled Regulation of Intercellular Adhesion Molecule-1 (ICAM-1) Expression on Cultured Human Pulmonary Vascular Endothelial Cells (collaborators were F. McGowan, P. Hickey, G. Zund, and S. Colgan). Third prize went to Elizabeth Eldredge, M.D., for her paper entitled Comparison of Intraoperative External Anal Sphincter Electromyography and Anorectal Manometry Monitoring During Surgical Release of Tethered Spinal Cord (collaborators were S. Soriano, S. Nurko, R. M. Scott, L. Goumnerova, S. Bauer, M. Kelley, M. Darby, and M. Rockoff).
All three trainee award recipients were members of the Department of Anesthesia of the Children's Hospital, Boston. The course's program director received a few gentle barbs because of this, but it was acknowledged that 14 reviewers judged the abstracts in a blinded fashion, and the AAP chose award recipients based on total grades achieved. The SPA also gave out two awards for the best papers by young investigators out of training less than 3 yr. First prize went to Douglas Ririe, M.D. (currently at Bowman-Gray University) for his paper entitled Increased Sensitivity to Vecuronium in Children with Duchenne's Muscular Dystrophy (collaborators were F. Shapiro and N. Sethna). Second prize went to Jennifer deVries, M.D. (Children's Hospital, Akron) for her paper entitled A Study of the Effects of a Parent's Presence in the Operating Room on Their Child's Experience (collaborator was T. Vetter).
Throughout the meeting, a number of hands-on workshops were held. Lynne Ferrari, M.D. (Massachusetts Eye and Ear Infirmary) organized two workshops on Airway Equipment and Techniques. Assisting her in one devoted to Laryngeal Mask Airways and Lightwands were Guy Dear, M.D. (Duke University), Joseph Frassica, D.M.D., M.D. (University of Massachusetts), Hernando DeSoto, M.D. (University of Florida, Jacksonville), and Scott Cook-Sather, M.D. (Children's Hospital of Philadelphia). Robert Moynihan, M.D. (University of California, Davis) and Charles Nargozian, M.D. (Children's Hospital, Boston) assisted with a workshop devoted to Fiberoptic Laryngoscopy. Linda Jo Rice, M.D. (Hartford Hospital) organized three workshops related to Pain Management. Brittany Vetter, Rachel Bailey, and Kristin Bailey, children of pediatric anesthesiologists, served admirably as very cooperative models. Assisting Dr. Rice in one workshop devoted to Common Regional Anesthesia Techniques were Ann Bailey, M.D. (University of North Carolina), Nancy Glass, M.D. (Texas Children's Hospital), and Connie Houck, M.D. (Children's Hospital, Boston). Allison Ross, M.D. (Duke University), Navil Sethna, M.B., B.Ch. (Children's Hospital, Boston), and Myron Yaster, M.D. (Johns Hopkins University) assisted in a workshop devoted to Advanced Regional Anesthesia Techniques. David Cohen, M.D. (Children's Hospital of Philadelphia), Jeffrey Koh, M.D. (Arkansas Children's Hospital), Blaine Miller, D.O. (Children's Healthcare, Minneapolis), and Thomas Vetter, M.D. (Children's Hospital, Akron) assisted in a workshop devoted to Organization of a Pain Treatment Service (Protocols, Procedures, Billing). Frank Kern, M.D. (Duke University) organized a workshop on ICU Care (Ventilators, CPR, Interosseous Infusions) and was assisted by Jay Deshpande, M.D. (Vanderbilt University), Sal Goodwin, M.D. (University of Florida, Gainesville), Ira Cheifetz, M.D. (Duke University) and Charles Schleien, M.D. (Jackson Memorial Hospital, Miami). Anne Lynn, M.D. (Children's Hospital, Seattle) organized a workshop on Echocardiography and was assisted by J. Geoffrey Stevenson, M.D. (Children's Hospital, Seattle) and Robert Friesen, M.D. (Children's Hospital, Denver).
One of the highlights of the meeting was the use of a computerized, audience-participation, survey system. Each registrant had access to a keypad that permitted anonymous responses to questions, with results being displayed immediately in graphic form to the entire audience. This technology was used throughout the meeting, but especially during an Anesthesia Practice Trend Survey conducted by Rae Brown, Jr., M.D. (Arkansas Children's Hospital) and David Lowe, M.D. (St. Christopher's Hospital, Philadelphia). Many questions were posed regarding common issues in the practice of pediatric anesthesiology, and the audience was able to participate and see how their practices were similar (or different) from their colleagues. This technology was also used extensively by Mark Rockoff, M.D. (Children's Hospital, Boston) during a novel, computer-interactive, audience-participation Case Presentation. Three discussants (Charles Lockhart, M.D., Children's Hospital, Denver; Lynda Means, M.D., Riley Children's Hospital, Indianapolis; and James Viney, M.D., Primary Children's Hospital, Salt Lake City) commented on how the audience responses corresponded to their practices. The session clearly displayed the varied opinions of experienced pediatric anesthesiologists when dealing with many controversial clinical issues.
The meeting's final session was devoted to an Anesthesia Practice Update, moderated by William Greeley, M.D., M.B.A. (Duke University). Jean Wright, M.D., M.B.A. (Egleston Children's Hospital, Atlanta) spoke on Managing Rapid Change, Jerome Modell, M.D. (University of Florida, Gainesville) spoke on Contracted Care: Effect on Subspecialist Practice, and David Jardine, M.D. (Children's Hospital, Seattle) demonstrated how Information Can Be Put To Use: The Internet and Other Applications for Pediatric Anesthesiologists. The meeting concluded with a very supportive message from Carden Johnston, M.D. (Children's Hospital, Birmingham), who is a member of the Board of Directors of the AAP and the newly elected Chairman of the Council of Medical Specialty Societies. He emphasized the AAP's desire to assist pediatric anesthesiologists, and other subspecialists, in their goal to improve care for children.
One of the purposes of this meeting was to enable anesthesiologists who care for children to interact with each other in a congenial setting. This was facilitated by a number of breakfasts, receptions, and an evening paddle-wheel boat cruise of Tampa Harbor.
The next joint meeting of the SPA/AAP Section on Anesthesiology is scheduled for a lovely family resort (The Hyatt Regency Hill Country Hotel) in San Antonio, Texas. It will be held on President's Weekend, February 13–16, 1997, and anyone with an interest in pediatric anesthesiology is welcome to attend.
Mark A. Rockoff, MD; Program Chairman and Vice President, Society for Pediatric Anesthesia, Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115–5737.