Welcome

By Linda J. Mason MD
Program Chair

This year’s Pediatric Anesthesiology 2010 Meeting will be held in conjunction with the American Academy of Pediatrics Section on Anesthesiology & Pain Medicine, April 15-18, 2010 at the Grand Hyatt, San Antonio, Texas.  This beautiful location will allow a combination of the presentation of new educational information and the opportunity to interact with colleagues in a unique environment.

As the Program Chair I am excited with how the program has evolved.  On behalf of myself, Assistant Program Chair – Mary Ellen McCann (Refresher Courses and Workshops), Julie Niezgoda (PBLD coordinator) and Constance Houck (AAP section chair) we welcome you to a meeting filled with innovative topics and knowledgeable speakers. 

The 2010 meeting has many highlights and offerings, including: 22 CME credits for the SPA meeting; plus eight additional credits for the CCAS meeting on Thursday.

Thursday will feature meetings of the Congenital Cardiac Anesthesia Society (CCAS) and an advanced ultrasound guided regional anesthesia workshop, which will also be repeated Friday, and Saturday afternoon.  Registration for the CCAS meeting is separate, and for those who register for the SPA meeting, a pediatric advanced life support course is available with a separate registration fee.

Friday’s topics include: Anesthesia Outside the OR: Adventures with Really Magnetic Personalities: New challenges in MRI and an Update on Pediatric Sedation Models.  The next session: The Pediatric Patient with Chronic Pain will include Prolonged Opioid Use in the Pediatric Patient and Anesthetic Considerations for Patients with Chronic Pain.  The final session of the morning will be an update on New Monitoring Devices for the Pediatric Patient – Do They Make a Difference in Outcomes?  Following the morning session will be lunch including the AAP - Robert M. Smith Award Presentation and the AAP Advocacy lecture – For Pain and Gain – Prescription Drug Abuse by Adolescents presented by Janet Williams, M.D., Chair, AAP Committee on Substance Abuse and Professor of Pediatrics, University of Texas Health Science Center, San Antonio, Texas.

On Saturday we will be repeating a morning session called, “The Pediatric Core.”  This year the core topic will be devoted to neurologic disease.  The session is intended to provide an update on what is new and relevant in the management of neurologic problems including, autism, AD/HD, cerebral palsy and seizure disorders.  After the morning scientific session - including the walk-around poster discussions and presentation of the AAP and SPA abstract awards - the AAP Ask the Experts panel will include an audience response discussion tied to the core lecture series, with specific cases addressing the anesthesia management of patients with neurologic disease.

Sunday will begin with a lecture from Nick Franks, FRCA, FMedSci, from Imperial College, London entitled Mechanisms of General Anesthesia.  This lecture will be followed by a review of the past year’s most significant articles by the editors from Pediatric Anesthesia, Anesthesia and Analgesia, Anesthesiology, and Pediatrics.

In addition, there are many new workshops and some truly excellent refresher courses as well as many of the old favorites such as Jeopardy, Walk Around Posters, and the Problem Based Learning Discussions on Friday, Saturday, and Sunday mornings. 

As I complete my service as Program Chair, I would like to say thanks to all those who have helped to assemble this meeting especially the Education Committee, the SPA Board Members, and the Staff of the SPA office.  Finally a huge thanks to Mary Ellen McCann, Julie Niezgoda and Constance Houck – I couldn’t have done this without their expertise and great ideas!

I hope you enjoy the meeting.

Meeting Information

Education Mission Statement

The annual Winter/Spring Meeting will focus on topics of interest to those who provide anesthesia, sedation, pain management, and critical care services to infants and children. The overall goals for attendees of the program are to reinforce and enhance their existing fund of knowledge, and to introduce them to new and state-of-the-art issues that affect their practice in order to improve the perioperative/critical care of pediatric patients.

Scope & Types of Activities

The program brings together experts from clinical and basic science disciplines related to pediatric medicine, anesthesia, and surgery.

General topic areas include anatomy, pathophysiology, anesthetic pharmacology, sedation, pain management, patient safety, and child advocacy issues. We will also discuss practice and career management issues. The presentation format is varied, and includes lectures and refresher courses, panel discussions, hands-on workshops and problem-based learning discussions. Additionally, an important part of the program is the presentation of new clinical and basic science research in oral and moderated poster-discussion forums. Significant attendee involvement and feedback are encouraged in all aspects of the program, and will be facilitated by the use of real time computerized audience polling as well as sessions where the audience directly participates in case discussions. Program content is, in fact, the direct result of membership input and extensive audience polling at prior meetings.

Target Audience

This program is intended for anesthesiologists and other practitioners who care for children in their practice of anesthesiology and/or critical care. It is also intended for clinical and basic science researchers whose areas of investigation relate to pediatric anesthesia.

Accreditation & Designation

SPA/AAP Program: The Society for Pediatric Anesthesia is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Society for Pediatric Anesthesia designates this educational activity for a maximum of 22 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Objectives

Anesthesia Outside the OR

Adventures with Really Magnetic Personalities: New Challenges in MRI
Learning Objectives:

1. The participants will be able to identify the impact of new MRI technology on
   • patient safety
   • patient monitoring and temperature control
   • type and quality of information obtained from studies
2. The participants will understand the importance of safety education and a team approach with imaging staff for optimal patient care

Update on Pediatric Sedation Models
Learning Objectives:

1. Review ASA and AAP guidelines for sedation of children in non-operative settings
2. Discuss design and implementation of pediatric anesthesia sedation services
3. Discuss pediatric sedation services run by non-anesthesiologists
4. Review PK and PD of commonly used drugs for pediatric sedation
5. Discuss quality assurance initiatives
6. Discuss role of the anesthesia department

The Pediatric Patient with Chronic Pain

Prolonged Opioids, Pediatric Patients and Problems
Learning Objectives:

1. To examine the clinical epidemiology of opioid tolerance and dependence
2. To briefly review the cellular biochemical mechanisms, clinical and pharmacological factors, pharmacogenetics and pharmacogenomics associated with opioid tolerance and withdrawal
3. To develop strategies for prevention of problems resulting from prolonged opioid therapy
4. To briefly review the therapeutic options to treating opioid withdrawal

Anesthetic Considerations for Patients with Chronic Pain
Learning Objectives:

1. Understand the common medications used in chronic pain patients
2. Understand important drug and pharmacogenetic interactions of medications used for chronic pain management
3. Understand perioperative management of the opioid tolerant patients

An Update on New Monitoring Devices for the Pediatric Patient – Do They Make a Difference in Outcomes?

Near Infrared Cerebral Oximetry: Is it ready for prime time?
Learning Objectives:
At the end of the talk the participants will have an understanding of the technology of cerebral oximetry, its clinical applications and impact on outcomes, currently available commercial devices and the limitations of cerebral oximetry.

Non Invasive Multimodal Monitoring
Learning Objectives:
Gain an understanding of current technologies for non invasively monitoring oxygen saturation, carboxyhemoglobin, methemoglobin and hemoglobin.

Continuous Glucose Monitoring and Outcomes
Learning Objectives:

1. To discuss the relationship between glucose control and critical illness
2. To describe the relationship between hyperglycemia and outcome in pediatric traumatic brain injury (TBI)
3. To describe currently available continuous glucose monitoring tool

Echocardiography for Every-Day Anesthesia
Learning Objectives:

1. Review the advantages and disadvantages for echocardiography as a means to monitor cardiac function and detection of air embolism during anesthesia
2. Discuss the current use of echocardiography during cardiac anesthesia and training requirements
3. Provide a rationale for the routine availability and use of echocardiography as a noninvasive monitor during non-cardiac anesthesia

AAP Advocacy Lunch - For Pain and Gain: Prescription Drug Abuse by Adolescents

Learning Objectives:
Through this presentation, learners will:

1. Review the trends associated with adolescent and young adult prescription drug abuse and dependence in the U.S.
2. Understand the relationship between prescription drug abuse and other substance abuse behaviors
3. Explore the challenges of effective pain management with respect to addiction risks
4. Be introduced to practice techniques to identify prescription drug abuse risk and facilitate substance abuse risk and facilitate substance abuse treatment utilization

Core Lectures – The Pediatric Patient with Neurologic Disease

Cerebral Palsy: An Update on Perioperative Management
Learning Objectives:

1. Discuss changing incidence of cerebral palsy
2. Discuss perioperative concerns and possible new information on management

Autism and AD/HD: An Overview of Current Concepts and Controversies
Learning Objectives:

1. To understand the current diagnostic criteria for AD/HD and Autism, as well as limitations of those criteria
2. To understand the most important aspects of contemporary, evidence-based treatment and intervention for Autism and AD/HD
3. To appreciate the major co-morbidities that affect children with Autism and AD/HD
4. To learn about current controversies in the diagnosis and treatment of children with Autism and AD/HD
5. To learn about current research that will impact the care of children with Autism and AD/HD in the next several years

Neurological Diseases of Children: Anesthesiological Issues
Learning Objectives:
It is expected that attendees may benefit form updated information concerning:

1. Pre-operative management of newer anticonvulsants
2. Special anesthetic problems in heritable metabolic or neuromuscular conditions
   • Intubation and supported ventilation
   • Anesthetic agents
3. Anesthetic agents and status epilepticus

AAP Ask the Experts Panel

Learning Objectives:

1. Review the important preoperative considerations for children with cerebral palsy, seizure disorders and ADHD/autism
2. Learn the most effective strategies for the anesthetic management of children with these neurologic disorders
3. Recognize the potential complications that may arise postoperatively and how to minimize them

Keynote Speaker: Mechanisms of General Anesthesia

Learning objectives:
Upon completion of this lecture the participant will review the current status of anesthetic action at the molecular level, will compare the extent to which anesthetics and natural sleep share common neuronal pathways and will review the possibility that anesthetics cause toxicity in the neonate.

Jeopardy

Learning Objectives:
Those attending this session will have the opportunity to review current pediatric anesthesia practice in a game-show format.

Workshops

Advanced Ultrasound Guided Regional Anesthesia Workshop
Learning Objectives:

1. Understanding basic functions of the US machine with particular attention to the US probes, machine settings for various age groups.
2. Review anatomy using US guidance of all peripheral nerve blocks including upper and lower extremity, truncal and central Neuraxial blocks.
3. Provide an instructional hands-on course with low faculty to attendee ratio to provide an understanding of how to scan and block most common peripheral/central Neuraxial nerve blocks in children.

Fellows Research Workshop
Learning Objectives:
This workshop is intended to provide residents and fellows with a basic overview of research methods and the opportunity to discuss specific topics of interest including, but not limited to: basic statistical methods, sample size, how to critically review the literature, and abstract/manuscript/grant preparation.

Junior Faculty Research Workshop
Learning Objectives:
This workshop is designed for junior and mid-level faculty who are beginning an academic career or who simply wish to advance their knowledge of research methodology. Topics include, but are not limited to: research design, statistical methods, and grant writing.

Success in Academics Workshop
Learning Objectives:
Junior faculty attending this workshop will be exposed to strategies for building a successful academic career.

ACGME Core Workshop
Learning Objectives:
Upon completion of this workshop, the learner will be able to describe the ACGME competencies including professionalism, interpersonal and communication skills, practice based learning and improvement and system based practice, discuss the use of psychometric inventories targeted around specific teaching models to help better teach the advanced competencies, and appreciate and describe the importance of multiple learning modalities including reflection and community-building activities (use of inventories, small and large group interactive techniques) to teach the advanced competencies.

Dexmedetomidine: Clinical Applications, Mechanisms of Action and New Developments Workshop
Learning Objectives:
Upon completion of this workshop, the attendee will review the pharmacology, physiology, pharmacokinetics and mechanism of action of dexmedetomidine, understand the range of clinical applications of dexmedetomidine when used for procedural sedation, in the ICU, in the operating room, understand the advantages, disadvantages and limitations of dexmedetomidine versus propofol, and review via an interactive discussion between faculty panel and the participants the shared experience with dexmedetomidine usage.

Epidural Workshop
Learning Objectives:
Upon completion of this workshop, the participant will have gained an indepth understanding of medications and adjuvants used in epidural management through and evidence-based review, will review different techniques in the placement of thoracic epidurals in neonates, and will discuss choices for neonatal epidural solutions.

Simulation Workshop
Learning Objectives:
Upon completion of this workshop, the participant will be introduced to high fidelity simulation and its uses, will gain an understanding of the elements of performance that can be taught and assessed using high-fidelity simulation, will gain an understanding of the elements of team performance that could impact patient care and will participate in scenarios involving patients with complex medical issues to deepen understanding of approaches to crisis in difficult patients.

Pediatric Airway Workshop
Learning Objectives:
Participants of this workshop will learn about and gain experience with different methods of assessing and securing the pediatric airway, including: imaging techniques, including CT/MRI and 3 dimensional reconstructions of the airway using OsiriX, ultrasound, fiberoptics and using digital video for fiberoptic teaching and review, glidescope, lightwand, supraglottic devices. Will learn about the advantages and limitations of different devices and techniques. Will learn when are they best employed and how do you decide what to use. Will learn about decision making, what are the options when faced with: a known or suspected difficult airway (advanced planning), an airway that proves difficult after induction, and how can they avoid disaster by developing systematic ways of decision-making and self assessment.

Peripheral Vascular Access Workshop
Learning Objectives:

1. Review the advantages and limitations of near infrared devices for achieving peripheral vascular access
2. Understand the issues in using ultrasound as an adjunct for peripheral IV access
3. Demonstrate the ease of intraosseous access as a rapid source of peripheral access

TEE Workshop
Learning Objectives:

1. Understand the mechanics of conducting a basic TEE exam
2. Be familiar with basic interpretation of normal and abnormal TEE images
Integrating Acupuncture in Pediatric Peri-Operative Care and Pain Medicine
Learning Objectives:

1. Review the history and theory of acupuncture
2. Understand scientific evidence of acupuncture practice
3. Evaluate acupuncture meridian systems and micro-system paradigms
4. Incorporate acupuncture in pediatric peri-operative care and pain medicine
5. Participate hands-on demonstration of acupuncture and related techniques

Overview of Personal Financial Planning Workshop
Learning Objectives:

1. Explain basic financial planning topics and terminology
2. Summarize well-accepted financial planning goals for professionals at different stages in their careers: debt management, retirement savings, paying for college, buying a home, etc.
3. Present an overview of reasonable techniques to approach these goals, regardless of economic circumstances
4. Highlight some of the changes in the financial system over the last 18 months
5. Make attendees aware of some avoidable financial pitfalls, inefficiencies and scams

Ultrasound Vascular Access
Learning Objectives:

1. To learn the basic skills necessary to use modern ultrasound equipment to identify cardinal vascular anatomy
2. To develop basic hand-eye coordination skills necessary to excel at ultrasound-guided vascular access
3. To spend a good deal of time using ultrasound equipment to gain access on simulations of neck, groin, and arm vessels

Refresher Courses

The Pediatric Jehovah’s Witness and Other Dilemmas
Learning Objectives:

1. Explain the legal issues concerning the care of Jehovah’s Witness patients
2. Recommend specific options for blood conservation in the perioperative period
3. Explain the treatment options to patients with differing religious beliefs
4. Detect other situations relating to pediatric patients that may present an ethical dilemma

Pediatric Airway Management: Current Modalities
Learning Objectives:

1. To discuss the use of video laryngoscopy in the management of the pediatric airway
2. To discuss the use of optical stylets in pediatric airway management
3. To discuss recent improvements to existing tools for pediatric airway management

We Have Come a Long Way...Is there Anything Left To Do? An Update on Acute Pain Management
Learning Objectives:

1. Identify effective methods for assessment of pain in children and potential pitfalls
2. Explore the concept of multi-modal analgesia for the pediatric patient
3. Present strategies for the more complex patient
4. Review current evidence for QA/QI processes in pediatric pain management

Anesthesia for Noncardiac Surgery in a Patient with CHD
Learning Objectives:

1. Describe a pathophysiologic approach to the patient with congenital heart disease
2. Discuss key features of the history, physical examination and laboratory tests used to determine readiness for surgery
3. Review commonly used anesthetics and their effects on the patient with congenital heart disease
4. Discuss the effects of positive pressure ventilation and cardiopulmonary interactions
5. Present specific case scenarios highlighting management issues for patients with congenital heart disease