By Mary Ellen McCann MD, MPH
Winter Meeting Program Chair

This year’s Pediatric Anesthesiology 2011 meeting will be held in conjunction with the American Academy of Pediatrics Section on Anesthesiology and Pain Medicine, April 1-3, 2011 at the Sheraton San Diego, San Diego, California. Our program includes presentations of ground-breaking research, audience participation in simulation scenarios, an emphasis on physician wellness and the opportunity to interact with colleagues in a beautiful harborside location.

As Program Chair, I am very excited about this year’s program. On behalf of myself, Assistant Program Chair-Julie Niezgoda (Refresher Courses and Workshops), Kirk Lalwani (PBLD coordinator) and Constance Houck (AAP section chair) we welcome you to a meeting that offers many highlights and offerings, including: 33.5 CME credits for the SPA meeting plus eight additional credits for the CCAS meeting and eight additional credits for the SIG meeting on Thursday, March 31.

Thursday will feature meetings of the Congenital Cardiac Anesthesia Society (CCAS), the Special Interest Group for Pediatric Pain Management. (SIGPPM) and an advanced ultrasound guided regional anesthesia workshop, which will be also repeated Friday and Saturday afternoon. We are also offering a special 6 hour workshop on leadership designed for young faculty preparing to increase their administrative roles within their departments. Registration for the CCAS and SIGPPM meeting are separate but in this brochure. 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 a module on neurotoxicity in the OR which includes lectures on the basic science and clinical evidence of neurotoxicity as well as a lecture on alternative anesthetic techniques. The next module examines: “Controversies surrounding other common therapies in the OR” including at the role of oxygen and other medications for neonates and the ongoing research into proper fluid management for children. The final session is entitled “Health Care Reform: The impact on healthcare delivery”. In this session we will learn about the Massachusetts experience with mandated healthcare and learn about the impact of unfunded federal mandates. Following the morning session there will be lunch meeting which will include the AAP-Robert M. Smith Award Presentation and the AAP Advocacy lecture : “The Affordable Care Act at Year One: Tracking the Law’s Progress for Children” given by Mark Del Monte, the Director of Department of Federal Affairs of the AAP.

Friday afternoon will include Refresher courses on Muscular Dystrophy and updates on Pain Management. This will be followed Pediatric Anesthesia Simulation Wars - NEW to the SPA.

Watch, vote and weigh in as two children’s hospital teams complete using live simulation on stage and screen for the title of SPA Sim Wars Champions. During this fast-paced, interactive session for the entire audience, teams will each participate in a crisis-management scenario, followed by a debriefing by a team of expert judges. The judges and the audience (using the audience response system) will determine the winner!

On Saturday, we will start off the day with our core lecture series devoted to the pediatric patient with endocrine disorders. This session is intended to provide an update on the stress response to surgery, craniopharyngioma and pheochromocytoma. After the morning scientific sessions which will include 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 endocrine disorders. This will be followed by refresher courses on cardiac anesthesia and neonatal anesthetic management.

I am especially delighted to end the day with our keynote speaker, Michael Roizen who will talk about physicians and wellness. Dr. Roizen is a New York Times #1 bestselling author and cofounder and originator of the very popular RealAge.com website. He is chief wellness officer and chair of the Wellness Institute of the Cleveland Clinic and health expert of The Oprah Winfrey Show and the Dr. Oz Show.
This lecture will segue into our Wellness Cocktail Party featuring light snacks, beverages and companionship with colleagues conducive to a wellness lifestyle.
Sunday will begin with a new Pro/Con format involving six senior members of our specialty who will be divided into two teams and will opine about important controversies in pediatric anesthesia. The audience, with help from our moderators, will determine which team has the most convincing opinions. This session will be followed by a review of the past year’s most significant articles by the editors from Pediatric Anesthesia, Anesthesia and Analgesia and Anesthesiology.

In addition, there are many new workshops, refresher courses which provide updates on this years and last years CCAS and SIGPPM meetings, Walk around Posters and 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 me assemble this meeting especially the Education Committee, the SPA Board Members and the Staff of the SPA office. Finally a huge thanks to Lynn Martin, Julie Niezgoda, Kirk Lalwani and Constance Houck-I couldn’t have done this without their expertise and great ideas!
I hope you enjoy the meeting.

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 33.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CCAS 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 7.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Special Interest Group – Pediatric Pain Medicine: 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 5.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Americans With Disabilities Act

The Society for Pediatric Anesthesia has fully complied with the legal requirements of the ADA and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please contact SPA at (804) 282-9780 by March 1, 2011 in order to receive service.

Hotel & City Information

Located at the edge of spectacular San Diego Bay, the Sheraton San Diego Hotel & Marina enjoys panoramic views of the bay and the city skyline yet is just 10 minutes from some of the city’s most popular attractions.

The redesigned hotel offers green initiatives, five restaurants, three swimming pools, tennis courts, a spa and jogging trails.

California’s second largest city and the United States’ eighth largest, San Diego is renowned for its idyllic climate, 70 miles of pristine beaches and a dazzling array of world-class family attractions.

Popular attractions include:

• The world-famous San Diego Zoo and Wild Animal Park,
• Sea World San Diego and
• LEGOLAND California.

San Diego offers an expansive variety of things to see and do, appealing to guests of all ages from around the world. The city’s arts, culture and culinary scenes are booming. The hottest new culinary arts talents prepare award-winning meals throughout the regions 6,400 eating establishments.

Balboa Park, the largest urban cultural park in the U.S., is home to 15 museums, numerous art galleries, beautiful gardens, the Tony Award-winning The Globe Theatres and the world-famous San Diego Zoo.

Pediatric Pain Medicine Special Interest Group Objectives

Integrative Techniques in the Treatment of Chronic Pain
After attending this lecture, the attendees will:

1. Know the common integrative therapies used for treatment of chronic pain
2. Be familiar with literature support for commonly used CAM therapies for treatment of chronic pain
3. Understand how to guide patients and families when asked about what CAM therapies to pursue

Regional Anesthesia Techniques for Palliative Care
Upon completion of this lecture, the attendee will:

1. Understand factors influencing clinical decision-making and potential risks and benefits of intraspinal infusions for children with chronic pain due to non-life-limiting illnesses and for children in palliative care, especially due to cancer and neurodegenerative disorders
2. Be aware of technical issues with placement of intraspinal devices, including the relative advantages and disadvantages of tunneled catheters, ports, or fully implanted pumps
3. Apply the information from goals 1 and 2 to optimize selection of techniques and management strategies for specific clinical settings

Chronic Abdominal Pain in Children
After attending this lecture, the attendees will:

1. Learn at least three common types of pediatric chronic pain and management of these conditions
2. Be able to diagnose and suggest appropriate treatment for pediatric crps
3. Be able to perform at least three common types of injections used in pediatric chronic pain patients
4. Understand how a psychological evaluation is done and why it is important in pediatric chronic pain.

Case Based Discussion on Managing the Complex Acute Pain Consults
Upon completion of this case-based discussion, the attendee will have a better understanding of:

1. The logistical challenges of undertaking a comprehensive biopsychosocial assessment and providing multidisciplinary treatment of pediatric pain in the inpatient setting
2. The interface and transition between an inpatient and outpatient pediatric pain service
3. The management of their own and others’ examples of complex and challenging acute, chronic, and acute-on-chronic pediatric pain patients in the inpatient setting

The Dark Side of Acute Pain Management in Pediatrics: How Did We Get Into This Mess?
Upon completion of this lecture, the attendee will be able to:

1. Describe the most common side effects of opioid therapy (vomiting, pruritus, bowel dysmotility, somnolence, tolerance)
2. Provide a management plan for the treatment of these side effects
3. Outline prospective model of a multi center trial to study medically induced opioid dependence

Pro/Con – Regional Should be First Line Treatment for CRPS
The controversies concerning the management of CRPS are numerous. The few pediatric studies on CRPS are too limited to provide evidence-based strategies. At the end of our presentation the participant will:

1. Understand the pros and cons of peripheral, neuraxial and sympathetic blockade in CRPS.
2. Be familiar with the spectrum of pharmacological intervention --from drug free programs to multi-receptor targeted, pharmacodynamic regimens.
3. Appreciate the multidisciplinary approach and the importance of physical therapy in various types of programs.

Jeopardy
Audience will participate in the discussion of various clinical scenarios, interpretation of diagnostic studies and decision-making processes regarding management of children with congenital heart disease.

SPA/AAP Objectives

Neurotoxicity in the OR-Are We Harming our Patients Brains?

Basic Science of Neurotoxicity
Upon completion of this lecture, the participant will be able to describe the preclinical science driving concern that a host of commonly used sedatives and anesthetic agents may harm the developing brain, identify the limitations of the laboratory research in relation to clinical care, and identify where research in this area is headed and what one can/should say to concerned parents based on the evidence available today.

Update on the Clinical Evidence of Anesthetic Neurotoxicity
Upon completion of this lecture, the participant will be able to review of recent epidemiologic evidence of anesthetic neurotoxicity, and update on the progress of national clinical trials.

Thoughts on Alternatives Techniques from a Survivor of Neonatal Anesthesia
Upon completion of this lecture, the participant will be able to develop strategies to minimize neuro-developmental toxicity of general anesthetics in neonates and infants to review regional anesthetic techniques in neonates and infants as to review the safety of regional anesthesia in neonates and infants.

Controversies Surrounding Other Common Therapies in the OR

Oxygen and Other Toxins
Upon completio n of this lecture, the participant will be able to discuss the role of oxygen toxicity in neurologic and pulmonary development in preterm and term infants to discuss the toxic implications of caffeine administered for apnea in newborns and to discuss the toxic implications of steroid administration in newborns.

The Myth of the Third Space
Upon completion of this lecture, the participant will be able to discuss the origins of perioperative fluid management in children, debate the existence of a third space and discuss isotonic versus hypotonic perioperative fluids and their relationship to postoperative hyponatremia.

Health Care Reform: The impact on healthcare delivery

The Massachusetts Experience
Upon completion of this lecture, the participant will be able to understand the factors precipitating MA Universal Coverage, brief overview of MA Universal coverage, efficacy of MA Universal Coverage, and make a comparison of MA Universal Coverage with new Federal Plan.

Unfunded Federal Mandates
Upon completion of this lecture, the participant will have a brief review of history of unfunded federal mandates, have an impact of recent unfunded mandates on healthcare, and understand the new unfunded mandates imbedded in the new healthcare bill.

AAP Advocacy Lunch - The Affordable Care Act at Year One: Tracking the Law’s Progress for Children
Upon completion of this lecture, the participant will haved learned about the first year of implementation of the Affordable Care Act (ACA) and its impact on children and pediatricians, be able to determine the role of the federal government in ensuring sufficient pediatric subspecialty workforce through ACA and other mechanisms, and learn effective ways to engage and educate federal policy makers through AAP and individual advocacy efforts.

Sim Wars: A Pediatric Anesthesia Simulation Scenario with Audience Participation
Upon completion of this presentation, the participant will have experienced an innovative approach to active learning and evaluation, learn about crisis- resource management during an acute pediatric perioperative event, discuss the importance of communication during and after a patient complication, ascertain and gather different approaches, guidelines and evidence for the management of unanticipated events in infants and children.

Core Lectures-The Pediatric Patient with Endocrine Disorders

Update on Stress Response to Surgery
Upon completion of this lecture, the participant will be able to review the psychologic stress response to surgery, be aware of the physiologic stress response to injury and physiologic stress response to anxiety, and discuss the perioperative and long term physiologic changes after surgery.

Craniopharyngioma
Upon completion of this lecture, the participant will be able to review incidence, treatment and typical presentation of patients with craniopharyngioma, discuss treatment options for patients with craniopharyngioma, discuss immediate perioperative concerns of craniopharyngioma surgery and discuss long term endocrine implications after craniopharyngioma surgery.

Pheochromocytoma
Upon completion of this lecture, the participant will be able to review incidence, treatment and typical presentation of patients with pheochromocytoma and other endocrinopathies associated with pheochromocytoma, discuss treatment options for pediatric patients with pheochromocytoma, discuss immediate perioperative concerns of pheochromocytoma surgery, and discuss longterm endocrine implications after pheochromocytoma surgery.

Keynote Lecture: Wellness and Physicians
Upon completion of this lecture, the participant will understand the connection between wellness and quality of life, and the quality of work environment. Strategies to develop a healthy lifestyle and work environment will be discussed. The costs and benefits of changing the workplace to a “wellness” environment will be discussed. This lecture will be followed by a brief reception with the speaker Dr Michael Roizen and will feature food and beverages which foster health.

Pro/Con Current Anesthesia Practices - A Family Feud Fest
Upon completion of this session, the participant will have the opportunity to review current pediatric anesthesia practice in a game-show format.

Editors Best Picks
Upon completion of this session, the participant will have the opportunity to critically review a few outstanding pediatric anesthesia papers published in the last year, Anesthesiology, Anesthesia and Analgesia, and Pediatric Anesthesia

Workshop Objectives

SPA Leadership Skills Workshop
Upon completion of the workshop the participant will be able to:

1. Differentiate between leadership and management
2. Define the components of emotional intelligence and how it relates to leadership
3. Define organizational culture
4. Delineate the relationship between organizational culture and leadership.
5. Identify the characteristics of an effective leader and team member.
6. Discuss characteristics of effective health care teams
7. Demonstrate use of key communication skills and modalities of conflict management to work effectively in a team
8. Describe different leadership models and identify when each style is most appropriately used
9. Evaluate leadership style usage through different instruments and be able to discuss one’s relative strengths and weaknesses

Advanced Ultrasound Guided Regional Anesthesia Workshop
Upon completion of this workshop, the participant will have an understanding of:

1. Basic functions of the US machine with particular attention to the US probes
2. Machine settings for various age groups
3. Anatomy using US guidance of all peripheral nerve blocks including upper and lower extremity, truncal and central neuraxial blocks, and
4. 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

Junior Faculty Research Workshop
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.

Practicing Pediatric Anesthesia During Surgical Missions, including Disaster Relief: What You Need to Know Workshop
Upon completion of this workshop, the participant will be able to discuss:

1. What equipment you will need to provide anesthesia for patients during non-cardiac short term surgical projects (missions) to a low-middle income country
2. Discuss Mapleson circuits commonly in use during short term surgical projects (missions)
3. Learn about pitfalls and dilemmas that occur in the mission environment by way of case discussions
4. Compare and contrast the provisions of anesthesia during typical missions to provision of anesthesia during relief missions.

Success in Academics
Upon completion of this workshop, the participant will be able to discuss:
1. The elements of career management
2. Enhancement their professional network
3. Completion of their career development plan
4. Taking a proactive role in managing their career.

Pediatric Epidural Workshop
Upon completion of this workshop, the participant will understand

1. The controversy surrounding direct needle placement of thoracic epidurals in infants
2. The technique of caudal advancement of epidural catheters in infants and young children
3. The technique of electrical stimulation to place epidural catheters,
4. The determination of whether the epidural catheter is in the correct surgical dermatome location
5. The infectious and neurologic complications associated with epidural catheters in infants and children and how to reduce associated risks
6. Choosing appropriate epidural solutions to provide the most effective and safe anesthesia and analgesia.

Difficult Pediatric Airway
Upon completion of this workshop, the participant will gain:

1. An understanding of situations in which alternative methods of securing the airway may be necessary
2. An understanding of the development of a systematic anatomic and physiologic approach to the assessment of the difficult airway and to planning airway management
3. An understanding of the availability of new devices and technologies for securing the airway and what their indications and limitations are, and
4. Hands on experience with these devices.

Simple Epidemiology for Clinicians
Upon completion of this workshop, the participant will understand:

1. The practical basics of clinical epidemiology,
2. The sources of bias in study design,
3. The concept of confounding in study design,
4. The various methods used to identify and control bias and confounding, including regression modeling, propensity scores, and instrumental variable, and
5. The readily available, user-friendly epidemiology software options for the clinical researcher.

Advanced Techniques for Peripheral Vascular Access
Upon completion of this workshop, the participant will be able to demonstrate and practice use of ultrasound to obtain peripheral venous access, demonstrate and practice the use of two types of intraosseous catheters to obtain emergent vascular access, and identify the potential advantages of near infra-red technology to optimize peripheral venous access.

Simulation
Upon completion of this workshop, the participant will be able to:

1. Introduce high fidelity simulation and its uses
2. Gain an understanding of the elements of performance that can be taught and assessed using high-fidelity simulation
3. Gain an understanding of the elements of team performance that could impact patient care
4. Participate in scenarios to deepen understanding of effective approaches to unanticipated crisis events in the perioperative environment.

Integrating Acupuncture in Pediatric Peri-operative Care and Pain Medicine
Upon completion of this workshop, the participant will be able to:

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

Principles of Retirement Planning: Whether it is 5 years to 35 years away, and Everything in Between
Upon completion of this workshop, the participant will be able to

1. Describe common types of employer-sponsored retirement plans,
2. Explain the distinctions between “qualified” and “non-qualified” retirement plans, and the significance to the employee. 401k and 403b plans, as well as various other common types of pension plans and profit-sharing plans will be covered.

Differences between “defined benefit” plans and “defined contribution” plans will be discussed, review aspects of commonly used individual retirement accounts (IRA’s): traditional and Roth, which contributions may be tax-deductible, contribution limitations, income limitations, investment limitations, common pitfalls, etc, and outline generally accepted investment strategies, which will be based on the expected time to need use of the invested funds, the “time horizon”.

TEE
Upon completion of this workshop, the participant will understand the mechanics of conducting a basic TEE exam, and be familiar with basic interpretation of normal and abnormal TEE images.

Effective Feedback in Anesthesiology Education and Beyond
Upon completion of this workshop, the participant will

1. Increase his/her understanding of the adult learner and his/her value of learner self-assessment,
2. Recognize effective feedback and appreciate its importance as a teaching technique, and
3. Identify barriers to effective feedback and learn practical tools to increase both frequency and quality of learner feedback.

Pediatric Anesthesia Careers in Private Practice vs Academics: What is right for you?
Upon completion of this workshop, the participant will be able to:

1. Understand the continuum of organization styles within American pediatric anesthesiology (what is really private practice and what is really academics?),
2. Understand the structure and working environment of the typical academic and private practice,
3. Understand the advantages and disadvantages of each working environment, and
4. Have a better idea on the questions to ask during interviews for joining the typical academic and private practice.

Simulation Workshop
Upon completion of this workshop, the participant will be able to:

1. Review key elements in scenario design,
2. Develop individual scenarios in small workgroups,
3. Enact and debrief one of the developed scenarios,
4. Understand positive and negative elements in developed scenario, and
5. Understand the resources required to run the scenario.

Refresher Course Objectives

Muscular Dystrophy
Upon completion of this refresher course, the participant will be able to compare physiologies underlying different muscular dystrophies, identify aspects of preoperative evaluation that may help in preparing their patients for surgery, and to better adjust their anesthetic plans to fit the diseases of the patients.

Updates on Cardiac Anesthesia
Upon completion of this refresher course, the participant will be aware of what’s new in pulmonary hypertension pathophysiology and management in children and the anesthetic implications. He/she will learn about chronic hypoxia and its effects on children’s heart, using that knowledge to develop safe anesthetic practices, and be aware of the pitfalls of imaging studies in children with heart disease, one breathhold too many and when to say no.

Review of Neonatal Anesthetic Management
Upon completion of this refresher course, the participant will review/update of principles of neonatal physiology as they apply to anesthetic care for neonatal surgery, and review/update specific neonatal and surgical care issues that are applicable to anesthetizing these patients.

Update on Pediatric Pain
Upon completion of this refresher course, the participant will be able to review new treatment modalities for chronic pain issues in children, discuss alternative pharmaceutical and regional techniques for the managment of acute post operative pain control, and review methods to reduce pain for the general pediatric hospitalized patient.

PBLD Objectives
Problem-based learning discussions will offer the opportunity for group discussion with faculty and other attendees of common clinical problems. The format will highlight aspects of clinical decision-making including preoperative evaluation and preparation, anesthetic induction and intra-operative management and possible intra- and postoperative pain and other management dilemmas.