Update From the Chair of the Section on Anesthesiology, the American Academy of Pediatrics
By Anita Honkanen, MD
Clinical Professor
Stanford University
It is an exciting time for pediatric anesthesiologists interested in advocating for children. The American Academy of Pediatrics (AAP) and its Section on Anesthesiology and Pain Medicine have had an amazing year, taking a lead in many areas: creating guidelines and policy to protect pediatric patients, educating colleagues in anesthesia and other medical specialties, raising awareness for parents and patients, and communicating directly with state and federal legislators to bring life-threatening concerns to the forefront.
We have all been repeatedly hammered by the ongoing gun-violence crisis in our country, too often targeting our children. In the Spring of 2019, at the Joint SPA/AAP winter/spring meeting, the AAP Ask the Experts Panel explored factors related to the gun crisis titled “The Pediatric Victims of Gun Violence: Health Effects, Injury Prevention, and Advocacy Efforts”. The SOA also facilitated the addition of the SPA and the SPPM as signatories on the AAP-led communication to the House and Senate, asking for appropriation of $50 million in gun violence prevention public health research funding for the CDC. After AAP’s efforts leading up to May 2019, the House Appropriations Committee on May 8 approved the fiscal year 2020 Labor, Health and Human Services, Education, and Related Agencies bill, which will provide $25 million to the CDC and $25 million to the NIH to research the prevention of gun violence, injury and death.
Revised AAP/American Academy of Pediatric Dentistry (AAPD) Guidelines for the Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures were released in June 2019 in Pediatrics. Lead author Charlie Cote’s focus with the revision was to clearly delineate the personnel required for sedation/general anesthesia in the pediatric population. The publication of the new Guidelines has spurred a concerted advocacy effort at both the state and federal level by many leaders of our section, including Rita Agarwal and Rae Brown, and by several leaders of our sister societies, including the ASA, SPA, and SPPM, raising consciousness about the repeated tragedy of healthy children dying during dental procedures due to sedation/anesthesia administration without sufficiently trained personnel in attendance. Concerted efforts are being led to both work with the dental societies and advance legislation that would mandate appropriate application of the current statements from the AAP, AAPD, and ASA related to safe administration of sedation and anesthetics to children in the dental setting.
The Opioid Crisis is another area in which the section has been making rigorous efforts to ensure our children continue to receive the pain care they need while appreciating the danger of addiction related to how their pain is treated. The section is actively educating our colleagues at the AAP’s National Conference and Exhibition, with two related joint programs, one on Integrative Approaches to Pain: Non-pharmacologic, Non-Invasive Options Amid the Opioid Crisis and a second on Pediatric Pain Management for Hospitalists: A Life Course Perspective; the Section has also developed and organized the AAP’s Pediatrics for the 21st Century Conference for 2019, titled Opioids Through the Ages: Caring for Children and Families in the Wake of the Opioid Crisis.
Educational efforts in 2018 focused on the use of acupuncture to facilitate pain control in children, appropriate pain control in the outpatient setting, and a joint program with the Section on Critical Care on the use of anesthesia in the ICU setting.
At the Joint AAP/SPA Winter meeting in Houston, Nancy Glass was honored for her many years of contribution to the care of children and the discipline of pediatric anesthesia by receiving the Section’s Robert M. Smith Award. Three residents, Senthil Packiasabapathy, MBBS, MD (Riley Hospital for Children), Tiffany Kim, MD (Loma Linda University), and Jon Andrews, MD (Duke University Medical Center) also won research awards for pediatric anesthesia at the same meeting.
Several Policy Statements are “under-construction” by the section, including statements addressing Oxymetazoline (Afrin) use in pediatrics; the care of children with chronic pain; the assessment and management of acute pain in pediatrics; and the perioperative management of children with obstructive sleep apnea. Shared statements on topics in collaboration with other AAP Sections include pain management in the neonate and premedication for neonatal intubation; the recognition and management of opioid dependence in children; the preoperative approach to pediatric patients with congenital heart disease; the approach to DNR orders for children coming for anesthesia and surgery; oral health care for developmentally disabled children; and the relief of anxiety and pain in children presenting to the emergency room. In addition, the Section has the opportunity annually to submit a Focus on Subspecialties article for publication in AAP News on a Section-identified topic of interest to general pediatricians. Justin Long’s article on how to handle URI in children coming for anesthesia was featured in the July 31, 2019 AAP News publication.
Finally, the section has had a wonderful year in recruiting both new members and new member leaders. We welcome Debnath Chatterjee as a newly elected member of the Section Executive Committee (EXCOM). As of November 1, 2019, there will be a number of leadership transitions within the EXCOM; Mary Landrigan-Ossar will become the Section Chairperson-Elect with Anita Honkanen moving into the Section Chairperson position at that time, following in the very large footsteps of Rae Brown. Rae will become Immediate Past Chair, after doing an extraordinary job as Chairperson for two years. One of the many projects Rae undertook as Chair was to begin an effort to look at the potential for creating boards for pediatric pain medicine with encouragement from the ABP and the ABA. A multidisciplinary group has been established to head up this project in collaboration with the SPPM, our Section, and many other sections of the AAP; the group is being supported by a grant from the Mayday Fund.
The AAP is also adding three new positions to its Board of Directors in January 2020, with one position being held for a surgical subspecialist: our own Connie Houck is in the running for that position. If you are a member of the AAP, please be sure to vote in that election; if you are reading this and are not yet a member of the AAP Section on Anesthesiology and Pain Medicine, now is the time to be involved! We need everyone working together to create a better world for our children.
