Section on Anesthesiology and Pain Medicine
 
Chair's Message

Rita Agarwal
MD FAAP

I hope you had a wonderful summer. Our section may be small, but it is mighty! We continue to be remarkably productive and are now seeing the fruit of many of the efforts that were started by Dr. Joe Tobias during his tenure as Section Chair. Two new clinical reports have been published in Pediatrics:

  • A revision of the AAP/AAPD “Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016” was published in Pediatrics in July 2016.
  • A new clinical report on “Codeine and the Potential for Toxicity in the Pediatric Patient,” a joint report with the Committee on Drugs, was published in Pediatrics in September 2016. For more information, see page 4.

In addition, the Section is working on:

  • A revision of the statement on “The Assessment and Management of Acute Pain in Infants, Children, and Adolescents”; Drs Corrie Anderson and Nathalia Jimenez are leading this effort.
  • A new statement on “Care of Pediatric Patients with Chronic Pain”
  • A revision of the clinical report, “Interpretation of Do-Not-Attempt-Resuscitation and Resuscitation Limitation Orders for Pediatric Patients Who Require Anesthesia and Surgery,” a joint effort with the Section on Surgery and the Committee on Bioethics. Dr. Coutney Hardy is representing the SOA as a co-author on this report.
  • A new policy statement, “Peri-operative Management of Children with Sleep Disordered Breathing/Obstructive Sleep Apnea,” which will be a joint effort with the Section on Otolaryngology – Head and Neck Surgery. Drs. Anita Honkanen and Mohamed Rehman are the lead authors from our Section.
  • Developing educational materials or possibly a statement regarding smoking abstinence (for both parents and children) in the perioperative period, with the Section on Tobacco Control. This is still very preliminary so ALL help, suggestions, and ideas are welcome.

This summer there were 2 more webinars produced by the Section and the AAP Committee on Substance Abuse in association with the Providers' Clinical Support System for Opioid Therapies Grant from SAMHSA. These were the 3rd and 4th offerings of a 6-part webinar series aimed at prevention, identification, and treatment of opioid dependence. They are designed for primary care health care providers, but all clinicians are welcome to view them. Payment is required for CME, otherwise a lot of the information is free. The 3rd Seminar is a discussion of managing youth with co-occurring psychiatric issues and substance abuse by Drs. Pamela Gonzalez and Diane Diester (both psychiatrists from the Committee on Substance Abuse), a group that I certainly see in my inpatient pain practice. You can view the slides, outline or the entire webinar. As a mother of teenagers with ADHD, I found their talk terrifying and thought-provoking. The 4th Seminar was given by Dr. Stephen Hays and can be viewed here. It is an excellent review of pain management in the child with chronic pain. Stay tuned for more information on Sessions 5 and 6 in 2017. Last year’s webinars by Drs. D’Souza and Golianu (Stanford University) and Dr. Breuner (Seattle Children’s Hospital) were extremely well received and are archived for future reference here.

I hope that many of you will be joining us for the 2017 SPA/AAP SOA Pediatric Anesthesiology Meeting in Austin, Texas. We have some great sessions planned, including the presentation of the Robert M. Smith Award to Dr. Peter Davis from Pittsburgh Children’s Hospital. Please come and celebrate his extraordinarily influential career with us (for more information on our 2017 Awardee, see page 15). Our AAP Advocacy Lecture will be on Bioethics in the Neonatal Intensive Care Unit. Our speaker will be Annie Janvier, BSc, MD, PhD, a neonatologist and clinical ethicist from Montreal. The Ask the Experts Panel will focus on the Weird and Wonderful (in honor of Austin’s unofficial motto, “Keep Austin Weird”). Dr. Susan Goobie (Boston Children’s) will talk about blood conservation techniques in Craniofacial Reconstruction, and Dr. Franklin Cladis will talk about “Challenging Craniofacial Syndromes.” The final offering from the SOA will be the John J. Downes Resident Research Awards for the top three abstracts from our trainees. These trainees will have an opportunity to present their work in front of a discerning audience and will hopefully be encouraged to continue their research. The John J. Downes awards and oral abstract presentations are given as part of the scientific session that also rewards young investigators (SPA Young Investigators Award) for their work.

As Chair of the Section on Anesthesiology and Pain Medicine, I was invited to participate in an IARS/SmartTots Teleconference in August. The purpose of this teleconference was to review the Basic science and clinical research on neurotoxicity in the developing brain and to determine future research directions. Animal research continues to show neurotoxicity in developing animals of all species, while clinical research continues to be mixed. The consensus is that there is still significant research to be done and many questions to be answered. Emphasis should be on the effects of surgery on neurodevelopment, not just anesthesia. In addition, there is promising research of neuroprotective agents that should be expanded.

The SOA continues their work on developing platforms for the education of physicians and healthcare providers on appropriate opioid use. We have been working with the Committee on Substance Abuse, as part of the by Providers' Clinical Support System for Opioid Therapies grant from SAMHSA, to begin developing a 6-part webinar series aimed at preventing, identifying, and treating opioid dependence. The first webinar in the series, which was offered in July 2015, focused on the Neurobiology of Pain. The second webinar, offered in August 2015, focused on Strategies for Pain Management. Four additional webinars will be offered in the near future. The AMA is currently working to develop a CME product for primary care providers on the topic of opioids. Rita Agarwal is participating as the AAP's representative to the AMA Pain Management Expert Panel.

In September 2016, the U.S. Food and Drug Administration (FDA) held a joint meeting of its Anesthetic and Analgesic Drug Products Advisory Committee (Chaired by Dr. Raeford Brown, SOA Chairperson–Elect), its Drug Safety and Risk Management Advisory Committee, and its Pediatric Advisory Committee. The number of our AAP SOA members were involved, including by Drs. Raeford Brown, Constance Houck (Chairperson, AAP Surgical Advisory Panel; Section Voting Member, AAP Committee on Drugs) and Randall Flick (SPA President-Elect; ASA Liaison to AAP SOA). An in-depth review of this meeting can be found on page 5. There is also a summary in the SPPM newsletter.

Over the last year, we have had the opportunity to work with colleagues within PediaLink, AAP’s Online Learning Center, to develop an online CME course on pediatric pain management and opioid use/misuse. The course, titled “Acute Pain Management: Changes and Challenges,” was just released in September 2016 and can be accessed here. It is aimed at pediatricians, pediatric specialists and subspecialists who prescribe opioids and or follow up with children who are on opioids. It is co-authored by myself and Dr. David Casavant (Intensivist, Boston Children’s Hospital). The project was funded by a generous grant from the AAP Friends of Children Fund. For more information about the course, see page 6.

The AAP National Conference and Exhibition will be held in San Francisco October 22-26, 2016, at the same time at the ASA meeting in Chicago. This year the AAP SOA will be sponsoring sessions on “Integrating Acupuncture in Pediatric Practice.” There will also be a “Hot Topic” presentation sponsored by our Section on “Babies, Anesthesia and the Developing Brain,” to be given by Lisa Wise-Faberowski. The AAP Surgical Advisory Panel will have a session that is co-sponsored by the SOA, the Section on Hospital Medicine and the Sections on Orthopedics and Surgery on “Co-Management of Surgical Patients in the Hospital.” Next year the AAP NCE will be in September in Chicago. They have accepted a proposal from our section for a session on “The Opioid Crisis: Implications for Pediatric Pain Management,” which will be given by Dr. Santhanam Suresh and Dr. Ravi Shah from Lurie Children’s.

I look forward to seeing everyone soon. I hope that everyone will consider being an active part of the AAP, and I would welcome phone calls, curb side chats at meetings, or e-mails with suggestions as to how to improve our section.

 

 

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