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Warde D. One hundred years ago: The first textbook on anesthesia for children. Paediatr Anaesth 2023; 33:1115-1116. [PMID: 37724507 DOI: 10.1111/pan.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/26/2023] [Indexed: 09/20/2023]
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Ambardekar AP, Furukawa L, Eriksen W, McNaull PP, Greeley WJ, Lockman JL. A Consensus-Driven Revision of the Accreditation Council for Graduate Medical Education Case Log System: Pediatric Anesthesiology Fellowship Education. Anesth Analg 2023; 136:446-454. [PMID: 35773224 DOI: 10.1213/ane.0000000000006129] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical experiences, quantified by case logs, are an integral part of pediatric anesthesiology fellowship programs. Accreditation of pediatric anesthesiology fellowships by the Accreditation Council of Graduate Medical Education (ACGME) and establishment of case log reporting occurred in 1997 and 2009, respectively. The specialty has evolved since then, but the case log system remains largely unchanged. The Pediatric Anesthesiology Program Directors Association (PAPDA) embarked on the development of an evidence-based case log proposal through the efforts of a case log task force (CLTF). This proposal was part of a larger consensus-building process of the Society for Pediatric Anesthesia (SPA) Task Force for Pediatric Anesthesiology Graduate Medical Education. The primary aim of case log revision was to propose an evidence-based, consensus-driven update to the pediatric anesthesiology case log system. METHODS This study was executed in 2 phases. The CLTF, composed of 10 program directors representing diverse pediatric anesthesiology fellowship programs across the country, utilized evidence-based literature to develop proposed new categories. After an approval vote by PAPDA membership, this proposal was included in the nationally representative, stakeholder-based Delphi process executed by the SPA Task Force on Graduate Medical Education. Thirty-seven participants engaged in this Delphi process, during which iterative rounds of surveys were used to select elements of the old and newly proposed case logs to create a final revision of categories and minimums for updated case logs. The Delphi methodology was used, with a two-thirds agreement as the threshold for inclusion. RESULTS Participation in the Delphi process was robust, and consensus was almost completely achieved by round 2 of 3 survey rounds. Participants suggested that total case minimums should increase from 240 to 300 (300-370). Participants agreed (75.86%) that the current case logs targeted the right types of cases, but requirements were too low (82.75%). They also agreed (85.19%) that the case log system and minimums deserved an update, and that this should be used as part of a competency-based assessment in pediatric anesthesia fellowships (96%). Participants supported new categories and provided recommended minimum numbers. CONCLUSIONS The pediatric anesthesiology case log system continues to have a place in the assessment of fellowship programs, but it requires an update. This Delphi process established broad support for new categories and benchmarked minimums to ensure the robustness of fellowship programs and to better prepare the pediatric anesthesiology workforce of the future for independent clinical practice.
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Affiliation(s)
- Aditee P Ambardekar
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Louise Furukawa
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Whitney Eriksen
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peggy P McNaull
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - William J Greeley
- Departments of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennyslvania, Philadelphia, Pennsylvania
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Ambardekar AP, Eriksen W, Ferschl MB, McNaull PP, Cohen IT, Greeley WJ, Lockman JL. A Consensus-Driven Approach to Redesigning Graduate Medical Education: The Pediatric Anesthesiology Delphi Study. Anesth Analg 2023; 136:437-445. [PMID: 35777829 DOI: 10.1213/ane.0000000000006128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pediatric anesthesiology fellowship education has necessarily evolved since Accreditation Council for Graduate Medical Education (ACGME) accreditation in 1997. Advancements in perioperative and surgical practices, emerging roles in leadership, increasing mandates by accreditation and certification bodies, and progression toward competency-based education-among other things-have created pressure to enrich the current pediatric anesthesiology training system. The Society for Pediatric Anesthesia (SPA) formed a Task Force for Pediatric Anesthesiology Graduate Medical Education that included key leaders and subject matter experts from the society. A key element of the Task Force's charge was to identify curricular and evaluative enhancements for the fellowship program of the future. METHODS The Task Force executed a nationally representative, stakeholder-based Delphi process centered around a fundamental theme: "What makes a pediatric anesthesiologist?" to build consensus among a demographically varied and broad group of anesthesiologists within the pediatric anesthesiology community. A total of 37 demographically and geographically varied pediatric anesthesiologists participated in iterative rounds of open- and close-ended survey work between August 2020 and July 2021 to build consensus on the current state, known deficiencies, anticipated needs, and strategies for enhancing national educational offerings and program requirements. RESULTS Participation was robust, and consensus was almost completely achieved by round 2. This work generated a compelling Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis that suggests more strengths and opportunities in the current Pediatric Anesthesiology Graduate Medical Education program than weaknesses or threats. Stakeholders agreed that while fellows matriculate with some clinical knowledge and procedural gaps, a few clinical gaps exist upon graduation. Stakeholders agreed on 8 nonclinical domains and specific fundamental and foundational knowledge or skills that should be taught to all pediatric anesthesiology fellows regardless of career plans. These domains include (1) patient safety, (2) quality improvement, (3) communication skills, (4) supervision skills, (5) leadership, (6) medical education, (7) research basics, and (8) practice management. They also agreed that a new case log system should be created to better reflect modern pediatric anesthesia practice. Stakeholders further identified the need for the development of standardized and validated formative and summative assessment tools as part of a competency-based system. Finally, stakeholders noted that significant departmental, institutional, and national organizational support will be necessary to implement the specific recommendations. CONCLUSIONS A Delphi process achieved robust consensus in assessing current training and recommending future directions for pediatric anesthesiology graduate medical education.
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Affiliation(s)
- Aditee P Ambardekar
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Whitney Eriksen
- Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marla B Ferschl
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
| | - Peggy P McNaull
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Ira T Cohen
- Division of Anesthesiology and Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Children's National, Washington, DC
| | - William J Greeley
- Departments of Anesthesiology and Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Justin L Lockman
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Andrew JK, Gitlin JA, Desai MS. Surgical operations at Massachusetts General Hospital in 1846 and 1847: Early impact of the discovery of anaesthesia. Anaesth Intensive Care 2022; 50:16-22. [PMID: 36168785 DOI: 10.1177/0310057x221105296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The introduction of anaesthesia on 16 October 1846 brought about tremendous changes in the discipline of surgery. We sought to determine whether the concept of painless surgery was accepted by practitioners and patients, and whether this led to an increase in frequency and variety of surgical operations performed. To study these changes, we analysed surgical records from Massachusetts General Hospital, Boston, Massachusetts (MGH) in the months surrounding the discovery of ether anaesthesia. Surgical records from MGH between 25 February 1846 and 14 March 1847 were examined, and the variables studied included number of operations, type of operations, patient demographics, complications and analgesics used, as well as comments made by surgeons. Immediately following the introduction of anaesthesia, MGH experienced a sizeable increase in the volume of surgical operations. This included a doubling in the percentage of female patients undergoing surgery. Orthopaedic procedures and amputations both increased in frequency, as did the number of surgeons operating. Several records indicated the presence of postoperative wound infection. Operations were still performed without anaesthesia. Following the introduction of ether anaesthesia in 1846, surgical volume increased, and more women underwent surgery. This suggests early acceptance of anaesthesia by patients and the medical profession. In an era prior to the introduction of antiseptic and aseptic techniques it is not surprising that wound infections were observed in several patients. We provide a glimpse of anaesthesia and surgery during the first few months after the first public demonstration of anaesthesia at MGH.
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Affiliation(s)
- Jacob K Andrew
- University of Massachusetts Chan Medical School, Worcester, USA
| | - Jacob A Gitlin
- University of Massachusetts Chan Medical School, Worcester, USA
| | - Manisha S Desai
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Chan Medical School, Worcester, USA
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Brooks Peterson M, Szolnoki J. Modes of ventilation for pediatric patients under anesthesia: A Pro/Con conversation. Paediatr Anaesth 2022; 32:295-301. [PMID: 34882920 DOI: 10.1111/pan.14368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
The development of sophisticated modes of ventilation for pediatric patients undergoing anesthesia is ongoing; what remains a challenge for the pediatric anesthesiologist is thoughtful selection of the mode(s) of ventilation for a particular patient in the context of the surgical procedure and the goals of the anesthetic. This article provides some historical accounting of a variety of modes of ventilation, defines the terminology of modern ventilatory modes, and reviews in detail the benefits and pitfalls of the specific modes of ventilation and their applicability to the practice of pediatric anesthesiology. In an attempt to debate the Pros and Cons of different modes of ventilation, and to finally resolve the debate "spontaneous vs. controlled ventilation," we share with you a thoughtful conversation of the continuum of modes of ventilation and their applicability to our pediatric anesthesia population.
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Affiliation(s)
- Melissa Brooks Peterson
- Pediatric Anesthesiology, University of Colorado / Children's Hospital Colorado Department of Anesthesiology, Aurora, Colorado, USA
| | - Judit Szolnoki
- Pediatric Anesthesiology, University of Central Florida, Nemours Children's Hospital Department of Anesthesiology, Orlando, Florida, USA
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Are There Common Network-level Correlates of the Anesthetized Brain in Infants and Adults? Anesthesiology 2019; 131:1202-1204. [PMID: 31596736 DOI: 10.1097/aln.0000000000002993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abdelgadir IS, Phillips RS, Singh D, Moncreiff MP, Lumsden JL. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev 2017; 5:CD011413. [PMID: 28539007 PMCID: PMC6481531 DOI: 10.1002/14651858.cd011413.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Direct laryngoscopy is the method currently used for tracheal intubation in children. It occasionally offers unexpectedly poor laryngeal views. Indirect laryngoscopy involves visualizing the vocal cords by means other than obtaining a direct sight, with the potential to improve outcomes. We reviewed the current available literature and performed a meta-analysis to compare direct versus indirect laryngoscopy, or videolaryngoscopy, with regards to efficacy and adverse effects. OBJECTIVES To assess the efficacy of indirect laryngoscopy, or videolaryngoscopy, versus direct laryngoscopy for intubation of children with regards to intubation time, number of attempts at intubation, and adverse haemodynamic responses to endotracheal intubation. We also assessed other adverse responses to intubation, such as trauma to oral, pharyngeal, and laryngeal structures, and we assessed vocal cord view scores. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and trial registers (www.clinicaltrials.gov and www.controlledtrials) in November 2015. We reran the search in January 2017. We added new studies of potential interest to a list of 'Studies awaiting classification' and will incorporate them into formal review findings during the review update. We performed reference checking and citation searching and contacted the authors of unpublished data to ask for more information. We applied no language restrictions. SELECTION CRITERIA We included only randomized controlled trials. Participants were children aged 28 days to 18 years. Investigators performed intubations using any type of indirect laryngoscopes, or videolaryngoscopes, versus direct laryngoscopes. DATA COLLECTION AND ANALYSIS We used Cochrane standard methodological procedures. Two review authors independently reviewed titles, extracted data, and assessed risk of bias. MAIN RESULTS We included 12 studies (803 children) in this review and meta-analysis. We identified three studies that are awaiting classification and two ongoing studies.Trial results show that a longer intubation time was required when indirect laryngoscopy, or videolaryngoscopy, was used instead of direct laryngoscopy (12 trials; n = 798; mean difference (MD) 5.49 seconds, 95% confidence interval (CI) 1.37 to 9.60; I2 = 90%; very low-quality evidence). Researchers found no significant differences between direct and indirect laryngoscopy on assessment of success of the first attempt at intubation (11 trials; n = 749; risk ratio (RR) 0.96, 95% CI 0.91 to 1.02; I2 = 67%; low-quality evidence) and observed that unsuccessful intubation (five trials; n = 263) was significantly increased in the indirect laryngoscopy, or videolaryngoscopy, group (RR 4.93, 95% CI 1.33 to 18.31; I2 = 0%; low-quality evidence). Five studies reported the effect of intubation on oxygen saturation (n = 272; very low-quality evidence). Five children had desaturation during intubation: one from the direct laryngoscopy group and four from the indirect laryngoscopy, or videolaryngoscopy, group.Two studies (n = 100) reported other haemodynamic responses to intubation (very low-quality evidence). One study reported a significant increase in heart rate five minutes after intubation in the indirect laryngoscopy group (P = 0.007); the other study found that the heart rate change in the direct laryngoscopy group was significantly less than the heart rate change in the indirect laryngoscopy, or videolaryngoscopy, group (P < 0.001). A total of five studies (n = 244; very low-quality evidence) looked at evidence of trauma resulting from intubation. Investigators reported that only two children from the direct laryngoscopy group had trauma compared with no children in the indirect laryngoscopy, or videolaryngoscopy, group.Use of indirect laryngoscopy, or videolaryngoscopy, improved the percentage of glottic opening (five trials; n = 256). Studies noted no significant difference in Cormack and Lehane score (C&L) grade 1 (three trials; n = 190; RR 1.06, 95% CI 0.93 to 1.21; I2 = 59%). AUTHORS' CONCLUSIONS Evidence suggests that indirect laryngoscopy, or videolaryngoscopy, leads to prolonged intubation time with an increased rate of intubation failure when compared with direct laryngoscopy (very low-quality evidence due to imprecision, inconsistency, and study limitations). Review authors had difficulty reaching conclusions on adverse haemodynamic responses and other adverse effects of intubation, as only a few children were reported to have these outcomes. Use of indirect laryngoscopy, or videolaryngoscopy, might lead to improved vocal cord view, but marked heterogeneity between studies made it difficult for review authors to reach conclusions on this outcome.
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Affiliation(s)
| | - Robert S Phillips
- University of YorkCentre for Reviews and DisseminationYorkUKYO10 5DD
| | - Davinder Singh
- Leeds General InfirmaryPaediatric Intensive Care Unit L47Great George StLeedsUKLS1 3EX
| | | | - Joanne L Lumsden
- Leeds Teaching Hospitals TrustPaediatric Intensive Care Unit L47PICU Office, D Floor Clarendon Wing, Leeds General InfirmaryLeedsUKLS2 9NS
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Lin D, Liu J, Kramberg L, Ruggiero A, Cottrell J, Kass IS. Early-life single-episode sevoflurane exposure impairs social behavior and cognition later in life. Brain Behav 2016; 6:e00514. [PMID: 27688943 PMCID: PMC5036436 DOI: 10.1002/brb3.514] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single-episode anesthetic exposure is the most prevalent surgery-related incidence among young children in the United States. Although numerous studies have used animals to model the effects of neonatal anesthetics on behavioral changes later on in life, our understanding of the functional consequences to the developing brain in a comprehensive and clinically relevant manner is unclear. METHODS The volatile anesthetic, sevoflurane (sevo) was administered to C57BL6 postnatal day 7 (P7) mice in a 40% oxygen and 60% nitrogen gas mixture. In order to examine the effects of sevo alone on the developing brain in a clinically relevant manner, mice were exposed to an average of 2.38 ± 0.11% sevo for 2 h. No sevo (control) mice were treated in an identical manner without sevo exposure. Mice were examined for cognition and neuropsychiatric-like behavioral changes at 1-5 months of age. RESULTS Using the active place avoidance (APA) test and the novel object recognition (NOR) test, we demonstrated that P7 sevo-treated mice showed a deficit in learning and memory both during periadolescence and adulthood. We then employed a battery of neuropsychiatric-like behavioral tests to examine social interaction, communication, and repetitive behavior. Interestingly, compared to the no-sevo-treated group, sevo-treated mice showed significant reductions in the time interacting with a novel mouse (push-crawl and following), time and interaction in a chamber with a novel mouse, and time sniffing a novel social odor. CONCLUSIONS Our study established that single-episode, 2-h sevo treatment during early life impairs cognition later on in life. With this approach, we also observed neuropsychiatric-like behavior changes such as social interaction deficits in the sevo-treated mice. This study elucidated the effects of a clinically relevant single-episode sevo application, given during the neonatal period, on neurodevelopmental behavioral changes later on in life.
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Affiliation(s)
- Daisy Lin
- Anesthesiology Department SUNY Downstate Medical Center Box 6, 450 Clarkson Ave Brooklyn New York 11203; Department of Physiology and Pharmacology SUNY Downstate Medical Center 450 Clarkson Ave Brooklyn New York 11203
| | - Jinyang Liu
- Anesthesiology Department SUNY Downstate Medical Center Box 6, 450 Clarkson Ave Brooklyn New York 11203
| | - Lea Kramberg
- Anesthesiology Department SUNY Downstate Medical Center Box 6, 450 Clarkson Ave Brooklyn New York 11203
| | - Andrea Ruggiero
- Anesthesiology Department SUNY Downstate Medical Center Box 6, 450 Clarkson Ave Brooklyn New York 11203
| | - James Cottrell
- Anesthesiology Department SUNY Downstate Medical Center Box 6, 450 Clarkson Ave Brooklyn New York 11203
| | - Ira S Kass
- Anesthesiology Department SUNY Downstate Medical Center Box 6, 450 Clarkson Ave Brooklyn New York 11203; Department of Physiology and Pharmacology SUNY Downstate Medical Center 450 Clarkson Ave Brooklyn New York 11203; The Robert F. Furchgott Center for Neural and Behavioral Sciences Brooklyn New York 11203
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Friesen RH. Herbert Rackow and Ernest Salanitre: the emergence of pediatric anesthesia as a specialty in the United States. Paediatr Anaesth 2015; 25:663-7. [PMID: 25736027 DOI: 10.1111/pan.12635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Abstract
Herbert Rackow and Ernest Salanitre were pediatric anesthesiologists at Babies Hospital at the Columbia-Presbyterian Medical Center in New York whose work spanned three decades beginning in the early 1950s. Their pioneering research included studies of the uptake and elimination of inhalational anesthetics and of the risk of cardiac arrest in infants and children. They were actively involved in the development of pediatric anesthesia as a specialty, and their efforts contributed to inter-disciplinary collaboration and to the formation of the Section on Anesthesiology of the American Academy of Pediatrics. Their 1969 review article, 'Modern Concepts in Pediatric Anesthesiology', provides a fascinating view of pediatric anesthesia 50 years ago. In 1990, they were jointly awarded the Robert M. Smith award by the Section on Anesthesiology of the American Academy of Pediatrics.
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Affiliation(s)
- Robert H Friesen
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, CO, USA
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Abdelgadir IS, Phillips RS, Moncreiff MP, Lumsden JL. Video-laryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd011413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
A number of articles and chapters in the pediatric anesthesia credit the first use of ether anesthesia to Crawford Long in an operation performed on an 8-year-old male slave. However, Long never gave the ages of any of his patients in any of his letters, articles, or communications. The 1840 and 1850 federal censuses give ages but no names for male slaves, two of whom are candidate patients. One possible age for the first was 22 years. The second was younger than 15 years and was identified as a child by a student working with Long. Thus, the date of the first pediatric anesthetic where documentation is reasonably certain is January 8, 1845, given the limitations in the use of slave censuses. After the Ether Dome demonstration in 1846, ether anesthesia for children was rapidly adopted in Boston and London.
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Affiliation(s)
- Don K. Nakayama
- From the Department of Surgery, The Mercer University School of Medicine and the Medical Center of Central Georgia, Macon, Georgia
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Mai CL, Yaster M, Firth P. The development of continuous positive airway pressure: an interview with Dr. George Gregory. Paediatr Anaesth 2013; 23:3-8. [PMID: 23170829 DOI: 10.1111/pan.12075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
Abstract
George Gregory, M.D. (1934-), Professor Emeritus at the University of California, San Francisco, has made numerous contributions to neonatology and pediatric anesthesia through his research efforts and authoritative textbook, Gregory's Pediatric Anesthesia. However he identified his defining moment as the occasion he saved the life of an infant suffering from neonatal respiratory distress syndrome by using continuous positive airway pressure (CPAP) ventilation. The development of CPAP by Gregory revolutionized the treatment of premature infants with respiratory failure. Prior to the creation of this treatment, the mortality rate of neonates with respiratory distress syndrome was >50%. The innovation markedly improved the ventilation of infants with respiratory distress and led to significant improvements in survival rates. Based on an interview with Dr. Gregory, this article describes the discovery of CPAP and reviews his career in advancing pediatric anesthesia and critical care medicine.
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Affiliation(s)
- Christine L Mai
- Department of Anesthesia, Critical Care Medicine & Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
The history of pediatric anesthesia is fascinating in terms of how inventive anesthesiologists became over time to address the needs for advances in surgery. We have many pioneers and heroes. We hope you will enjoy this brief overview and that we have not left out any of the early contributors to our speciality. Obviously there is insufficient space to include everyone.
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Affiliation(s)
- Christine L Mai
- Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, The MassGeneral Hospital for Children, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
This review summarizes the evolution of the pediatric laryngoscope using some of the established landmarks in the history of anesthesia. Children were rarely intubated before 1940 though the subsequent 30 years saw a proliferation of pediatric laryngoscopes in part driven by the developments in pediatric anesthesia and surgery, manufacturing techniques and materials and a change in airway management philosophy exemplified by Jackson Rees's argument against the notion that intubation was to be avoided in children. A perspective on the present day describes the modifications to popular straight and curved blade laryngoscopes and the development of new devices that enhance direct visualization of the larynx. There are an ever-increasing number of laryngoscope devices that assist in indirect visualization of the larynx such as rigid optical stylets and flexible fiber-optic scopes. Images from many of these devices may be enhanced by digital camera or real-time video technology. The prospect of future laryngoscope development is glimpsed in the arrival of light emitting diode light source technology and questions remain regarding the consequences of equipment disposability and at the fidelity of disposable equipment manufacture.
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Affiliation(s)
- Jane S Doherty
- Department of Anaesthetics and Intensive Care Medicine, University Hospital of Wales, Cardiff, UK.
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