Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society.

The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.

Development of Volunteer International Craniofacial Surgery Missions: The Komedyplast Protocol.

Volunteer surgical missions to provide cleft care to patients in developing countries has been done successfully for a number of years. Similar missions that provide craniofacial surgery introduce a dramatic step up in complexity. While articles have addressed protocols for the safe delivery of cleft care around the world, little has been written on volunteer craniofacial surgical missions. Komedyplast was established in March 2001 as a 501c(3) nonprofit organization to provide craniofacial surgical care to underserved populations and educate local surgeons in craniofacial principles. During 9 annual missions, the organization has provided surgical care to more than 150 patients with various complex, congenital, craniofacial conditions. The article addresses important safeguards that have been implemented to maximize safety and minimize risk.

Preprocedural evaluation: considerations outside of the operating room.

PURPOSE OF REVIEW: There are an increasing number of procedures performed in locations outside of the operating room both for children and adults. From the perspective of the anesthesiologist, the preprocedural evaluation is essential in providing safe and high-quality care. This review focuses on the purpose, considerations and methods for providing information during the preprocedural evaluation process based on the most recent literature review. RECENT FINDINGS: Upon review of the literature, there is an agreement that a preprocedural evaluation is fundamental to the management of our patients. This evaluation is the process of clinical assessment that precedes the delivery of anesthesia for all procedures. Consideration must be given to information from many sources and consultation ordered only as necessary. A determination of the medical condition as indicated by the American Society of Anesthesiologists score must be applied. The evaluation process is relatively standard across institutions. It appears to be more clearly defined among adult patients particularly when presenting with multiple comorbidities, and will tend to be assessed days to weeks prior to the scheduled procedure. Differences may exist, however, among an institutions' overall approach to the preprocedural evaluation of children. Ultimately, the results are efforts by the institutions to improve efficiency, reduce delays and cancellation rates. SUMMARY: It is important for the anesthesia provider to perform a thorough preprocedural evaluation. Tests that are ordered as part of the evaluation are done to understand the current medical state, verify a condition or formulate a plan. Informed consent must be obtained and the risks and benefits of the anesthesia plan in a manner understandable to the patient and parent or care giver.Many pediatric patients undergoing procedures outside of the operating room are in good health, and their evaluation will be relatively routine. Other children will present with complex medical conditions that require more time for the evaluation process. This may include the consultation of a pediatric specialist(s) as a necessary step toward completion of the preprocedural evaluation.Similarly, there are adult patients undergoing procedures outside of the operating room, which will have a straightforward preprocedural evaluation and others are more complex. Disease states that might require further testing include diabetes, leukemia, kidney and liver disease, central nervous system disease, malabsorption syndrome, coronary artery disease, coagulopathies and patients on diuretics.

Anesthesia for magnetic resonance imaging.

PURPOSE OF REVIEW: This review focuses on the technological principles, safety considerations, monitors and equipment, patient issues, and a general overview of the anesthetic management of both conventional and intraoperative magnetic resonance imaging based on the most recent literature. RECENT FINDINGS: As a diagnostic imaging modality, magnetic resonance imaging remains unparalleled in its diagnostic and clinical value. The clinical applications for magnetic resonance imaging continue to evolve, and include its latest use in minimally invasive procedures as well as in the operating room. Intraoperative magnetic resonance imaging is steadily gaining acceptance for neurosurgical procedures. The safety considerations, monitor and equipment issues for intraoperative magnetic resonance imaging are similar to the conventional setting. However, they differ in their focus on anesthesia management. Most monitoring compatible with magnetic resonance imaging has been available for many years. In the USA, the newest available monitoring option during magnetic resonance imaging is for temperature. This option has been available in other countries for a number of years. A fiberoptic surface sensor provides a safe and accurate monitor of adult, pediatric, and neonatal body temperature. SUMMARY: The magnetic resonance imaging suite is a challenging environment for the anesthesiologist, and carries inherent risks. Several factors account for this, including the remote location, the unique features of the magnetic resonance imaging scanner, and patient-related factors. Understanding the implications of the magnetic resonance imaging environment will facilitate ensuring the safety of the patient and personnel.