The impact of the COVID-19 pandemic on the education and wellness of U.S. Pediatric Anesthesiology Fellows.

BACKGROUND: The global coronavirus disease 2019 (COVID-19) pandemic caused state-wide shutdowns of elective surgical activities in March and April of 2020 forcing graduate medical education program directors and their trainees in the United States to quickly adapt to new rules and circumstances. AIM: The aim of this study was to determine the effect of the current pandemic on pediatric anesthesiology fellow education and wellness nationally in order to guide creation of optimal support systems for fellows during the ongoing pandemic. METHODS: In July 2020, an electronically distributed survey was sent to all United States-based pediatric anesthesiology fellowship program directors who were asked to distribute the survey to all current/graduating fellows. RESULTS: A total of 75 out of 184 pediatric anesthesiology fellows (41%) responded to the survey. Major domains identified include reduction of clinical time, financial impact, mental health/wellness effects, and concerns about the overall quality of the fellowship educational experience. Respondents indicated that the pandemic has led to personal quarantine (and/or illness) leave time (21.3%), changes in finances (42.7%) and career opportunities (37.3%), decreased clinical education/experience (28%), and a dissatisfaction with the modified didactic experience (22.7%). In addition, a majority of respondents (97.3%) experienced increased stressors during this pandemic, including worry for family members (80%), stress due to changes in certifying examinations (76%), and fear of contracting COVID-19 from a patient (72%). CONCLUSION: While the results of this survey are only one snapshot in time during an evolving pandemic, these results highlight important domains where program directors and other departmental leaders might focus limited resources to maximize the educational experiences and overall wellness for pediatric anesthesiology fellows.

Anesthetic Management of Pediatric Liver and Kidney Transplantation.

Pediatric patients with liver dysfunction and renal failure may exhibit many comorbidities. There are often associated congenital syndromes to be taken into account. Liver and renal transplantation offer a solution and substantial improvement in quality of life. Anesthetic management of pediatric liver and renal transplantation has not been well described. There are key differences between adults and children undergoing these procedures, and acknowledgment of some key principles provide a solid foundation to optimize perioperative outcomes. This article provides an overview of the perioperative management and considerations in pediatric patients undergoing liver and renal transplantation.

Day surgery regional anesthesia in children: safety and improving outcomes, do they make a difference?

PURPOSE OF REVIEW: The objective of this review is to provide an overview of recent developments in pediatric regional anesthesia and elucidate outcomes as it relates to patient safety and overall satisfaction. RECENT FINDINGS: Since the inception of the Pediatric Regional Anesthesia Network database, the acquisition of data has enabled the pediatric anesthesiologist to extrapolate results and translate them into useful outcomes. Despite the growing trend to provide regional anesthesia in the pediatric population, there continues to be a paucity of available research studies to evaluate outcomes of various regional nerve blocks. This review serves as a conduit to explore the most recent data available, in each regional anesthetic technique, as it relates to outcomes such as analgesia, patient safety and satisfaction. SUMMARY: Despite the limited number of randomized controlled trials evaluating the safety of individual regional anesthetic techniques, the growing body of data, such as presented in the Pediatric Regional Anesthesia Network database, suggests a high degree of safety in performing various regional anesthetic modalities. Modern medicine should continue to embrace the use of regional anesthesia, particularly in the ambulatory setting, to reduce perioperative pain and improve patient outcomes.