Preoperative pregnancy testing in my institution for the majority of surgical cases:

A 4-year-old patient has come from a significant distance for hydrocele repair. The parents are Non-English speaking and need an interpreter - you find out the child ate breakfast 5 hours ago. You perform point of care ultrasound (US) of the gastric antrum which demonstrates an empty antrum in both supine and right lateral decubitus position. A nomogram (link below) is used to calculate the volume of gastric contents using the cross-sectional area measured around the muscularis with the patient’s age. The volume is less than 1.5 ml/kg in the right lateral decubitus position. This finding suggests low risk of aspiration. {https://www.gastricultrasound.org/en/special-patients/} What would be your next plan of action?

When personally intubating an otherwise healthy 2-week-old term neonate with no indication of potential difficult airway for elective surgery, which of the following techniques do you most frequently attempt for your initial laryngoscopy?

(Pre anesthesia pregnancy screening: an imperative or a bubbe meise? Ethical considerations part one (substack.com) Reference: Jackson S, Hunter J, Van Norman GA. Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review. Anesthesia and analgesia 2024;138(5):980-991. DOI: 10.1213/ane.0000000000006669.) - - In the light of recent articles on routine preoperative pregnancy testing our current institutional practice is:

As opposed to paper anesthesia records, electronic pediatric anesthesia records can now be accessible in real-time by parents. How and when this information is presented can introduce new challenges. In context of the Cures Act and the lawful freely sharing of information, how has your practice adapted? (https:/pubs.asahq.org/monitor/article/85/2/e3/115119/Open-Anesthesia-Records-Guidance-for-Anesthesia__;!!Ls64Rlj6!xjqV8KQA6qLl6WFfUIl0QpGLBupbqSHRDctOWwx3ecpRloriG0zIPxP4eQrfb4biag7ghbBIaG2NAiDzagJ-b1PKgA$)

Our current stand of perioperative use of methadone:

A 5 year old with 20% TBSA burn is coming to the OR for a debridement and dressing change. The patient has been receiving continuous postpyloric tube feeds on the floor as confirmed by imaging the day before surgery. An LMA is planned. How many hours should this patient remain NPO prior to the surgery?

As indicated by a recent PAAD, routine or at least more common EEG monitoring is likely on the horizon in anesthetic management of patients, including infants and children. In my practice, I (https://ronlitman.substack.com/p/eeg-to-guide-the-depth-of-anesthesia?utm_source=publication-search)

In light of the IV fluid shortages (check all that apply):

A healthy 2 yo comes in for an inguinal hernia repair. He has an LMA placed as well as what appears to be a functioning caudal block. His blood pressure is consistently reading 70/30, occasionally dipping to 65/30. He has had 20/kg of IVF. What is your next approach? You may choose more than one answer.

A 2-year-old patient with scald burns to the lower abdomen and bilateral lower extremities presents for debridement and grafting under anesthesia. A harvest from the right lower flank is planned. My multi-modal pain management strategy would include:

Regarding the ‘time out’ process for regional blocks, in my practice:

A 15-year-old female patient with severe anxiety but no other comorbidies has been taking GLP-1 agonist Mounjaro for weight loss for one year. She wants to get her MRI brain for headaches under anesthesia at the ambulatory center which has ORs and an MRI. BMI (30) and other medical criteria are within institutional guidelines for ambulatory center. Standard institutional practice for MRI at ambulatory site is deep sedation with natural airway; there is no MRI safe anesthesia machine available.

With regards to availability of Nitrous Oxide for anesthesia at my institution:

My practice for intravenous ketorolac dose in a 5-year-old child when indicated is:

A 13-year-old presents for Heller myotomy for achalasia. RSI is indicated to prevent aspiration of gastric (or in this case, esophageal) contents. What is your preferred analgesic for PIV starts in nervous, awake teens? Choose all that apply.