Society for Pediatric Anesthesia
We make anesthesia for children safer

Written by Myron Yaster, MD

We lost a giant this week, Dr. Estela Melman (1939-2022),¹ who passed away after a tragic traumatic injury.  If there was such a thing as an international Mount Olympus of Pediatric Anesthesia, Estela would be a prominent figure carved into that stone.  Often thought of as the “mother of pediatric anesthesia in Mexico”, Dr. Melman overcame enormous sexist and anti-semitic obstacles to pioneer the modern practice of anesthesia in Mexico.  She inspired generations of anesthesiologists, pediatricians, and surgeons in Mexico and internationally.  Despite her enormous contributions to anesthesia and critical care medicine, she remained a remarkably humble and gracious mentor, colleague, and friend.  I had several opportunities of meeting Estela and her beloved husband, Dr. Guillermo Bierzwinsky, at SPA annual meetings and as an invited visiting professor.  Their kindness and love for each other, medicine, and Mexico were an inspiration to me and I will truly miss her.

Perhaps her most internationally important contribution to pediatric anesthesia was her pioneering work with regional anesthesia in children.  It may be hard for many of you to believe but until the 1980s regional anesthesia was rarely used in pediatric anesthesia practice.  Working initially in a cadaver laboratory to determine the doses of local anesthetic needed to achieve satisfactory dermatomal spread, and then with children in IRB‐approved research trials, Dr. Melman was among the first to demonstrate the effectiveness of neural blockade, particularly the caudal approach to the epidural space, in pediatric anesthesia.² Indeed, her original study was met with substantial skepticism and was rejected by one of the editors at Anesthesia and Analgesia.  According to Melman, the editor wrote that “regional anesthesia in pediatrics would never be accepted in the United States nor any of the developed countries and would be of interest only in underdeveloped countries like Mexico.” Fortunately, others on the editorial board disagreed and the published manuscript² revolutionized care, making pediatric regional anesthesia and caudal blockade ubiquitous throughout the world.

Aside from her leadership roles in the Mexican College of Anesthesiologists and the National Board of Certification in Anesthesia, she was a member of the Mexican National Academy of Medicine (Academia Nacional de Medicina), the Mexican Academy of Pediatrics (Academia Mexicana de Pediatría), the Federation of Mexican Colleges of Anesthesiologists (part of the WFSA), and the Mexican Society for Pediatric Anesthesiologists. Finally, she was a member of the American Academy of Pediatrics, the American Society of Anesthesiologists, the American Society of Regional Anesthesia and Pain Medicine, and was a founding member of the Society for Pediatric Anesthesia.

I haven’t given justice in recounting her amazing journey and her contributions in this PAAD.  I would urge all of you to read her story, which was published in the Journal of Pediatric Anesthesia as part of an ongoing history project.¹

1. Melman E, Arenas JA, Tandazo WE. Caudal anesthesia for pediatric surgery. An easy and safe method for calculating dose requirements. Anesthesiology. 1985;63:3A, 463.
2. Melman E, Arenas JA, Tandazo WE. Caudal anesthesia for pediatric surgery. An easy and safe method for calculating dose requirements. Anesthesiology. 1985;63:3A, 463.

The recent decision of the Supreme Court of the United States, the rescinding of Roe vs Wade and overturning the constitutional right to abortion, directly impedes the sanctity of the doctor-patient relationship and will harm our patients and colleagues. The mission of the SPA is to care for children, their families, and our pediatric anesthesia community based on the science and best evidence available to us.  Therefore, as patient safety experts, we stand firm in our support for access to safe abortion care for all who seek it and the reproductive rights of all. We offer our support to our members as we all navigate the new waters raised by this decision.

SPA Board of Directors

Dear Colleagues,

It is with profound sadness that we inform you of the passing of our dear friend and a beloved member of our Pediatric Anesthesiology family, Kelly Ann Machovec, MD, MPH. She passed away on March 30th, at the age of 43. Her untimely death has left a huge hole in our lives where this amazing, impactful and dedicated pediatric cardiac anesthesiologist used to stand.

Kelly will be remembered as an exceptional academician and physician who dedicated her career to improving the lives of children undergoing cardiothoracic or vascular surgery, and for her special impact that was palpable to her colleagues and patients throughout the Duke Children’s Heart Center and larger Congenital Cardiac Anesthesiology Society.

Kelly was originally from Baltimore, Maryland. She received her Master of Public Health degree in 2005 and her Doctor of Medicine degree in 2006, both at the University of North Carolina. She went on to complete a residency in Anesthesiology at Drexel University College of Medicine in Philadelphia and a fellowship in Pediatric Anesthesiology here at Duke University School of Medicine. In 2013, we were thrilled when we convinced Kelly to stay on as faculty at Duke Children’s and she joined our Duke Anesthesiology faculty as an Assistant Professor of Anesthesiology; she was appointed an Associate Professor of Anesthesiology in 2019.

Dr Kelly Machovec was an accomplished Pediatric Anesthesiologist whose research primarily focused on the hemostasis management of children following open heart surgery performed on cardiopulmonary bypass. Earlier this year she received the Duke Pediatric and Congenital Heart Center Impact Award, recognizing her exceptional impact on the clinical practice around hemostasis, on both local and national levels. She was a fierce advocate for child-centered health care policies and always questioned the status quo. For example, she led the charge to discontinue preoperative blood testing in children to prevent them from having unnecessary painful blood draws in the preoperative clinic. Dr. Machovec’s excellence and research led to her invitation to write the book chapter on “Anesthesia for Pediatric Cardiac Surgery” in Miller’s Anesthesia textbook. In 2015, she co-founded the Hemostasis Interest Group, a committee within the Congenital Cardiac Anesthesia Society which she served on for six years as committee chair, member and mentor; she also served as an at-large member on the Board of Directors of the Congenital Cardiac Anesthesia Society. Kelly was a passionate educator, serving as chair of the Clinical Competency Committee for Duke’s Pediatric Anesthesiology Fellowship and as a question writer and committee member for the American Board of Anesthesiology’s Pediatric Maintenance of Certification. Residents and fellows loved working with her as she always brought her passion and sharp sense of humor to every encounter. Kelly was not one to leave her opinion unheard. In addition to being an outstanding clinician and a dedicated educator, she was recognized with the high honor of the Leonard Tow Humanism in Medicine Award at the Duke University School of Medicine in March of this year. Recipients of this distinguished award are recognized as exemplars of humanism in the care of their patients, their compassionate delivery of care and respectfulness given to their patients and health care colleagues, as well as for their clinical excellence.

Kelly did not let her illness define her – if anything, it brought a renewed focus and intensity. She became an advocate for basic science cancer research and raised more than $63,000 for the Dana-Farber Cancer Institute as part of her anticipated participation on their team in the 126th Boston Marathon this April. All of the money she raised will go to the Claudia Adams Barr Program in Innovative Basic Cancer Research. She said she was “running this race to raise money for the future, for the next generation of people diagnosed with cancer who need good treatments.”

Kelly was also a citizen of the world and had many passions. From 2013-2017, she advocated for pediatric health care on a global scale by taking part in medical missions in India, the Philippines and Haiti for Operation Smile and Gift of Life International.

At a recent grand rounds she gave, I introduced Kelly as having “the determination of Ruth Bader Ginsberg, the curiosity of Marie Curie and the fierceness of Wonder Woman” and these are the qualities that we all loved and admired in her. Kelly was also super funny, strong-willed and energetic, and a dedicated team member. We are going to miss her desperately.

To preserve Kelly’s legacy at Duke, our department has formally established the Kelly Machovec Humanism Award. The recipient of this annual departmental award will exemplify grace and compassion in their delivery of patient-centered care, reverence for patients, their loved ones and colleagues, ethical principles, and a continuous commitment to clinical excellence. Most importantly, her legacy will live on through her family. She was a dedicated and loving wife to her husband, Scott Matthews, and proud mother to her three young daughters, Vivienne, Eva and Caroline. Her loved ones will remember her as an engaged, talented and powerful woman with unwavering passion and optimism, who loved spending time with her family and friends, running, practicing yoga, reading, and baking.

She will be deeply missed by so many; her legacy and work will continue to inspire us all.

In honor and remembrance of Dr Kelly Machovec.

Eddie Jooste and the Pediatric Anesthesia Team at Duke.