Poll of the Month Archives

NOTE: To cite a question and poll results: Society for Pediatric Anesthesia Quality and Safety Poll Question; month, year.

September 2020

Recent literature has raised doubts regarding the efficacy and safety of the routine use of gabapentin or pregabalin in perioperative protocols. Further to that, what is your practice plan regarding use of gabapentinoids as a part of perioperative multimodal analgesic protocol for pediatric surgery patients?

(a) We have not been using gabapentinoids in perioperative pediatric protocols; no change in practice – ( 45 votes )
(b) We have been using gabapentinoids in perioperative pediatric protocols; we currently plan to continue this practice – ( 20 votes )
(c) We have been using gabapentinoids in perioperative pediatric protocols; we are re-evaluating our practice – ( 31 votes )
(d) We have already discontinued gabapentinoids in peri-operative practice – ( 3 votes )

Total Answers 99

Total Votes 99

Contributors
Poll Question edited and reviewed by:
Chris Edwards, Katherine Keech, Tracy Wester, Shivani Patel, Brad Taicher, Rajeev Subramanyam, Priti Dalal, R J Ramamurthi

October 2020

Consensus guidelines from Pediatric Anesthesia Societies in Europe, Australia and New Zealand have recommended a decrease in the minimum NPO (Nil Per Os) time to 1 hour for clear fluids in case of elective procedures. Some US centers have locally implemented similar NPO guidelines for clear fluids. Prior to inducing anesthesia for an elective procedure, which of the following statements best fits your practice regarding NPO time for clear fluids:

My institutional guidelines require a minimum of 2 hours NPO time – I support 2 hours – (48 votes)
My institutional guidelines require a minimum of 2 hours NPO time – I support 1 hour – (62 votes)
My institutional guidelines require minimum 1 hour NPO time – I support 1 hour – (14 votes)
My institutional guidelines require minimum 1 hour NPO time – I support 2 hours – (2 votes)

Total Answers 126

Total Votes 126

Contributors
Poll question submitted by: Brad Taicher
Poll Question edited and reviewed by:
Brad Taicher, Rajeev Subramanyam, Audra Webber, Shivani Patel, Priti Dalal, Tracy Wester, Katherine Keech, Vikram Patel, R J Ramamurthi

November 2020

Current literature suggests that continued oxygenation techniques increase the time to desaturation during difficult airway management in children. Please indicate your current practice with regards to continued oxygenation during management of a difficult pediatric airway:

I do not currently use continuous oxygen insufflation during difficult airway management because I think it is ineffective – ( 2 votes )
I do not currently use continuous oxygen insufflation during difficult airway management, though I believe it may be effective and may use it after reviewing the literature – ( 25 votes )
I currently use continuous oxygen insufflation during difficult airway management via high flow nasal cannula – ( 18 votes )
I currently use continuous oxygen insufflation during difficult airway management via a supra glottic technique – (16 votes )

Total Answers 66

Total Votes 66

Contributors
Poll Question edited and reviewed by:
Chris Edwards, Audra Webber, Sheri Jones Oguh, Katherine Keech, RJ Ramamurthi, Tracy Wester, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Priti Dalal, Brad Taicher

December 2020

Which of the following best describes your current practice in managing patients without SARS-CoV-2 (recent negative test) presenting for anesthesia involving an aerosol generating procedure (ie, endotracheal intubation, bronchoscopy, etc):

I routinely use N95 or equivalent and a protective eye shield – ( 51 votes )
I routinely use N95 or equivalent but not protective eye shield – ( 10 votes )
I routinely use protective eye shield but not N95 or equivalent – ( 25 votes )
I do not use either N95 or protective eye shield because my hospital supply is insufficient – ( 1 vote )
I choose not to use either N95 or protective eye shield although I am offered these by my hospital – ( 8 votes )

Total Answers 96

Total Votes 96

Contributors
Poll question written and edited by:
Priti Dalal, Tracey Wester, Audra Webber, Vikram Patel, Chris Edwards, Katherine Keech, Shivani Patel, Rajeev Subramanyam, R J Ramamurthi, Sheri Jones Oguh, and Brad Taicher

January 2021

What is the maximum cut-off period for accepting a SARS-CoV-2 virus screening test prior to outpatient elective procedures in asymptomatic non-immunocompromised children presenting for a procedure under anesthesia at your institute?

No test required – ( 6 votes )
Test must be within 24 hours or on day of surgery – ( 2 votes )
Test must be within 2 days (or 48 hours) – ( 15 votes )
Test must be within 3 days (or 72 hours) – ( 45 votes )
Test must be within 5 days – ( 15 votes )
Test >/= 6 days – 14 days is acceptable – ( 6 votes )

Total Answers 96

Total Votes 96

Contributors
Poll question written and edited by:
Audra Webber, Tracy Wester, Katherine Keech, RJ Ramamurthi, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Priti Dalal, Chris Edwards, Sheri Jones Oguh, and Brad Taicher

February 2021

The Anesthesia Patient Safety Foundation and the American Society of Anesthesiologists have published a joint statement addressing the timing of elective surgery to reduce complications in patients who tested SARS-Cov-2 positive. The recommendation states: waiting 4 weeks for asymptomatic patients or those with mild non-respiratory symptoms, 6 weeks for patients with symptoms like cough or dyspnea not requiring hospitalizations, 8-10 weeks for patients with cough or dyspnea requiring hospitalizations, 8-10 weeks in patients with symptoms who are diabetic or immunocompromised, 12 weeks for patients requiring intensive care. (https://www.apsf.org/news-updates/asa-and-apsf-joint-statement-on-elective-surgery-and-anesthesia-for-patients-after-covid-19-infection/, December 2020) Which of the following most closely describes your institution’s current practice in scheduling elective surgery in patients who tested SARS-Cov-2 positive:

A. We follow the ASPF guideline as stated – ( 9 votes )
B. We schedule for surgery once the patient is no longer considered to be clinically infectious (10-20 days after symptoms resolve) or 10-20 days after an asymptomatic positive test – ( 13 votes )
C. We schedule for surgery only after a subsequent negative test – ( 5 votes )
D. We do not have a clear institutional policy – physician discretion is used on a case by case basis -( 10 votes )

Total Answers 39

Total Votes 39

Contributors
Poll question written and edited by:
Katherine Keech, Vikram Patel, Christopher Edwards, Audra Webber, RJ Ramamurthi, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Tracy Webster, Priti Dalal, Brad Taicher

March 2021

Following an infant single shot caudal, how long do you wait before re-dosing a caudal anesthetic (via repeat single shot) after a procedure that has lasted 4+ hours?

A) I do not redose – ( 15 votes )
B) I do not redose, but all my caudals have additives (e.g. clonidine) added to prolong analgesic effect – ( 10 votes )
C) I will give a half dose at the end of the procedure – ( 17 votes )
D) I will give a full dose after 4 hours – ( 12 votes )
E) I will give a full dose after 6 hours – ( 5 votes )

Total Answers 64

Total Votes 64

Contributors
Poll question written and edited by:
Christopher Edwards, Tracy Wester, Audra Webber, RJ Ramamurthi, Vikram Patel, Sheri Jones Oguh, Katherine Keech, Rajeev Subramanyam, Shvani Patel, Priti Dalal, Brad Taicher

April 2021

Regarding NPO time in a non-intubated patient who is receiving post-pyloric feeds (naso-duodenal or naso-jejunal) and scheduled for non-airway surgery, my practice is to:

A) Allow the feeds to continue until the start of the procedure, without an X-ray confirming post-pyloric position – ( 4 votes )
B) Allow the feeds to continue until the start of the procedure, after an X-ray confirming post-pyloric position – ( 6 votes )
C) Stop the feeds 2 hours prior to the procedure – ( 6 votes )
D) Stop the feeds 4 hours prior to the procedure – ( 6 votes )
E) Stop the feeds ≥ 6 hours prior to the procedure – ( 22 votes )

Total Answers 45

Total Votes 45

Contributors
Poll question written and edited by:
Brad Taicher, Rajeev Subramanyam, Shivani Patel, Tracy Wester, RJ Ramamurthi, Sheri Jones Oguh, Lauren Lobaugh, Audra Webber, Vikram Patel, Christopher Edwards, Katherine Keech, Neha Patel, James Bradley, Priti Dalal

May 2021

Does the pediatric anesthesiology service at your institution have a detailed pediatric mass casualty policy/plan in place?

a) I work at a level 1 trauma center and we have a peds mass casualty policy/plan – ( 31 votes )
b) I work at a level 1 trauma center and we do NOT have a peds mass casualty policy/plan – ( 4 votes )
c) I work at a level 2/3 trauma center and we have a peds mass casualty policy/plan – ( 3 votes )
d) I work at a level 2/3 trauma center and we do NOT have a peds mass casualty policy/plan – ( 5 votes )
e) I don’t know – ( 13 votes )

Total Answers 59

Total Votes 59

Contributors
Poll question written and edited by:
Kelly Chilson, Lauren Lobaugh, Katherine Keech, Audra Webber, James Bradley, Tracy Wester, Christopher Edwards, RJ Ramamurthi, Shivani Patel, Neha Patel, Vikram Patel, Sheri Jones Oguh, Rajeev Subramanyam, Priti Dalal, Brad Taicher

June 2021

In light of a current CDC report regarding post-vaccination myocarditis in children following administration of mRNA COVID vaccination (https://www.cdc.gov/vaccines/acip/work-groups-vast/technical-report-2021-05-17.html), what is your practice regarding timing of scheduled elective surgery after second dose of COVID vaccination?

a) No change in practice – ( 25 votes )
b) Schedule after 1 week – ( 0 votes )
c) Schedule after 2 weeks – ( 6 votes )
d) Schedule after 4 weeks – ( 2 votes )
e) Schedule after 6 weeks – ( 1 vote )

Total Answers 34

Total Votes 34

Contributors
Poll question written and edited by:
Brad Taicher, Christopher Edwards, RJ Ramamurthi, James Bradley, Tracy Wester, Lauren Lobaugh, Audra Webber, Katherine Keech, Rajeev Subramanyam, Sheri Jones Oguh, Shivani Patel, Vikram Patel, Neha Patel, Priti Dalal

July 2021

In light of increasing community vaccination and de-escalation of state mask mandates, my center:

A) No longer requires COVID-19 testing prior to surgery for all asymptomatic patients without exceptions – ( 5 votes )
B) No longer requires COVID-19 testing prior to surgery for asymptomatic patients but with exceptions (eg those being admitted post-operatively or high risk patients) – ( 5 votes )
C) No longer requires COVID-19 testing prior to surgery for any patient who has been vaccinated – ( 6 votes )
D) Continues to require COVID-19 testing prior to surgery for all asymptomatic patients, no plan to change – ( 19 votes )
E) Continues to require COVID-19 testing prior to surgery for all asymptomatic patients, plan to change in near future – ( 9 votes )

Total Answers 49

Total Votes 49

Contributors
Poll question written and edited by:
Brad Taicher; Christopher M. Edwards; RJ Ramamurthi; James R. Bradley; Tracy E. Wester; Lauren Lobaugh; Audra Webber; Katherine Keech; Rajeev Subramanyam; Sheri Jones Oguh; Shivani Patel; Vikram Patel; Neha Patel; Priti G. Dalal

August 2021

Liposomal bupivacaine has recently been approved by the FDA for use in local wound infiltration for pediatric patients ages 6 and up.

A) I am NOT interested in using liposomal bupivacaine at this time for any form of regional anesthesia – ( 15 votes )
B) I am interested in using liposomal bupivacaine for field blocks (ie, TAP, ESB, ilioingiunal, etc) in patients aged 6 and up – ( 6 votes )
C) I am interested in using liposomal bupivacaine for field blocks (ie, TAP, ESB, ilioingiunal, etc) in neonates and infants as well as patients aged 6 and up – ( 6 votes )
D) I am interested in using liposomal bupivacaine for all blocks (ie, sciatic, femoral, TAP, etc) in patients aged 6 and up – ( 4 votes )
E) I am interested in using liposomal bupivacaine for field blocks (ie, sciatic, femoral, TAP, etc) in neonates and infants as well as patients aged 6 and up – ( 2 votes )

Total Answers 34

Total Votes 34

Contributors
Poll question written and edited by:
James Bradley, Lauren Lobaugh, Katherine Keech, Tracy Wester, Audra Webber, RJ Ramamurthi, Christopher Edwards, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Nancy Kota, Priti Dalal, Brad Taicher

September 2021

Despite the high sensitivity of precordial doppler ultrasound to detect of venous air embolism (VAE), it is unknown the frequency with which it is used clinically. In your practice, is precordial doppler use for VAE detection common?

Yes, it is used routinely for all neurosurgical procedures – ( 2 votes )
Yes, it is used only for high-risk procedures – ( 23 votes )
No, it is not used since clinically significant VAE are rare events – ( 15 votes )
No, it is not used due to noise and distraction in the operating room – ( 3 votes )
No, it is not used due to lack of resources and/or experience – ( 30 votes )

Total Answers 76

Total Votes 76

Contributors
Poll question written and edited by:
James Bradley, Christopher Edwards, Nikolaus Gravenstein, Anthony Destephens, Audra Webber, Sheri Jones Oguh, Vikram Patel, Katherine Keech, RJ Ramamurthi, Lauren Lobaugh, Tracy Wester, Neha Patel, Shivani Patel, Rajeev Subramanyam, Ferenc Rabai, Nancy Kota, Priti Dalal, Brad Taicher

October 2021

How long after asymptomatic SARS-CoV-2 infection would you schedule elective surgery?

>10 days – ( 8 votes )
>2 weeks – ( 30 votes )
>4 weeks – ( 27 votes )
>6 weeks – ( 20 votes )

Total Answers 87

Total Votes 87

Contributors
Poll question written and edited by:
Priti Dalal, James Bradley, Lauren Lobaugh, Katherine Keech, Tracy Wester, Audra Webber, RJ Ramamurthi, Christopher Edwards, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Brad Taicher

November 2021

In the past year at my center, we:

1) have not had any cases of perioperative IV infiltration – ( 10 votes )
2) have had cases of IV infiltration, no adverse patient sequelae – ( 29 votes )
3) have had cases of IV infiltration, minimal adverse patient sequelae (no upgrade in care) – ( 22 votes )
4) have had cases of IV infiltration, significant adverse patient sequelae (upgrade in care, fasciotomy, limb loss) – ( 10 votes )

Total Answers 72

Total Votes 72

Contributors
Poll question written and edited by:
Brad Taicher, James Bradley, Lauren Lobaugh, Katherine Keech, Tracy Wester, Audra Webber, RJ Ramamurthi, Christopher Edwards, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Priti Dalal

December 2021

During surgery, when an IV site is not visually accessible under the drapes, the most frequent strategy I use to check for IV infiltration is:

1) a free flowing iv (63 votes)
2) flush with a saline syringe (12 votes)
3) rely on the downstream occlusion alarm of the infusion pump (2 votes)
4) use special iv infiltration monitoring device (3 votes)
5) periodic visual inspection (30 votes)

Total Answers 112

Total Votes 112

Contributors
Poll question written and edited by:
James Bradley, Lauren Lobaugh, Katherine Keech, Tracy Wester, Audra Webber, RJ Ramamurthi, Christopher Edwards, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Priti Dalal, Brad Taicher

January 2022

For children undergoing tonsillectomy surgery, my routine practice with regards to NSAID (Non-steroidal Anti-inflammatory Drugs) is to:

A. Avoid administration of NSAIDs altogether due to concern of bleeding – ( 21 votes )
B. Avoid administration of ketorolac due to concern for bleeding, but administer ibuprofen or other oral NSAID perioperatively – ( 40 votes )
C. Administer ketorolac only for intracapsular tonsillectomies – ( 3 votes )
D. Administer ketorolac for all tonsillectomies – ( 10 votes )

Total Answers 87

Total Votes 87

Contributors
Poll question written and edited by:
Tracy Wester, Audra Webber, RJ Ramamurthi, Christopher Edwards, James Bradley, Lauren Lobaugh, Katherine Keech, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Priti Dalal, Brad Taicher

February 2022

During inhalation induction in a 4 y/o 18 kg healthy child (ASA-PS 1), what fresh gas flow combinations do you routinely use?

a) Less than 4 L/min with 100% O2 – ( 9 votes )
b) Greater than 4L/min with 100% O2 – ( 20 votes )
c) Less than 4 L/min with 50% O2: 50% N2O mix – ( 5 votes )
d) Greater than 4L/min with 50% O2: 50% N2O mix – ( 18 votes )
e) Less than 4 L/min with 30% O2: 70% N2O mix – ( 12 votes )
f) Greater than 4L/min with 30% O2: 70% N2O mix – ( 89 votes )
g) Other – ( 3 votes )

Total Answers 161

Total Votes 161

Contributors
Poll question written and edited by:
Surya Narayanasamy, Diane Gordon, Elizabeth Hansen, Tracy Wester, Audra Webber, RJ Ramamurthi, Christopher Edwards, James Bradley, Lauren Lobaugh, Katherine Keech, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Priti Dalal, Brad Taicher

March 2022

Which medications do you commonly use for analgesic management of ambulatory tonsillectomy? Choose all that apply:

A. Acetaminophen (pre/intra/post) – ( 135 votes )
B. Pre-op or intraop ibuprofen or ketorolac – ( 25 votes )
C. Post-op ibuprofen or ketorolac – ( 61 votes )
D. Pre-op or intra-op opioid – ( 108 votes )
E. Post-op opioid – ( 70 votes )
F. Ketamine – ( 15 votes )
G. Intra-op local anesthetic – ( 29 votes )
H. Other – ( 20 votes )

Total Answers 491

Total Votes 146

Contributors
Poll question written and edited by:
RJ Ramamurthi, Lauren Lobaugh, Katherine Keech, Audra Webber, Tracy Wester, Christopher Edwards, James Bradley, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Priti Dalal, Brad Taicher

April 2022
No Poll for April 2022

May 2022

Brady-arrhythmia during inhalation induction with sevoflurane occurs frequently in children with Trisomy 21. What do you believe is the possible/probable cause?

A. Hypoxia – ( 5 votes )
B. Sevoflurane overdose – ( 10 votes )
C. Parasympathetic excess – ( 77 votes )
D. Sympathetic failure – ( 13 votes )
E. Other – ( 3 votes)
Other Comments:
–Anatomic difference in heart muscle/conduction
–Abnormal conduction system

Total Answers 108

Total Votes 108

Contributors
Poll question written and edited by:
Jamie Sinton, Tracy Wester, Audra Webber, RJ Ramamurthi, Christopher Edwards, James Bradley, Lauren Lobaugh, Katherine Keech, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Priti Dalal, Brad Taicher

June 2022

In an infant presenting for scheduled laparoscopic inguinal hernia repair with COVID-negative URI with clear runny nose without evidence of other symptoms and signs, my practice is to:

a. Proceed with anesthesia as planned – ( 54 votes )
b. Defer surgery for up to 2 weeks – ( 8 votes )
c. Defer surgery for >2 weeks-4 weeks – ( 11 votes )
d. Defer surgery for > 4 weeks – ( 5 votes )

Total Answers 79

Total Votes 79

Contributors
Poll question written and edited by:
Priti Dalal, RJ Ramamurthi, Jamie Sinton, Lauren Lobaugh, Katherine Keech, Audra Webber, Tracy Wester, Christopher Edwards, James Bradley, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Brad Taicher

July 2022

In an ex-premature infant presenting for elective inguinal hernia repair, the cut-off post-conceptional age (PCA) for post-operative monitoring that I use is:

A. None – ( 0 votes )
B. </= 45 weeks – ( 5 votes )
C. >45 weeks to 50 weeks – ( 5 votes )
D. >50 weeks to 55 weeks – ( 26 votes )
E. >55 weeks to < 60 weeks – ( 19 votes )
F. >/= 60 weeks – ( 32 votes )

Total Answers 91

Total Votes 91

August 2022

In an ex-premature infant (<60 weeks post-conceptional age) presenting for elective inguinal hernia repair, the post-operative duration of monitoring I follow is:

A. 2 hours – ( 3 votes )
B. >2 hours-12 hours – ( 6 votes )
C. >12 hours – 16 hours – ( 16 votes )
D. > 16 hours- 24 hours – ( 36 votes )
E. >24 hours – ( 14 votes )

Total Answers 75

Total Votes 75

September 2022

With regard to the FDA warning on effects of anesthesia-induced neurotoxicity on the developing brain (https://www.fda.gov/media/104705/download), during pre-anesthesia evaluation of children < 3 years of age it is my practice to discuss the topic with parent/guardian:

A. Routinely for ALL Cases – (2 votes)
B. Routinely for ELECTIVE Cases – (0 votes)
C. Only if ASKED specifically – ( 53 votes )
D. Routinely for ALL cases as I am obligated by law/policy – ( 3 votes )
E. Other – ( 2 votes )

Total Answers 60

Total Votes 60

October 2022

In a 3-year-old Trisomy 21 patient scheduled for tonsillectomy for obstructive sleep apnea without a previous cervical spinal radiograph, my practice is to:

A. Routinely request a pre-operative cervical spine radiograph to rule out atlanto-axial instability – ( 0 votes )
B. Request a cervical spine radiograph if no previous cervical radiograph – ( 7 votes )
C. Request a cervical spine radiograph if none within last 2 years – ( 3 votes )
D. Request a cervical radiograph only if symptoms – ( 20 votes )
E. No radiographs but implement precautions for cspine if symptoms are present – ( 36 votes )

Total Answers 66

Total Votes 66

Contributors
Poll question written and edited by:
Priti Dalal, RJ Ramamurthi, Jamie Sinton, Lauren Lobaugh, Audra Webber, Tracy Wester, Christopher Edwards, James Bradley, Sheri Jones Oguh, Rajeev Subramanyam, Shivani Patel, Vikram Patel, Neha Patel, Brad Taicher, Katherine Keech, MD

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