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

November 2022

In the light of recent literature surrounding Desflurane’s exceptionally large global warming potential compared to other modern volatile anesthetics (https://www.asahq.org/about-asa/governance-and-committees/asa-committees/environmental-sustainability/greening-the-operating-room last revised 2017 ; Varughese S, Ahmed R. Anest Analg 2021 Oct; 133(4): 826–835), do you support the removal of desflurane from hospital formularies?

A. Yes – ( 48 votes )
B. No – ( 12 votes )
C. Maybe – ( 10 votes )

Total Answers 70

Total Votes 70

December 2022

In your practice, a teenager undergoing an electrophysiology study with ablation receives which of the following anesthetic techniques:

A. General anesthesia with inhalational agents – ( 69 votes )
B. General anesthesia with Total Intravenous Anesthesia (TIVA) – ( 56 votes )
C. General anesthesia with combination of inhalational and IV agents – ( 86 votes )
D. Monitored Anesthesia Care – ( 22 votes )

Total Answers 233

Total Votes 233

January 2023

Do you use tranexamic acid in pediatric trauma cases where there is anticipated significant blood loss or need for transfusion?

a. Yes, I routinely use it – ( 29 votes )
b. Yes, but only in specific situations – ( 26 votes )
c. No, I never use it – ( 10 votes )

Total Answers 66

Total Votes 66

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

February 2023

In the light of recent joint statement recommending against routine universal asymptomatic screening for SAR-CoV-2 (https://www.apsf.org/news-updates/asa-and-apsf-updated-statement-on-perioperative-testing-for-sars-cov-2-in-the-asymptomatic-patient/), my hospital’s policy for asymptomatic patients in the pre-operative setting is as follows:

a. We do not use routine pre-operative testing – ( 26 votes )
b. With these new recommendations we are stopping all routine pre-operative testing – ( 6 votes )
c. Perform pre-operative testing on a case by case basis – ( 12 votes )
d. Routinely use pre-operative testing – ( 10 votes )

Total Answers 56

Total Votes 56

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

March 2023

In case of a normal healthy six year old presenting for MRI of the brain due to past history of febrile seizure, my routine practice for anesthesia induction is:

A. Inhalation induction followed by supraglottic airway or endotracheal tube placement – ( 46 votes )
B. Inhalation induction followed by intravenous propofol infusion with supplemental oxygen – ( 41 votes )
C. Awake peripheral intravenous placement followed by intravenous propofol infusion with supplemental oxygen – ( 20 votes )
D. Awake peripheral intravenous placement followed by intravenous propofol infusion with supraglottic airway or endotracheal tube placement – ( 6 votes )

Total Answers 115

Total Votes 115

April 2023

In my practice when a critically ill neonate presents to the OR for surgery, intraoperatively:

a. I decrease the preoperative rate of TPN infusion to half and monitor blood sugar – ( 13 votes )
b. I decrease the preoperative rate of TPN infusion to less than half and monitor blood sugar – ( 1 vote )
c. I decrease the preoperative rate of TPN infusion to two-thirds and monitor blood sugar – ( 1 vote )
d. I do not change the preoperative TPN rate but monitor the blood sugar – ( 47 votes )
e. I discontinue TPN and replace it with D 10 containing fluid and monitor blood sugar – ( 11 votes )

Total Answers 78

Total Votes 78

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

May 2023

When transporting an intubated, ventilated patient from the operating room to the Neonatal Intensive Care Unit (NICU) after surgery, which of the following best describes your practice with regards to continuous end tidal carbon dioxide (ETCO2) monitoring:

a. I use continuous ETCO2 monitoring during transport on patients – ( 19 votes )
b. I use continuous ETCO2 monitoring during transport of some patients on a case-by-case basis – ( 10 votes )
c. I do not used continuous ETCO2 monitoring during transport, but it is available in my set-up – ( 9 votes )
d. I do not have ETCO2 monitoring available, but would use it if it was readily available at my institution – ( 19 votes )
e. I do not feel that ETCO2 monitoring is necessary for transport – ( 7 votes )

Total Answers 64

Total Votes 64

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

June 2023

For pediatric MRIs managed by anesthesiology at our institution, we:

A. Routinely monitor temperature in all patients, and have MRI-specific temperature management protocols in place for some situations (ie neonates) – ( 11 votes )
B. Routinely monitor temperature in all patients, but have no MRI-specific temperature management protocols – ( 20 votes )
C. Monitor temperature in only some patients / at the discretion of the anesthesiology team – ( 10 votes )
D. Do not have MRI-compatible temperature monitoring equipment available – ( 18 votes )

Total Answers 59

Total Votes 59

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

July 2023

Considering the significant environmental cost of nitrous oxide, the following best fits my practice:

A. I use or plan to use nitrous oxide tanks sparingly with a plan to remove the nitrous oxide pipelines – ( 3 votes )
B. I use nitrous oxide for an inhalational induction of general anesthesia only and turn it off during maintenance of general anesthesia – ( 25 votes )
C. I try to avoid nitrous oxide usage but very occasionally use it to aid induction – ( 22 votes )
D. We have stopped using nitrous oxide completely – ( 8 votes )

Total Answers 59

Total Votes 59

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

August 2023

With regards to temperature monitoring for pediatric patients under general anesthesia in the MRI suite, the following best fits my practice:

A. I routinely monitor patient’s temperature in case of all MRI procedures under general anesthesia including all age groups – ( 29 votes )
B. I routinely monitor temperature in all neonates and infants but selectively in older age groups – ( 3 votes )
C. I don’t have temperature monitoring capabilities in the MRI monitor in my set-up – ( 26 votes )

Total Answers 60

Total Votes 60

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

September 2023

How long would you delay an elective ambulatory case requiring endotracheal intubation (eg tonsillectomy in ASC) due to a symptomatic but uncomplicated URI (frequent cough, rhinorrhea, without fever, has not required medical treatment) in an otherwise healthy patient?

A. No delay – ( 18 votes )
B. 1 week – ( 5 votes )
C. 2 weeks – ( 37 votes )
D. 3 weeks – ( 10 votes )
E. 4 or more weeks – ( 20 votes )

Total Answers 90

Total Votes 90

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

October 2023

At my institution:

A. We offer flu shots to any patient having a surgical procedure – ( 7 votes )
B. We offer flu shots to only select patients having a surgical procedure who have no concern for post-op fever confusing the clinical picture – ( 3 votes )
C. We only offer flu shots if there is a request from a family/other service ahead of time because we do not have a good system in place – ( 6 votes )
D. We do not offer flu shots due to concerns with efficacy – ( 1 vote )
E. We do not offer flu shots, but I don’t know why not! – ( 17 votes )

Total Answers 34

Total Votes 34

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

November 2023

At my hospital, preoperative NPO recommendations for pediatric patients prescribed GLP-1 agonists:

A. Follow the same NPO/medication hold guidelines as everyone else – ( 2 votes )
B. Follow the ASA (2023) consensus recommendations for medication cessation and NPO – ( 15 votes )
C. Have unique NPO/medication hold guidelines that differ from the ASA consensus recs – ( 1 vote )
D. I have never encountered a pediatric patient on a GLP1 agonist – ( 15 votes )

Total Answers 34

Total Votes 34

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

December 2023

Your medical center has been notified that a critical 2-year-old is arriving to the trauma bay post-MVC. Intubation has not been attempted in the field. In your practice, in the Emergency Department (ED) trauma bay, who is most likely to manage the initial attempt(s) at endotracheal intubation if indicated:

A. ED resident – ( 15 votes )
B. ED attending / pediatric fellow – ( 27 votes )
C. Anesthesia resident – ( 1 vote )
D. Anesthesia attending / pediatric fellow / CRNA – ( 11 votes )
E. Other (critical care, ENT) – ( 2 votes )

Total Answers 57

Total Votes 57

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

January 2024

For children undergoing bowel prep for colonoscopy, how much time after a polyethylene glycol (PEG)-based prep administration do you require before induction of general anesthesia?

A. One hour – ( 6 votes )
B. Two hours – ( 32 votes )
C. Four hours – ( 15 votes )
D. Six or more hours – ( 27 votes )

Total Answers 81

Total Votes 81

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

February 2024

In light of the recent article in JAMA, at your institution, how long do you delay elective procedures requiring a general anesthetic in a patient with a recent history of symptomatic TBI/concussion? —— Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery: A TRACK-TBI Study | Emergency Medicine | JAMA Surgery | JAMA Network https://open.substack.com/pub/ronlitman/p/surgery-anesthesia-and-tbi-outcomes?r=2c9fwl&utm_campaign=post&utm_medium=email

A. No delay – ( 5 votes )
B. Delay until symptoms have resolved – ( 17 votes )
C. Delay for 4-6 weeks – ( 13 votes )
D. Delay 6 months – ( 1 vote )
E. Other (4 votes )

Total Answers 40

Total Votes 40

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

March 2024

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

Is mandatory (no waiver accepted) (1 vote)
Is a standard order but waivers are accepted (5 votes)
Is “opt in” – patients can choose to have a urine HCG but the order is not standard (0 votes)
My institution has no policy/I am unsure of my institutions policy (3 votes)

Total Answers 9

Total Votes 9

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

April 2024

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?

Proceed with general anesthesia with endotracheal intubation (31 votes)
Proceed with general anesthesia with a laryngeal mask airway (14 votes)
Delay/Cancel – I utilize gastric US for training/informational purposes only (9 votes)
Delay/Cancel – I do not utilize gastric US (26 votes)

Total Answers 80

Total Votes 80

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

May 2024

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?

Direct Laryngoscopy (67 votes)
Video Laryngoscopy with non-hyperangulated blade (ie, Miller 0/1) (37 votes)
Video Laryngoscopy with hyperangulated blade (4 votes)
No single modality is most common (0 votes)

Total Answers 108

Total Votes 108

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

June 2024

(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:

A. Is mandatory (no waiver accepted) (7 votes)
B. Not mandatory (waiver are accepted) (24 votes)
C. Is ‘opt in’ – patients may choose to have preoperative pregnancy testing (3 votes)
D. We don’t have an institutional policy (5 votes)

Total Answers 39

Total Votes 39

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

July 2024

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$)

A. Mention live anesthesia records are in flux and not finalized as you observe care of your child in real-time. (0 votes)
B. Mention annotation errors in anesthesia records occur. (1 vote)
C. Discuss anesthesia record only if parents have questions. (31 votes)

Total Answers 32

Total Votes 32

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

August 2024

Our current stand of perioperative use of methadone:

A. We do not use methadone (15 votes)
B. We use single induction dose for inpatients only (8 votes)
C. We use multiple doses on inpatients (9 votes)
D. We use single doses on selected ambulatory patients in addition to in patients (4 votes)
E. We use single doses for a select type(s) of cases (24 votes)

Total Votes 60

Total Answers 60

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

September 2024

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?

8 hours (9 votes)
6 hours (20 votes)
2 hours (8 votes)
0, floor is to stop feeds when OR calls for patient (18 votes)
0, tube feeds to be continued perioperatively (11 votes)

Total Votes 66

Total Answers 66

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

October 2024

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)

Routinely use EEG monitoring (2 votes)
Use some form of EEG monitoring only when using TIVA (20 votes)
Do not use any form of EEG monitoring (14 votes)
Am interested to learn more but currently do not have the setup for this (7 votes)

Total Votes 43

Total Answers 43

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

November 2024

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

Our center has asked us to minimize fluids given to patients which has resulted in some adverse outcomes (more intraoperative hypotension, more PONV, etc) (13 votes)
Our center has asked us to minimize fluids given, however I have not noticed any adverse outcomes (25 votes)
Our center has needed to cut back on surgical volumes (3 votes)
We have made an effort across the institution to minimize fluid waste, but have not made changes to volume administration (8 votes)
We haven’t noticed any changes (8 votes)

Total Votes 50

Total Answers 57

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

December 2024

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.

Phenylephrine (34 votes)
Dopamine (2 votes)
Epinphrine (5 votes)
Ephedrine (27 votes)
Angiotensin II (1 vote)
Additional fluid (57 votes)
Albumin (11 votes)

Total Votes 88

Total Answers 137

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

January 2025

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:

Caudal analgesia (37 votes)
Intrathecal morphine (6 votes)
Regional block at harvest site (5 votes)
No regional/central neural block (14 votes)

Total Votes 62

Total Answers 62

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

February 2025

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

I do separate consent, site marking and separate block specific ‘time out’ (18 votes)
I perform separate regional block specific ‘time out’ (24 votes)
I perform a ‘time out’ addressing regional block in conjunction with the surgical ‘time out’ (4 votes)
I do not perform a ‘time out’ at all for regional blocks (3 votes)
Other (1 vote)

Total Votes 50

Total Answers 50

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

March 2025

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.

Patients on GLP-1 agonists are not accepted for surgery-center procedures or imaging studies under anesthesia. (1 vote)
Patients on GLP-1 agonists may be scheduled for surgical cases at surgery center where GETA is planned. Cannot be scheduled for imaging studies under anesthesia. (4 votes)
Patients on GLP-1 can be scheduled at ambulatory site procedures and imaging studies provided they fill institutional guidelines on GI side effect profile. (25 votes)
We have no limitations on scheduling patients on GLP-1 agonists for ambulatory sites. (10 votes)

Total Votes 40

Total Answers 40

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

April 2025

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

Nitrous Oxide has free availability through central supply and cylinders. (41 votes)
Nitrous Oxide has limited availability through central supply and cylinders. (8 votes)
Nitrous Oxide has limited availability through cylinders only, no central supply. (10 votes)
Nitrous Oxide is no longer available at my institution. (2 votes)

Total Votes 61

Total Answers 61

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

May 2025

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

0.5 mg/kg with maximum dose 15 mg (55 votes)
0.5 mg/kg with maximum dose 30 mg (24 votes)
0.25 mg/kg with maximum dose 15 mg (2 votes)
0.25 mg/kg with maximum dose 30 mg (0 votes)
Other (not listed) (1 vote)
I do not use ketorolac (3 votes)

Total Votes 85

Total Answers 85

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

June 2025

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.

Topical anesthetic placement in advance of IV (EMLA or other) (34 votes)
Avoid the hand veins, the child is nervous and the distal veins are contracted (eg, instead use ultrasound for a forearm vein) (9 votes)
J-tip (13 votes)
Buzzy (7 votes)
Child Life involvement for distraction (25 votes)
Virtual Reality or other distraction techniques (15 votes)
Utilization of oral or intranasal premedication such as midazolam (27 votes)
Call the vascular access team (ie, it wouldn’t be my responsibility) (5 votes)
Nothing, just poke the child (8 votes)

Total Votes 59

Total Answers 143

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

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