American Academy of Pediatrics Section on Anesthesiology (AAP SOA)
Review of Activities

By Rita Agarwal, MD, FAAP, Section Chair
Stanford University, Palo Alto

The AAP Section on Anesthesiology and Pain Medicine was created as a Section of the American Academy of Pediatrics over 50 years ago by a group of dedicated pediatricians, anesthesiologists and critical care specialists to advocate for the needs of children undergoing anesthesia, needing pain management or critical care; to educate pediatricians and pediatric subspecialists; and to support pediatric anesthesiologists. The Section is open to all pediatric anesthesiologists or anesthesiologists who spend a significant amount of time caring for children. Please consider joining the Section if you are interested in advocacy or education, and if you enjoy working with your colleagues in pediatrics to help achieve these goals.

Dr. Raeford Brown will be taking over as Chair at the end of October 2017. He has been a wonderful addition to the Executive Committee and is also the current Chair of the FDA Advisory Committee on Anesthesia and Analgesia. He has been involved with several major initiatives impacting the pediatric anesthesiology community, including the Opioid Crisis,the FDA Warning on the Neurotoxicity of Anesthesia and Sedation in Children under three, and the controversy over the safer provision of dental sedation. Dr. Anita Honkanen was just chosen to be our next Chair Elect. Dr. Stephan Hays will be taking over her position on the Executive Committee.

Education

Policies, Statements and Clinical Reports
The Section has continued its multipronged approach toward education, including the writing and publishing of Clinical Statements and Guidelines for all physicians and other professionals caring for children. These include:

  • A revision of the AAP/AAPD “Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016”, published in Pediatrics in July 2016.
  • A new clinical report on “Codeine: A Time to Say No?,” a joint report with the Committee on Drugs, was first authored by Dr. Joseph Tobias and published in Pediatrics in October 2016.

The Section is currently working on the following:

  • A revision of the statement on “The Assessment and Management of Acute Pain in Infants, Children, and Adolescents”, authored by Drs. Corrie Anderson and Nathalia Jimenez. The draft is complete and has been approved by the SOA, but will be reviewed by the section and other interested AAP committees prior to publication.
  •  A new statement on “Care of Pediatric Patients with Chronic Pain” to be co-authored by Drs. Kenneth Goldschneider, Sabine Kost-Byerly and Raeford Brown.
  • A revision of the clinical report, “Interpretation of Do-Not-Attempt-Resuscitation and Resuscitation Limitation Orders for Pediatric Patients Who Require Anesthesia and Surgery,” a joint effort with the Section on Surgery and the Committee on Bioethics; co-authored by Dr. Courtney Brown.
  • A new clinical report on “Perioperative Management of Children with Sleep Disordered Breathing/Obstructive Sleep Apnea,” a joint effort with the Section on Otolaryngology; co-authored by Drs. Anita Honkanen and Vidya Raman.
  • A new clinical report on “Oxymetazoline (Afrin®): Considerations for Pediatric Use,” another joint effort with the Section on Otolaryngology; coauthored by Dr. Joseph Tobias and Richard Carabuke.
  • The Section’s new Manual on Procedural Sedation for Infants and Children was published in July 2016.
  • The Section is currently working on an intent for a new manual on pediatric airway management.

Webinars, On-line Modules and Live Events

  • Providers' Clinical Support System for Opioid Therapies Grant from SAMHSA: http://pcss-o.org/. Since the summer of 2015 there have been six webinars produced by the Section and the Committee on Substance Abuse. These webinars are aimed at prevention, identification, and treatment of opioid dependence. They are designed for primary care healthcare providers, but all clinicians are welcome to view them. The webinars are free but payment is required for CME.  AAP: PCSSO link

    • Webinar #1: Unraveling the Mystery of Acute and Chronic Pain in the Child & Adolescent, July 2, 2015
    • Webinar #2: Putting the Pieces Together: Strategies for Pain Management, August 6, 2015​ 
    • Webinar #3: Co-Occurring Psychiatric Illness and Substance Use in Youth, May 24, 2016 
    • Webinar #4: Rational Pain Management in Children with Chronic Medical Conditions, June 29, 2016
    • Webinar #5: Demystifying Buprenorphine Prescribing for Youth with Opioid Use Disorders, June 21, 2017
    • Webinar #6: Understanding Neonatal Abstinence Syndrome for the General Pediatrician, August 23, 2017
  • Acute Pain Management On-line Learning Module (Pedialink®) 2016-2019. This module is written for pediatricians and pediatric subspecialists. Members and non-members of the AAP are encouraged to take the course. For most pediatric anesthesiologists this is an easy CME credit that can help fulfill licensing requirements (opioid prescribing education) that is pediatrics-specific
  • This year a new Pedialink® module has been approved and is currently being developed on Chronic Pain Management in Children by Drs. Robert Wilder and Nisha Kandiah.
  • The National Conference and Exhibition is the major annual AAP Meeting. It is notoriously difficult to get sessions accepted and is open to all Sections, Committees and Councils of the AAP. Many of our surgical and other specialty colleagues have individual programs affiliated with the bigger meeting. There is a preconference every alternate year called "Peds21: Pediatrics for the 21st Century" that focuses on cutting-edge topics and is usually accompanied by a great deal of publicity and media coverage. Some of our recent accepted sessions:
    • “Hot Topic” at the annual National Conference and Exhibition (NCE) in 2016: Babies, Anesthesia and the Developing Brain by Dr. Lisa Wise-Faberowski.
    • Integrating Acupuncture into Pediatric Practice with Dr. Yuan Chi Lin was another
    • The Opioid Crisis: Implications for Pediatric Pain Management by Drs. Samanthan Suresh and Ravi Shah), will be presented at NCE 2017.
    • Anesthesia in Young Children: Do we need to be worried? By Dr. Ravi Shah NCE 2017
    • Several sessions have been submitted for NCE 2018 thanks to our new Education Subcommittee, and we are hopeful that some will get accepted.
    • Opioids Through the Ages: The Good, the Bad and the Ugly has been accepted as a Peds21, a special program for the 2019 NCE.
    • Dr. Courtney Hardy has been working with the Section on Critical Care to develop a program for their meeting in 2018.
  • Currently working with the SPA Education Committee to help develop the 2018 SPA/AAP  Pediatric Anesthesiology Meeting.

Advocacy

The ongoing initiatives of the AAP Section on Anesthesiology & Pain Medicine continue to focus on the improved health and well-being of pediatric patients of all ages. The SOA continues to work closely with the SPA, ASA and FDA on providing information to families, physicians and other healthcare professionals on the safe use of anesthesia and sedation in young children, the opioid crisis and dental anesthesia.

FDA Warning and Labeling on anesthesia neurotoxicity in developing brains

  • FAQ’s have been published on the AAP’s Healthy Children website addressing questions regarding the safe use of anesthetics and sedatives in young children. Anesthesia Safety in Infants and Toddlers
  • Drs.  Raeford Brown and Rita Agarwal have written an article on the FDA neurotoxicity warning for AAP News. AAP Responds to FDA warning on anesthesia
  • The AAP Surgical Advisory Panel, an expert panel made up of the chairs of each of the surgical sections within the AAP, has established a Subcommittee on Optimal Timing of Surgery, to try to better delineate the appropriate time for surgery/procedures in children.
  • Working with IARS, ASA, SPA and Smarttots

Opioid Crisis

  • Resolution passed by the Annual Leadership Forum to promote Sage Storage and Disposal of Leftover Opioids and Other Controlled Substances

    • Creation of educational posters for the NCE
    • Brainstorming other ideas for educating families and clinicians
  • AMA Opioid Taskforce involvement
  • Peds21 - National Convention and Exhibition (NCE) 2019 on Opioids Through the Ages.

Dental Anesthesia Safety

  • Annual Leadership Forum Resolution “Not One More Child Should Die in a Dental Chair: Remembering Caleb” with the AAP-California
  • Working with the AAP-California and the California Society of Anesthesiology to advocate at the state level for safer sedation and anesthesia guidelines-Caleb’s Law: http://www.calebslaw.org
  • Healthy Children Parent Information page: Anesthesia or Sedation for Your Child's Dental Work
  • Article submitted to Pediatrics on this topic
  • AAP News Focus on Subspecialties, July 2017, Guidelines Evolving for Safer Dental Anesthesia, Mary Landrigan Ossar, Charles J Coté
  • Article in preparation for ASA Monitor
  • Working with SPA to improve education of anesthesiologists

Other

  • Button Battery Taskforce with the Section on Otolaryngology, Emergency Medicine, Gastroenterology, Hepatic and Nutrition, Poison Control Center and representatives from industry. Drs. Lisa Wise-Faberowski and Debnath Chatterjee are representing both AAP SOA and SPA.

The AAP Section on Anesthesiology is a vibrant and active society that benefits from everyone’s involvement. Because of its unique relationship within the AAP, it is important to educate and advocate outside of our specialty. Please consider joining. Click HERE for membership information.

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