Although the summer is winding down, there’s much to be happy for: the U.S. Open is in full swing, school starts soon (the real Mother’s Day!), and football season starts this week. I took a break from my obsessive tennis watching to record this interview with @OpenAnesthesia’s Ed Nemergut. We discussed the current state of fetal surgery, anesthetic-related neurotoxicity in children, susceptibility to malignant hyperthermia, and discharge criteria after tonsillectomy. Listen to it here: http://www.openanesthesia.org/OpenAnesthesia.org:MultimediaPlayer#tab=Ask_the_Expert

RSL

Here at CHOP, we’ve run out of chloral hydrate (for the foreseeable future), which has been the mainstay for the pulmonologists’ sedation for PFTs. We haven’t found a good alternative. Has anyone had success with anything else? Ideally it should be oral only, so no IV is necessary, but we’ll consider anything.

Check out this nice review of Basics in the December issue of A&A: http://journals.lww.com/anesthesia-analgesia/Fulltext/2013/12000/Basics_of_Pediatric_Anesthesia___Tablet_Edition.42.aspx even though the author thought my sense of humor was “distracting” (can you imagine?). But I wish she would have mentioned the two most important parts of the book: the search function (no more looking in indexes) and the fact that the reader can just touch a referenced hyperlink and the article miraculously appears! I think another review will be in the Sunday NY Times sometime soon, I hope.

After doing this for 23 years, I actually enjoy the challenge of dealing with the overly anxious or hostile parent…but yesterday, I think I met my match! My patient was a little girl with a chronic medical condition that needed an MRI and then an invasive procedure in IR. During her current hospitalization she had a procedure that resulted in a severe bradycardia, necessitating a brief period of chest compressions. The anesthesiologists attributed it to a “vagal reaction caused by distention of a hollow viscus”. The parents insisted on a cardiac consultation, which revealed nothing and recommended anticholinergic tx next time. When the parents arrived to the MRI suite the dad insisted on interviewing me first, or he would cancel the case. In my usual caring and ingratiating manner, I talked with him for a while and gained his trust…and he seemed fine. In the induction room he told me to give the atropine (I gave glyco) and wanted to know the dose of propofol I was using so he could make sure it wasn’t too much. I responded by asking him what he does for a living, and when he told me that he’s a car dealer, I told him that I wouldn’t come to his business and tell him how to deal cars. He actually appreciated that and backed off. After an easy MRI/IR anesthetic, my patient woke up a little weak, nothing terrible, and was transported to the PACU on room air with SpO2 100%. But dad let me know in no uncertain terms he wasn’t happy with her breathing. We reassured him that she would get stronger within the hour. He insisted to me that we gave too much anesthetic, going against what he said. After giving the usual explanations, I left for him to be alone with the PACU nurse. I came back to check on them about 20 min later where I learned that he told the nurses that “the anesthesiologist didn’t know what he was doing.” For probably the first time in my career I almost lost it (but I didn’t) and I addressed him fairly sternly about letting us do what’s best for his child without him antagonizing the staff. Since then, I’ve debated with myself whether to have increased empathy for a stressed dad with a chronically ill child, (and as I later found out, a newborn at home and a recent job loss) vs. the inappropriateness of his anxiety and disrespect for his daughters caretakers. Am I out of line? Thoughts?