Study objective: The primary goal of this study was to determine if the addition of clonidine to ropivacaine prolonged periumbilical numbness compared to ropivacaine alone in pediatric patients receiving ultrasound guided rectus sheath nerve blocks for laparoscopic appendectomy. The secondary goals were to evaluate differences in perioperative pain scores, analgesic consumption, sedation, anxiolysis, and hemodynamic effects from clonidine. Design: This was a single center, randomized, double-blinded prospective study. Setting: This study was conducted within the pediatric operating rooms at the Children's Hospital of Pittsburgh, a large university-based academic medical center. Patients: Fifty pediatric patients (ages 10-17 years old) without pre-existing cognitive impairment, developmental delay or chronic pain undergoing laparoscopic appendectomy during weekday hours were enrolled and randomized to control versus intervention groups. Intervention: Ultrasound guided rectus sheath nerve block injections were performed at the beginning of surgery with either ropivacaine 0.5% plus normal saline or ropivacaine 0.5% plus clonidine (2 mcg/kg, maximum of 100 mcg). Measurements: The duration of periumbilical numbness, Numeric Pain Rating Scale scores, University of Michigan Sedation Scale, State-Trait Anxiety Inventory for Children, analgesic consumption, heart rate, blood pressure, and mean arterial pressures, were recorded for each patient at several time points in the perioperative setting. Main results: There were no significant differences in demographic characteristics between groups. The median duration of periumbilical numbness did not significantly differ between the ropivacaine only and the ropivacaine plus clonidine groups 540.0 minutes [360.0 -1015.0] (median [interquartile range (IQR)]) versus 823.5 minutes [509.5- 1080.0], p = 0.451. There were no significant differences in perioperative analgesic consumption, pain and anxiety scores, PACU sedation, or hemodynamic instability. Conclusions: The addition of clonidine did not significantly prolong rectus sheath nerve block duration and was well tolerated in pediatric patients. Perioperative analgesia, hemodynamics, anxiety, and PACU sedation did not differ between groups. Trial registration: Clinical Trials NCT02439281

STUDY OBJECTIVE:Physician burnout is a pervasive problem in the United States. The goal of this study was to investigate use of the smartphone meditation application Headspace® as a well-being improvement tool in anesthesia trainees.DESIGN:Prospective self-controlled observational study.SETTING:Anesthesia training program in an academic hospital.SUBJECTS:Resident and fellow trainees in the Department of Anesthesiology and Perioperative Medicine at the University of Pittsburgh Medical Center.INTERVENTIONS:Resident and fellow trainees were given a free 1-year subscription to the mindfulness application. Participation was voluntary and included questionnaires at baseline, 1 month, and 4 months for assessment of burnout and well-being. Questionnaires were linked with the use of de-identified codes and completed via REDCap. Questionnaires included the abbreviated Maslach Burnout Inventory, Becks Depression Index, Cohens Stress Score, Pittsburgh Sleep Quality Index, and a Headspace® Self-Reporting Questionnaire.MEASUREMENTS:Depression, stress, sleep quality, emotional exhaustion, depersonalization, and personal achievement.MAIN RESULTS:Of 112 trainees eligible to participate, 71 completed baseline questionnaires, 54 created application accounts, and 29 completed the entire questionnaire protocol with 4 months of app use. Application use was associated with reduced depression scores and increased feelings of personal achievement at both 1 month (p = 0.003, p = 0.066) and 4 months (p = 0.011, p = 0.005). Burnout from feelings of depersonalization and emotional exhaustion did not improve with application use. Over the study period, trainees completed 786 meditation sessions, accounting for 6123 min of app engagement.CONCLUSIONS:Findings of decreased depression scores and improved feelings of personal achievement suggest that Headspace® could serve as a mindfulness tool for incorporating meditation into the daily practice of anesthesia trainees in an effort to improve well-being.

This paper reviews the past 50 years of liver transplantation in children from the perspective of patient demographics, perioperative patient management, surgical techniques, immunosuppression and patient outcomes.

To the editor, Sciatic nerve blocks are commonly performed in the popliteal fossa by injecting local anesthetic at the level of the major bifurcation of the common sciatic nerve into its common peroneal and tibial branches. Injections near this branch point have the advantage that they are

The physiologic benefits of high-flow nasal cannula (HFNC) therapy are well documented in the intensive care literature, yet only a handful of case reports describe its perioperative use. Our single center experience explored comprehensive applications of HFNC in the perioperative setting. Over a ten-month period, HFNC was used in the care of 85 medically complex patients either as an adjuvant or main oxygen therapy during induction of general anesthesia, maintenance of deep intraoperative sedation, and during early postoperative care. Here, we illustrate clinical scenarios in which HFNC therapy made patient care safer and describe a framework for integrating this technology into the anesthesia practice at our institution.