Day 3 of the IARS Annual Meeting: 
Congratulations to the Best of Meeting Award Winners, Dr. Jan Larmann (Basic Science Research Award) and Dr. Julie Huffmyer, (Patient-Oriented Research Award), and the Kosaka Award Winners, Yin Hsu, (Basic Science Research) and Dr. Tomoko Yoroozu, (Patient - Oriented Research)!
Pediatric Anesthesia: Little People With Lots of Problems!
Peter J. Davis, MD
Do Anesthetics Make You Stupid?
Dr. Davis presented two important issues that confront pediatric anesthesiologists: 1) neurotoxicity of the anesthetic agents in the developing brain; and 2) obstructive sleep apnea. 
Animal and non-human primate data suggest that neurotoxicity occurs, but the mechanisms are still unclear.  Without a human phenotype, we cannot determine the clinical relevance. The FDA has determined that the extent to which dose and duration of anesthetic exposure is relevant to clinical use is unclear; therefore, there is no scientific basis to recommend changes in clinical practice.
One to 3% of children have obstructive sleep apnea (OSA), and morbidities associated with OSA include neurocognitive impairment, behavioral disturbances, enuresis, and cardiovascular dysfunction.  For the pediatric anesthesiologist, concerns are technical, airway, drug effect and recovery.  Pediatric patients with significant OSA, defined as 85% or less oxygen saturation, have an increased sensitivity to opioids. 
For more information about ongoing studies in neurotoxicity in pediatric patients, visit http://www.smarttots.org to learn more about pediatric OSA in Anesthesia & Analgesia, see http://www.anesthesia-analgesia.org/content/109/1 /60.full
Clinical Research Symposium
The Role of Specialist Societies in Clinical Outcomes Research: How Can They Take a Lead?
Introduction by Keith A. (Tony) Jones, MD and Moderated by Andreas Hoeft, MD, PhD
Presenters:  Simon C. Body, MBChB, MPH, Rupert Pearse, FRCA, MD, Jaume Canet, MD, PhD, Marcus J. Schultz, MD, PhD, and Lars S. Rasmussen, MD, PhD
What is a learning health care system?  It is one in which a systematic approach is used for assessing which new pharmaceuticals, technology, or clinical approaches work and then ensures that the knowledge is used in clinical decision making. The challenges facing academic physicians include the time-financial demands of clinical practice, shortage of trained investigators, complexity of regulations and contracts, lack of local supportive infrastructure, inadequate research training and data collection challenges.

How can the anesthesiology specialty take the lead?  In a word: collaborate; establish a national (global) research of anesthesia and perioperative medicine; develop public/private partnerships, develop sustained collaborative research networks, and create a federated multi-society meeting.

Clinical research in the United States is expensive.  For every $1 million dollars invested in research, we can enroll about 860 patients in a trial. The primary reasons for the higher cost are physician salaries, the research infrastructure, and a shrinking clinical investigator workforce.  Dr. Hoeft suggests a new type of study be developed, a hybrid, which is a combination of routine data and specific observational data.

Size Matters:  Perioperative Management of the Morbidly Obese Frances Chung, MBBS, FRCPC

"Super” obese surgical patients (>50 body mass index) are becoming more common. There are two types of morbid obesity:  gynoid and android.  Gynoid obesity, the “pear-shape” type found more commonly in women, is less worrisome than android obesity.  Android obesity, the “apple shape,” more common in men, presents a higher risk of morbidity in surgical patients because they tend to have higher incidences of obstructive sleep apnea, cardiomyopathy, pulmonary hypotension, obesity hypoventilation syndrome, difficult airway, and anesthetic challenges.

Gastric bypass surgeries are becoming more common.

There are five principles in the anesthetic management of morbidly obese patients: 

  1. Use regional anesthesia when possible

  2. Be prepared

  3. General anesthesia: tracheal intubation and ventilation

  4. Postoperative care: monitoring, early mobilization

  5. Judicious use of any opioid by any route

For an article in Anesthesia & Analgesia about gastric bypass, see http://www.anesthesia-analgesia.org/content/107/4/1257.full

Reading Your Mind: Monitoring the Brain Under Anesthesia

Michael S. Avidan, MBBCh, FCASA

The brain is not routinely monitored, even though it is the target organ of anesthesia.  Anesthesiologists monitor the heart during surgery, yet the brain is not consistently monitored. Dr. Avidan discussed the use of electroencephalographic monitoring and described how to get meaningful information from the raw EEG.  He continued by presenting pEEGs (processed EEGs) and discussed the future of EEG monitoring. The motivation for using EEG include 1) the brain is the target organ of general anesthesia, 2) there is no standard monitor for the brain, 3) the EEG provides useful information, 4) one can be trained in EEG interpretation, and 5) EEG is available.

Visit www.icetap.org for a free EEG educational resource.  To read more about EEG in Anesthesia & Analgesia, see http://www.anesthesia-analgesia.org/content/109/2/506.full