Section on Anesthesiology and Pain Medicine

Newsletter

SPRING 2010

Copyright © 2010, American Academy of Pediatrics Section on Anesthesiology and Pain Medicine

Chair's Report 

In This Issue 

Constance S Houck, MD, FAAP  [email protected]  It's been an exciting year so far for the Section on Anesthesiology and Pain Medicine, and I'd like to update you on the highlights. I am excited and honored (as well as a bit overwhelmed) by the trust you have placed in me as your new Chair. I am hoping that together we can build on all of the work of the previous chairpersons in improving the care that we provide to children every day. Unfortunately, our Section administrator, Linda Lipinsky, recently resigned from her position at the AAP for health reasons so our faithful administrator for many years, Kathy Ozmeral, is filling in until a replacement can be found. Though Linda's tenure with our Section was short, we'll miss her enthusiasm and drive. The AAP is currently interviewing for a new administrator, and I'll keep you updated on their progress. With the economic downturn affecting all of us and the decline in what some may consider "discretionary" spending, the American Academy of Pediatrics has once again demonstrated its commitment to our Section by crafting a pilot membership program for new members. This program will initially be offered to two surgical subspecialties (the Section on Anesthesiology and Pain Medicine and the Section on Ophthalmology) and, if successful, could be expanded to include other surgical and medical subspecialties. This pilot program recognizes the fact that many pediatric surgical subspecialists belong to several different sister societies (such as SPA and ASA) and includes a provision that would allow for a significant reduction in membership dues for all of the members of the Section if a certain target membership is reached. The need for a significant dues reduction is something we have been working towards for a long time (for at least the last 11 years I have been active on the Section Executive Committee). We're hoping to have this pilot membership program up and running at the upcoming SPA/AAP meeting in San Antonio. Our Section has also been involved in a number of advocacy efforts this past year, especially in the area of Pain Medicine. In May, I represented the AAP at a meeting organized by the Mayday Fund (a private philanthropic organization dedicated to educating the public about the treatment of pain) from which a White Paper was produced advocating for better and more effective pain management for both adults and children. This paper was evaluated by our Section Executive Committee as well as several other committees and sections and ultimately received AAP endorsement (see http://www.maydaypainreport.org). There was also a special article in the January issue of AAP News about this initiative (see p. 3).

Chairperson Dr Constance Houck, thanking Dr Joseph Cravero for his service as Section Chair, at the Society for Pediatric Anesthesia (SPA) Meeting, March 2009

Several members of the Section also participated in the FDA and IARS-sponsored workshop entitled "Safety of Key Inhaled and Intravenous Drugs in Pediatrics (SAFEKIDS) Initiative" in Silver Spring, MD, and the AAP Board has asked us to keep them updated on the proceedings. Also, Dr Nancy Glass represented the AAP at an AMA Summit on Pain in Houston, TX on November 5. Continued on p. 2

Chair's Report 2009 Robert M Smith Award John J Downes Resident Research Award AAP News article on chronic pain In Memoriam ~ Dr Robert M Smith FAAP CDC H1N1 Update The Inside Story on Health Care Reform ~ Judith S Palfrey, MD, FAAP, Pres., AAP Society for Pediatric Sedation Upcoming Meetings AAP Advocacy Snapshot: Health Care Reform Membership Update Section Executive Committee

1 2 2 3 4 4 5 6 7 8 9 9 

 

   

  Newsletter Editor  Corrie T. M. Anderson, MD, FAAP ~ [email protected]

Section Managers (temporary)  Kathy Ozmeral ~ [email protected] Hope Hurley ~ [email protected]

Newsletter Designer  Ruth Podjasek ~ [email protected] This is a newsletter of the Section on Anesthesiology and Pain Medicine of the AAP. The opinions expressed herein do not necessarily reflect the opinions of the American Academy of Pediatrics.

American Academy of Pediatrics

National Conference & Exhibition   

October 2‐5, 2010  ~ San Francisco, CA 

http://www.aapexperience.org/ 

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Section on Anesthesiology and Pain Medicine Awards  presented at the March 2009 meeting of the AAP Section on Anesthesiology and Pain Medicine and the Society for Pediatric Anesthesia The Robert M. Smith Award recognizes an individual who has advanced the field of pediatric anesthesiology. 2008 Winner 2009 Winner

Frederick Berry MD Ryan Cook, MD

The John J Downes Resident Research Award recognizes the best research presented by the Section on Anesthesiology and Pain Medicine residents.

1st Place   Resident Research Award  Patrick Callahan, MD Children's Hospital of Pittsburgh Pittsburgh, PA Electrocardiographic Effects of Dexmedetomidine in Patients following Cardiothoracic Surgery - Preliminary Results.   2nd Place   Resident Research Award  Alison Considine, MD, MPH Yale School of Medicine New Haven, CT An Innovative Wellness Program for Residents in Training.

Dr Cravero with Frederick Berry MD and Mrs. Berry (right) and Ryan Cook, MD and Mrs. Cook (left).

Chair's Report continued from p. 2 Things remain busy on the education front. Dr Carolyn Bannister is gradually taking over the reins as our new Education Chair and has been a big help in organizing the Section programs this year. Though the ASA annual meeting and the AAP National Conference & Exhibition meeting were at the exact same time this year, several of our Section members shuttled back and forth between New Orleans and Washington, DC to present programs for our pediatric colleagues. Joe Cravero teamed up with members of the Section on Emergency Medicine to provide a talk on procedural sedation in the office setting. Lynne Maxwell educated our pediatric colleagues on "Preparing the child for surgery," and Sabine Kost-Byerly spoke on "Chronic Pain Management – What the Pediatrician Should Know." This year's SPA/AAP Breakfast Panel at the ASA was on Saturday, October 17 from 7:00 – 8:15 am and was entitled "Surprises in the Day Surgery Unit" and included talks on obstructive sleep apnea, unexpected pregnancy and anesthetic concerns for ex-premature infants. In September we learned that Dr Helen Lauro has been selected as the Anesthesiology Section Editor for the Journal Pediatrics. We had a tremendous response from the Section membership when this position was announced, which was a nice reflection of how much commitment you all feel toward the advancement of our subspecialty. I am committed to regular communication with our Section members over the next year about the many opportunities within the AAP for our Section members' participation. Check your email for updates!

3rd Place   Resident Research Award  Jonathan C. Rowell, MD Seattle Children's Hospital, Seattle, WA Continuous Lumbar Plexus Blocks for Perioperative Pain Management in Children. Photos: Dr Houck presenting award certificates to winners.

Save the Date! Mark your calendars now to attend the AAP 2010 National Conference & Exhibition in San Francisco October 2-5 with FREE special events and sessions scheduled for registrants on Friday, October 1.

Never Miss a Thing at the AAP NCE! Order audio recordings of NCE sessions today (http:// www.aapexperience.org/09tapes.pdf) at an affordable price and convenient format (download MP3s and listen on PC) or save on mobile phones/media players and listen while you're on the move. Check out year-round conference coverage at www.AAPconvergeNCE.com.

Section on Anesthesiology and Pain Medicine Newsletter

FOCUS ON SUBSPECIALTIES

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AAP News Vol. 31 No. 1 January 2010, p. 12 © 2010 American Academy of Pediatrics

Experts call for revolution in chronic pain treatment Constance S. Houck, MD, FAAP A committee of pediatric and adult pain experts recently released a white paper outlining the enormous cost of untreated pain and the tremendous burden on the health care system due to lack of education about the causes of chronic pain and the effectiveness of early treatment. Titled "A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform," the paper also emphasizes the importance that primary care practitioners play in identifying and treating adults and children in pain. Dr Houck

The treatment of pain should be a priority on par with that of other chronic conditions, according to a white paper endorsed by the Academy and dozens of other groups.

• More than 30 major health care organizations have endorsed the paper, including the American Academy of Pediatrics, the American Academy of Family Physicians, the American • Development of a public awareness campaign about chronic College of Emergency Physicians and the Joint Commispain by the Surgeon General's office similar to that launched sion. to raise awareness about the risks of tobacco products. • The document includes 12 specific recommendations directed at government and private health insurers, regulators, The committee that developed the white paper included anesagencies and physicians to make the treatment of pain a pri- thesiologists, neurologists, primary care doctors, emergency ority on par with that of other chronic condiphysicians, nurses, pharmacists, psychologists tions such as diabetes, cancer and heart disand patient advocates and was co-chaired by Resource ease. Of particular interest to pediatricians Lonnie K. Zeltzer, MD, FAAP, a member of "A Call to Revolutionize are the following proposals: the AAP Provisional Section on Hospice and Chronic Pain Care in America: • The development of coordinated health inPalliative Medicine and director of the Pediatric An Opportunity in Health Care formation technology systems by insurers Pain Program at Mattel Children's Hospital. Reform" can be accessed at and physicians that could be utilized to track www.maydaypainreport.org. They began their work to develop initiatives to pain disorders, treatments and outcomes as a encourage better treatment for people with mechanism to improve pain care. chronic pain in June 2009. The meeting was sponsored by the • A mandate for state medical boards, medical schools and Mayday Fund, a family foundation dedicated to reducing human professional organizations to assure that health care providers suffering caused by pain. have the education and skills to assess and treat pain effectively. • An appeal for a substantial increase in funding by the Dr Houck was a member of the committee that released the National Institutes of Health for pain research and the white paper on chronic pain care in America. She also is chair Agency for Healthcare Research and Quality to develop of the AAP Section on Anesthesiology and Pain Medicine quality initiatives for the treatment of pain. executive committee.

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In Memoriam  Robert M. Smith, MD, FAAP, Clinical Professor

of Anaesthesia, former Chief of Anesthesiology at Children's Hospital Boston and a pioneer in clinical anesthesiology in children, died on November 25, 2009. He would have been 97 on December 10.

multi-authored text. Dr Smith's legacy and basic messages of safety and compassion for children are continued today in his textbook, which is soon to reappear in its 8th edition—the longest running textbook of pediatric anesthesia in the world.

Included among his many accomplishments is serving as the president of the Children's Hospital Boston medical staff, Dr Smith received his bachelor's degree director of the Massachusetts Society of from Dartmouth College in 1934 and his Anesthesiologists, president of the New medical degree from Harvard Medical England Society of Anesthesiologists, and School (HMS) in 1938. He completed a chairman of the Section on Anesthesiology rotating internship at the Faulkner Hospital of the American Academy of Pediatrics. and two years of general surgery at Boston In addition, he was the first pediatric anesCity Hospital before going into general thesiologist to receive the Distinguished practice in Cohasset for a year. Service Award from the American Society In 1942 he entered the army and received three months of anesthesia training before being appointed Chief of Anesthesia of the 100th General Hospital (in France and Germany), a position he held until 1946. Following this service, he joined the HMS community as Assistant in Anaesthesia and served on the staff of Children's Hospital Boston (CHB), where he was appointed the hospital's first Anesthesiologist-in-Chief. He remained at CHB for over three decades as Anesthesiologist-in-Chief and rising to the position of Clinical Professor of Anaesthesia. Dr Smith was a distinguished pioneer of pediatric anesthesia. The pediatric anesthesia fellowship program he started at CHB is one of the oldest in North America and includes intimate bedside teaching. At a time when anesthesia monitoring consisted primarily of simple visual observation of the anesthetized child, Dr Smith initiated the concept of physiological monitoring using the precordial stethoscope and pediatric and neonatal blood pressure cuffs (Smith cuffs), initially handmade in his garage. In 1959, Dr Smith wrote a major comprehensive textbook specifically dedicated to the anesthetic management and care of children, titled Anesthesia for Infants and Children. In 1990, after the fourth edition by Dr Smith, the fifth edition was renamed Smith's Anesthesia for Infants and Children, when Dr Smith passed the baton to colleagues Dr Etsuro K. Motoyama, his former associate, and Dr Peter J. Davis, who expanded the book to a scholarly

of Anesthesiologists. His many honors also include a Special Recognition Award from the Section on Surgery of the American Academy of Pediatrics. After retiring as Clinical Professor of Anaesthesia, Emeritus, from HMS in 1980, Dr Smith practiced at the Franciscan Hospital for Children from 1980-1992. Dr Mark Rockoff, Associate Anesthesiologist-in-chief at CHB and HMS Professor of Anaesthesia said, "He is widely considered the Father of Pediatric Anesthesia in the U.S.A. and had a truly remarkable impact on the development of the specialty."

Centers for Disease Control and Prevention  Your Online Source for Credible Health Information  Key Flu Indicators—04/02/10  http://www.cdc.gov/h1n1flu/update.htm Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of March 21-27, 2010, nationally most key flu indicators remained about the same as during the previous week; however, increasing activity has been reported in certain areas. Below is a summary of the most recent key indicators: • Visits to doctors for influenza-like illness (ILI) remained stable and relatively low nationally. However, ILI is also looked at by region, and one of 10 U.S. regions, region 9, reported elevated ILI for the week ending March 27. Region 9 is comprised of Arizona, California, Hawaii and Nevada. (Last week, regions 4, 7 and 9 had elevated ILI.) • Laboratory-confirmed hospitalizations rates have leveled off and very few hospitalizations were reported by states during the week ending March 27; however, some states in the Southeast are reporting recent increases in the number of flu-related hospitalizations. • The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report increased over last week and is now above baseline. One flu-related pediatric death was re-

ported this week, and it was associated with 2009 H1N1. Since April 2009, CDC has received reports of 333 laboratory-confirmed pediatric deaths: 279 due to 2009 H1N1, 52 pediatric deaths that were laboratory confirmed as influenza A, but the flu virus subtype was not determined, and two pediatric deaths that were associated with seasonal influenza viruses. (Laboratoryconfirmed deaths are thought to represent an undercount of the actual number. CDC has provided estimates about the number of 2009 H1N1 cases and related hospitalizations and deaths). • No states reported widespread influenza activity. Three states reported regional influenza activity. They are: Alabama, Georgia and South Carolina. Local and regional flu activity has been sustained in the Southeast United States over the past several weeks. • The majority of the influenza viruses identified so far continue to be 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception. *All data are preliminary and may change as more reports are received.

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The Inside Story on Health Reform  Judith S. Palfrey, President, American Academy of Pediatrics  Posted By: Judith S. Palfrey @ 03/31/2010 09:40 AM (http://forums.aap.org/blog/index.cfm?forumid=483)  Over the past week, I have had the incredible honor of sending out a number of official press releases on the passage of the Senate bill, the passage of the Fix-It Bill and on the contentious issue of insurance for children with pre-existing conditions. The DC office of the AAP has written a number of wonderful pieces on health reform and has prepared a useful set of FAQs. I have also posted a Huffington Post blog on health reform. What I want to share here to the members of the AAP is the inside story. During the past year, the AAP Executive Committee, the Committee on Federal Government Affairs and its access subcommittee, the Committee on State Government Affairs, AAP board members and the grassroots advocates within the Key Contact network have had the amazing opportunity to experience the making of the legislation from the inside out, through meetings and visits with the folks who have been crafting, drafting and voting on health reform legislation every step of the way. What is striking about these visits to office after office on Capitol Hill and in the Administration is that the real inside story is about the seriousness of creating a health reform law that will work. The detailed discussions and difficult grappling with concepts and innovations that has gone into the nearly yearlong effort to create the current health reform law is a far cry from the angry public debates and ugly external exchanges of words that hit the media and sell the daily newspapers.

been listened to respectfully. The words we have said in those hearings have found their way onto the Senate and House floor, and the examples we have given of struggling families and heroic pediatricians battling insurance companies and state Medicaid offices have provided the practical reality base that our elected representatives and their staff have turned into the law of the land. Inside, we have learned that our suggestions carry enormous weight. Our focus on the ABC's - access, benefits and coverage - has been articulated clearly, and now many of the issues that we care deeply about are incorporated into statute as fundamental reforms. We care about access, and the news is that we finally broke through on the issue of Medicaid payment reform. This probably would not have happened outside of the big push for health reform. For years in the AAP, we have had a debate as to whether we should just keep wearing our Children First buttons or whether we should embrace a larger advocacy stand. The events of the last few weeks would argue that, at least for now, our voice for the larger reform has netted us a longsought victory: a first-time-ever recognition that we must have parity of Medicaid to at least Medicare rates.

In terms of benefits, because of Mark Del Monte, Cindy Pellegrini, Bob Hall and the rest of our wonderful DC staff, there is not an office in the Capitol or a health care staff member in the White House who does not know about Bright Futures and how critical prevention is for children and youth. A fundamental premise of health Instead, what we have experienced, work- reform has been that the U.S. health care ing with the Academy's extraordinarily system has invested far too little in pretalented Washington, DC office, is that the vention over the years. With "chance faSenate and House staff (Democrats and voring the prepared mind," when ConRepublicans alike) have worked incredibly gress asked how the AAP thought we hard to come up with real solutions to the could focus better on prevention, we had very complicated problems that have ham- the Bright Futures program to offer. Recpered our health care system. They have ognizing that many private payers require reached out to experts for help and asked heavy co-pays for preventive services, we for very specific suggestions and input. were able to argue that a major reform The AAP has been welcomed into Senate would be first-dollar coverage for Bright and House hearing rooms and we have Futures services. Those staffers also now

understand what a medical home is and why coordination of care is such a critical element. While the original language in the legislation provided for Medicare pilots for medical homes, the AAP was able to get Medicaid pilots added to the mix. We've recently learned that the intent of the legislation is also to require large employers (self-insured ERISA or so-called "large employer plans") to cover Bright Futures for no co-pay as well. Since the founding of the AAP, our mission has been universal coverage of affordable health care for all children. What an incredible journey it has been, from Martha Eliot inserting language about mothers and children into the 1935 Social Security Act, to the 1965 passage of Medicaid, to Julie Richmond creating the Neighborhood Health Centers, to the hardfought battles for CHIP and CHIPRA, to the March 23 and March 30 signings of the Patient Protection and Affordable Care Act. And the inside story? Kids matter. And people care that our nation's children have quality, affordable health insurance coverage. Toward the closing days of the health reform debates and as the votes were being counted, it became clear that Americans really want their children protected. The AAP has always known this. The end of the inside story is that the AAP is welcomed into Congress, into committee rooms, into the White House. The AAP is welcomed with respect and an open door because of what you all do day in and day out. You protect children. You care for children. You provide children with a medical home and the bright future they deserve. Thank you for all that you do. As always, I love to hear from you. Please write me at [email protected].

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Society for Pediatric Sedation: What Role Anesthesiologists?  Jerard Michael Connors, MD, President‐Elect, Society for Pediatric Sedation  Director, Pediatric Sedation Service, East Tennessee Children's Hospital  President, Pediatric Analgesia & Sedation Specialists, PLLC, Knoxville, TN  If one samples the literature since the late 1800's, you will find that a wide variety of specialties discuss sedation. Veterinarians, dentists, psychiatrists, and anesthesiologists have all played a role in the development of pediatric sedation or "ultralight" anesthesia as it was once referred. Today, the field of pediatric sedation continues to be multidisciplinary as specialists in Emergency Medicine, Critical Care and Hospital Medicine have joined the ranks of pediatric sedation providers. The same issues remain that were raised in the literature over the past 100 years including what types of training, monitoring, medications and strategies can achieve the best outcomes. To seek these answers and to foster multidisciplinary collaboration, the Society for Pediatric Sedation was founded in 2006 as a collaborative effort among several AAP Sections, including the Section on Anesthesiology and Pain Medicine. The SPS's mission is to be the multidisciplinary leader in the advancement of pediatric sedation by promoting safe, high quality care, innovative research and quality professional education. Sir William Osler was one of the first to advocate for specialty medical societies. He wrote in the Boston Medical and Surgical Journal in 1892 that "these societies stimulate work, promote good fellowship, and aid materially in maintaining the standard of professional scholarship … this body offers to men the opportunity of knowing each other, of discussing subjects of common interest, and through medium of their publications making general the more special details of value in practice."

Through collaboration, we can improve the care we provide for pediatric patients undergoing all types of procedures. It is clear that no one specialty can meet the needs of all children and all times.

panding field of pediatric sedation. There are many ways that you and the Society can be of benefit to each other: 1.

2.

3.

The Society of Pediatric Sedation needs 4. the continued involvement of anesthesiologists. Therefore, I appreciate this opportunity, as a non-anesthesiologist, to offer the members of your Section my personal views on the vital role of anesthesiologists in the activities of the Society of Pediatric Sedation. I would like to 5. invite you to become involved in the Society and help us advance the rapidly ex-

Promoting safety – Without question, the role that pediatric anesthesiologists have played in promoting patient safety has had a tremendous impact on pediatric sedation practice. Anesthesiologists continually advocate for patient safety issues and have promoted best practices in regard to NPO guidelines, emergent sedation, medical risk factors, and proper training and monitoring. Gaining perspective and promoting collaboration – Dialogue among multiple specialties helps in gaining perspective on different approaches to the same problem. Anesthesiologists might have one approach, Emergency Medicine physicians another and dentists may have their own. The anxious child in the dental office, the emergent need for a fracture reduction in the emergency department and the morbidly obese child in need of an elective MRI all have unique issues which would benefit from multidisciplinary dialogue. Improving training – Much is discussed about which medications should be given and by whom. However, we also know that most medications can and do have the potential of progressing to a deeper level of sedation than intended. So, perhaps the question should be how do we collaborate to improve training to allow more providers to have the skills, monitors and resources to recover a patient from a deeper level of sedation? These improvements will come from a multidisciplinary approach. Conducting research – Research into medications, patient safety, provider training, procedural pain, and the psychological impact of procedures on children are important areas of research for this expanding field. Improving access to safe sedation – This clearly is the ideal of the society and of all of us as sedation providers.

The Society for Pediatric Sedation was formed to bring sedation providers together and is currently targeting the following areas: •

•

•

Membership – Our membership is now over 500 and we also have 20 institutional members. Members include physicians in Anesthesia, Critical Care, Emergency Medicine, Hospital Medicine, dentists, advanced practice nurses and sedation nurses. Our Board also represents the many disciplines involved in pediatric sedation. Current anesthesiologists on the board include; Dr Mark Buckmaster, Dr Joe Cravero, Dr Cheryl Gooden and Dr Jeana Havidich. Annual Conference – the SPS holds an annual conference to reach out to all providers interested in pediatric sedation. The conferences have offered a wonderful opportunity for sharing of "best practice," multidisciplinary approaches to common problems and research poster presentations. Anesthesiologists have been involved in planning, presenting and attending these conferences and are a critical role in their success. Last year's conference was hosted by Children's Hospital of Philadelphia and this year's conference will be hosted by Kosair Children's Hospital in Louisville, KY in May. Please check out our website for more information at www.pedsedation.org. Sedation Provider Course – The society has now held two "Sedation Provider Courses." This course emphasizes core knowledge of the physiology of sedative drugs in children and provides hands-on simulation scenarios to aid in the early recognition and treatment of airway adverse events. Continued on p. 7

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Upcoming Meetings  2010 Pediatric Anesthesiology 

Pediatric Sedation Outside the Operating Room 

A meeting co-sponsored by the Society for Pediatric Anesthesia and the American Academy of Pediatrics Section on Anesthesiology and Pain Medicine April 15-18, 2010 The Grand Hyatt ~ San Antonio, Texas www.pedsanesthesia.org/meetings

4th Annual Pediatric Anesthesiology and Critical Care  Medicine Conference  Perioperative Care of the Infant and Child May 26-28, 2010 The Fairmont Copley Plaza Hotel, Boston, MA Offered by: Children's Hospital Boston and Children's Hospital of Philadelphia http://cme.med.harvard.edu/index.asp? SECTION=CLASSES&ID=00302645&SO=N

The 6th International Symposium on the Pediatric Airway  June 4-6, 2010 The Children's Hospital, Aurora, CO 80045 http://www1.thechildrenshospital.org/Events/calendardetail.aspx?eventId=e0efbf3b-78f5-de11-965b-005056947103 Oct 2-5, 2010 Oct 15-18, 2011 Oct 20-23, 2012

Future AAP NCE Meetings 

September 11-12, 2010 Intercontinental Hotel, San Francisco, CA Sponsored by: Children's Hospital, Boston http://cme.med.harvard.edu/cmeups/custom/00301418/index.htm

Regional Anesthesia in Children  September 24-26, 2010 Seattle Children's, Wright Auditorium, Seattle, WA Seattle Children's Hospital http://www.seattlechildrens.org/healthcare-professionals/ education/cme/calendar/

2010 AAP National Conference & Exhibition  Children's Health Climbing to New Heights! October 2-5, 2010 Moscone Center ~ San Francisco, California http://www.aapexperience.org

Joint SPA/SPANZA ‐ 24th Annual Meeting  October 15, 2010 San Diego, CA http://www.pedsanesthesia.org/meetings/index.iphtml San Francisco Boston New Orleans

Oct 26-29, 2013 Oct 11-14, 2014 Oct 17-20, 2015

Orlando (New!) San Diego (New!) Chicago

Society for Pediatric Sedation Continued from p. 6

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Our goal is to make this course, developed by the input of a multidisciplinary group, more widely available in the future. This provider course gives us as a society a great opportunity to improve sedation practice through training. Attendees have represented the diverse group of providers who deliver sedation to pediatric patients and feedback has been overwhelmingly positive. Research – The Pediatric Sedation Research Consortium initially developed by Drs. Joe Cravero and George Blike continues as part of the SPS. The consortium is actively gathering data and continues to focus on various areas related to pediatric sedation including adverse events, propofol, obesity, and emergent sedation. This multi-centered, multi-disciplinary data gathering is yet another way the society is working to improve the standardization of sedation practice. Your research interests and participa-

•

tion would be most welcomed by this group. Listserv® – The society also sponsors a listserv® for discussion about any and all areas related to pediatric sedation. This group has over 600 members and includes input from around the world. Information about the listserv® can be found on the website at www.pedsedation.org

The Society for Pediatric Sedation needs multi-disciplinary collaboration to improve training, enhance education, and deepen the research into safety, efficiency and quality. The involvement of anesthesiologists is critical to the advancement of this field. The SPS wants to encourage all members of the Section on Anesthesiology and Pain Medicine to become involved. We welcome your input, participation and collaboration in any and all areas of your interest. Please join us in this collaborative effort to improve pediatric sedation.

Free Registration for Online   Patient Safety Alerts from Health  Care Notification Network  (HCNN)  The HCNN delivers drug and medical device recalls to physicians and their staff securely online, replacing the current paper process that is both slow and error-prone. Registration to receive this service is free to AAP members, and it only takes a few minutes to enroll in the HCNN. To register now go to: https://www.hcnn. net/registration/aap/registration.aspx Information you provide is secure and used only for patient safety Alerts and HCNN communication. Email addresses and contact information provided to the HCNN is not sold, shared or disclosed to third parties. All eligible AAP members are encouraged to register for this important patient safety notices. For more information visit www.hcnn.net, or call 1-(866) 925-5155.

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AAP Advocacy Snapshot:   What the Health Reform Law Means for Children and Pediatricians  What's in the Law  In March 2010, President Obama signed into law The Patient Protection and Affordable Care Act (Public Law 111-148) and an accompanying package of modifications to the law, including Medicaid payment reform.

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The new law contains many strong child health provisions, a direct result of decades-long efforts by the Academy to urge Congress to prioritize children's health needs on the national policy agenda. AAP members and staff advocated throughout the health reform debate to amplify the voices of children and pediatricians, and the resulting new law will improve the quality, affordability and accessibility of health care services for children and families. Throughout the health reform process, the Academy has been focused on "the ABC's" of fundamental priorities for children and pediatricians: • appropriate payment rates and workforce improvements to allow real Access to covered services • age-appropriate Benefits in a medical home health care Coverage for all children in the United States

immediate benefit for no co-pay. The law also includes new funding for Medicaid medical home demonstration projects. Coverage: The law projects that nearly thirty-two million children, parents and individuals will now gain insurance coverage. The law also prevents children from being denied health insurance due to pre-existing conditions, and allows young adults to remain on their parents' insurance until the age of 26; both provisions will take effect in 2010. In addition, the law preserves the Children's Health Insurance Program (CHIP) with funding until the end of fiscal year 2016 and includes a renewed federal funding commitment to states through 2019.

In addition to these reforms, the current law also reauthorizes the Emergency Medical Services for Children program, which provides grants to all 50 states to support activities and efforts related to pediatric emergency care.

The current law addresses these issues in the following ways:

In the weeks and months ahead, the Academy will work with Congress and the Administration to ensure that the health reform law is appropriately implemented to provide the best possible outcomes for children and the pediatricians who care for them.

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How to Get Involved 

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Access: The law provides pediatric primary and subspecialty workforce improvements, including a new loan repayment program ($35,000 per year) for pediatric subspecialists who practice in subspecialty shortage areas. In addition, for the first time ever, a new $8.3 billion federal investment will bring parity to Medicaid and Medicare payments for primary care doctors. The increase applies to payments for evaluation and management codes recognized by Medicare starting in 2013, and is available to physicians with a specialty designation of internal medicine, family medicine or pediatrics. Benefits: All Bright Futures services will now be covered for children with private and public insurance as an

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Visit the AAP Department of Federal Affairs Member Center Web site AAP members can log into the AAP Member Center and visit FederalAdvocacy.aap.org for resources related to health reform and other priority federal legislative issues, including a link to an implementation timeline that details when provisions of the health reform law will take effect and a frequently asked questions document on what health reform means for children and pediatricians. Become a Key Contact To receive additional communication on health reform implementation and other federal legislative issues, be-

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come a Key Contact. Key Contacts are AAP members who have asked to receive timely legislative updates and advocacy requests from the AAP Department of Federal Affairs on federal legislative issues important to the Academy. To enroll in the Key Contact program, visit FederalAdvocacy.aap.org (AAP Member Center login required) and click on "Become a Key Contact." Contact the AAP Department of Federal Affairs The AAP will continue its advocacy on issues of importance to children and pediatricians at the national level. We welcome and encourage you to contact the AAP Department of Federal Affairs at [email protected] if you become aware of similar efforts underway in other organizations or if you have any additional questions about the Academy's federal advocacy activities.

Web Sites:  AAP Member Center http://www.aap.org/moc/ FederalAdvocacy.aap.org http://federaladvocacy.aap.org/ implementation timeline http://www.kff.org/healthreform/8060.cfm frequently asked questions document http://www.aap.org/securemoc/ fedlegislation/ HealthReformTop12QuestionsandAnswers.pdf

Moved recently? Changed your e-mail address or phone number? Update your contact info by visiting AAP Member Center at http://www.aap.org/moc/ and clicking on Online Services.

Section on Anesthesiology and Pain Medicine Newsletter

Pediatric Anesthesiology Fellows can join the

Section on Anesthesiology  and Pain Medicine at the very affordable price of $90/year. Please encourage your fellows and colleagues to consider joining our Section. See the Section Website for membership information.

www.aap.org/sections/anes  Jeff Koh, MD, MBA, FAAP Membership Chair

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Welcome to our   New and Renewed Members  March  2009 to March 2010   Robert K Bailie MB BCh Jennifer Brunworth MD Veronica Carullo MD Denise Chan MD Corey Collins DO Sean Elliott DO Andrius Galinis MD Susan Goobie MD Howard Gutstein MD Juan Ibla MD Cathie Jones MD Rahul Koka MD Asif Malik MD Michelle Marino MD Mark Meyer MD Veronica Miler MD Loc Nguyen MD Sarah Rebstock MD Thomas Romanelli MD

Brookline MA Denver CO Boston MA Boston MA Reading MA University City MO Gulf Breeze, FL Boston MA Houston TX Boston MA San Antonio TX Brookline MA Troy MI Brookline MA Cincinnati, OH Columbus OH Denver CO Lancaster PA Boston MA

Section on Anesthesiology and Pain Medicine  Executive Committee 2009‐2010  Members 

Immediate Past Chairperson 

Constance S Houck, MD Chairperson Boston, MA [email protected]

Joseph P Cravero, MD Lebanon, NH [email protected]

Corrie T M Anderson, MD Newsletter Editor Seattle, WA [email protected]

Liaisons 

Carolyn Bannister, MD Stone Mountain, GA [email protected] Kenneth R Goldschneider , MD Cincinnati, OH [email protected] Jeffrey L Koh, MD Lake Oswego, OR [email protected] David Polaner, MD Denver, CO [email protected]

Mark A Singleton, MD Liaison, ASA Committee on Pediatrics San Jose, CA [email protected] Jeffrey L Galinkin, MD Liaison, AAP Committee on Drugs Denver, CO [email protected]

Section Managers (temporary)  Kathy Ozmeral ~ [email protected] Hope Hurley ~ [email protected] AAP, Division of Hospital & Surgical Services Elk Grove Village, IL

Copyright © 2010, American Academy of Pediatrics Section on Anesthesiology and Pain Medicine