Chair of Paediatric anaesthesia, University of Western Australia; Consultant Paediatric Anaesthetist, Perth Children’s Hospital; Team Leader, Perioperative Medicine Team; Program Lead, Perioperative Care
MD, PhD, DEAA, FANZA
Professor Britta Regli-von Ungern-Sternberg, leader of the Perioperative Medicine Team, holds the foundation Chair of Paediatric Anaesthesia at the University of Western Australia (the first of its kind in Australasia), and is a specialist paediatric anaesthetist at Perth Children’s Hospital. She leads the most active paediatric anaesthesia research program in Australasia which is also an internationally leading program focusing on continuously driving improvements in safety and quality of care along the perioperative pathway. The research team is strengthened by its multidisciplinary nature comprising anaesthetists, surgeons, physicians, nurses, allied health professionals, engineers, scientists, statisticians and health economists across multiple medical and academic institutions. These diverse clinical networks provide strong evidence for immediate translation into tangible health benefits for young Australians.
Her main research interests relate to the prediction and prevention of respiratory complications in paediatric anaesthesia, lung function changes during anaesthesia, the evaluation of different airway devices, as well as the impact of anaesthesia in early life on a child’s neurodevelopment.
Britta was appointed to the Clinical Senate of Western Australia (2020-2022) and sits on the Scientific Advisory Safety Committee of the Child and Adolescent Health Service Human Research Ethics Committee. She is a member of the Executive for the Clinical Trials Network of the Australia and New Zealand College of Anaesthetists (ANZCA) as well as a member of the ANZCA Research Committee and sits on the Society for Paediatric Anaesthesia Research Committee. She is a Section Editor and Editorial Advisory Board member for the journal Pediatric Anesthesia.
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Publications
September 2023
Efficacy of a hybrid technique of simultaneous videolaryngoscopy with flexible bronchoscopy in children with difficult direct laryngoscopy in the Pediatric Difficult Intubation Registry
Children with difficult tracheal intubation are at increased risk of severe complications, including hypoxaemia and cardiac arrest. Increasing experience with the simultaneous use of videolaryngoscopy and flexible bronchoscopy (hybrid) in adults led us to hypothesise that this hybrid technique could be used safely and effectively in children under general anaesthesia.
Published research Perioperative Medicine Paediatric anaesthesiaDecember 2023The role of WhatsApp™ in pediatric difficult airway management: A study from the PeDI Collaborative
Management of the pediatric difficult airway can present unique clinical challenges. The Pediatric Difficult Intubation Collaborative (PeDI-C) is an international collaborative group engaging in quality improvement and research in children with difficult airways. The PeDI-C established a WhatsApp™ group to facilitate real-time discussions around the management of the difficult airway in pediatric patients.
Published research Technology & Kids Perioperative Medicine Paediatric anaesthesiaMarch 2024Patient positioning and its impact on perioperative outcomes in children: A narrative review
Patient positioning interacts with a number of body systems and can impact clinically important perioperative outcomes. In this educational review, we present the available evidence on the impact that patient positioning can have in the pediatric perioperative setting. A literature search was conducted using search terms that focused on pediatric perioperative outcomes prioritized by contemporary research in this area.
Published research Perioperative Medicine Paediatric anaesthesiaJuly 2023Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry
Difficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation.
Published research Perioperative Medicine Paediatric anaesthesiaFebruary 2024Flexible bronchoscopy insufflated and high-flow nasal oxygen pilot trial (BUFFALO protocol pilot trial)
Hypoxaemia occurs in approximately 30% of children during anaesthesia for flexible bronchoscopy. High-flow nasal oxygen (HFNO) can prolong safe apnoea time and be used in children with abnormal airways. During flexible bronchoscopy, there is limited evidence if HFNO confers advantages over current standard practice in avoiding hypoxaemia. The aim is to investigate feasibility of HFNO use during anaesthesia for flexible bronchoscopy to reduce frequency of rescue oxygenation and hypoxaemia.
Published research Perioperative Medicine Paediatric anaesthesiaFebruary 2024Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time
The Paediatric Difficult Intubation Collaborative identified multiple attempts and persistence with direct laryngoscopy as risk factors for complications in children with difficult tracheal intubations and subsequently engaged in initiatives to reduce repeated attempts and persistence with direct laryngoscopy in children. We hypothesised these efforts would lead to fewer attempts, fewer direct laryngoscopy attempts and decrease complications.
Published research Perioperative Medicine Paediatric anaesthesiaFebruary 2024Jelly snakes to reduce early postoperative vomiting in children after adenotonsillectomy: The randomized controlled snakes trial
Despite the use of dual antiemetic agents, postoperative nausea and vomiting (PONV) occurs in an unacceptably large number of patients post-tonsillectomy. There has been increased interest in alternative and non-pharmacological treatments for PONV e.g., chewing gum. We investigated if chewing a large confectionary jelly snake had prophylactic antiemetic effects postoperatively in young children.
Published research Perioperative MedicineAugust 2023Performance Accuracy of Wrist-Worn Oximetry and Its Automated Output Parameters for Screening Obstructive Sleep Apnea in Children
Obstructive sleep apnea (OSA) increases the risk of perioperative adverse events in children. While polysomnography remains the reference standard for OSA diagnosis, oximetry is a valuable screening tool. The traditional practice is the manual analysis of desaturation clusters derived from a tabletop device using the McGill oximetry score. However, automated analysis of wearable oximetry data can be an alternative. This study investigated the accuracy of wrist-worn oximetry with automated analysis as a preoperative OSA screening tool.
Published research Children's Lung Health Subsite: Walyan Perioperative MedicineJanuary 2024Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines
Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups.
Published research Perioperative Medicine Paediatric anaesthesiaOctober 2023Predicting obstructive sleep apnoea and perioperative respiratory adverse events in children: role of upper airway collapsibility measurements
Obstructive sleep apnoea (OSA) and perioperative respiratory adverse events are significant risks for anaesthesia in children undergoing adenotonsillectomy. Upper airway collapse is a crucial feature of OSA that contributes to respiratory adverse events. A measure of upper airway collapsibility to identify undiagnosed OSA can help guide perioperative management. We investigated the utility of pharyngeal closing pressure for predicting OSA and respiratory adverse events.
Published research Perioperative Medicine Paediatric anaesthesiaJun 2023Beta Agonists for Prevention of Respiratory Adverse Events in Children Undergoing Adenotonsillectomy: Long-Acting, Short Acting, or Not Acting
Adenotonsillectomy is one of the most common surgical interventions in children, and while generally safe, it is associated with a risk of significant adverse events. In this issue, Kim et al report a prospective randomized controlled study comparing preoperative use of a tulobuterol (longacting beta agonist) dermal patch with placebo on the incidence of perioperative respiratory adverse events (PRAEs) in children undergoing adenotonsillectomy.
Published research Perioperative Medicine Paediatric anaesthesiaNovember 2022Feasibility of upper airway collapsibility measurements in anesthetized children
Patients with a propensity for upper airway obstruction, including those with obstructive sleep apnea (OSA), are vulnerable in the perioperative period. OSA is an increasingly common disorder in children and, when present, is associated with an increased risk of perioperative respiratory adverse events (PRAE),1 morbidity, and mortality. Therefore, identifying at-risk patients is vital to provide tailored perioperative anesthetic management.
Published research Perioperative Medicine Paediatric anaesthesiaOctober 2023Early life predictors of obstructive sleep apnoea in young adults: Insights from a longitudinal community cohort (Raine study)
Early-life obstructive sleep apnoea (OSA) predictors are unavailable for young adults. This study identifies early-life factors predisposing young adults to OSA.
Published research Perioperative Medicine Raine studyAugust 2023Early life predictors of obstructive sleep apnoea in young adults: Insights from a longitudinal community cohort (Raine study)
Obstructive sleep apnea (OSA) increases the risk of perioperative adverse events in children. While polysomnography (PSG) remains the reference standard for OSA diagnosis, oximetry is a valuable screening tool. The traditional practice is the manual analysis of desaturation clusters derived from a tabletop device using the McGill oximetry score. However, automated analysis of wearable oximetry data can be an alternative. This study investigated the accuracy of wrist-worn oximetry with automated analysis as a preoperative OSA screening tool.
Published research Early Childhood Development Children's Lung Health Perioperative MedicineAugust 2023Taste-Masked Flucloxacillin Powder Part 2: Formulation Optimisation Using the Mixture Design Approach and Storage Stability
Flucloxacillin is prescribed to treat skin infections but its highly bitter taste is poorly tolerated in children. This work describes the application of the D-optimal mixture experimental design to identify the optimal component ratio of flucloxacillin, Eudragit EPO and palmitic acid to prepare flucloxacillin taste-masked microparticles that would be stable to storage and would inhibit flucloxacillin release in the oral cavity while facilitating the total release of the flucloxacillin load in the lower gastrointestinal tract.
Published research Perioperative MedicineAugust 2023A review of pediatric fasting guidelines and strategies to help children manage preoperative fasting
Fasting for surgery is a routine step in the preoperative preparation for surgery. There have however been increasing concerns with regard to the high incidence of prolonged fasting in children, and the subsequent psycho-social distress and physiological consequences that this poses.
Published research Perioperative Medicine Paediatric anaesthesiaJuly 2023Perioperative management of infant inguinal hernia surgery; a review of the recent literature
Inguinal hernia surgery is one of the most common electively performed surgeries in infants. The common nature of inguinal hernia combined with the high-risk population involving a predominance of preterm infants makes this a particular area of interest for those concerned with their perioperative care. Despite a large volume of literature in the area of infant inguinal hernia surgery, there remains much debate amongst anesthetists, surgeons and neonatologists regarding the optimal perioperative management of these patients.
Published research Perioperative Medicine Paediatric anaesthesiaJuly 2023Patient and Process Outcomes among Pediatric Patients Undergoing Appendectomy during the COVID-19 Pandemic: An International Retrospective Cohort Study
COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. The authors hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy.
Published research Infectious Diseases Perioperative Medicine COVID-19 Paediatric anaesthesiaApril 2022A randomised controlled trial of a novel tramadol chewable tablet: pharmacokinetics and tolerability in children
Tramadol is a bitter atypical opioid analgesic drug and is prescribed to treat postoperative pain in children. However, in many countries there is no licensed paediatric tramadol formulation available. We have formulated a novel chewable chocolate-based drug delivery system for the administration of tramadol to children.
Published research Perioperative MedicineOctober 2022Sedation versus General Anesthesia for Tracheal Intubation in Children with Difficult Airways: A Cohort Study from the Pediatric Difficult Intubation Registry
Sedated and awake tracheal intubation approaches are considered safest in adults with difficult airways, but little is known about the outcomes of sedated intubations in children. The primary aim of this study was to compare the first-attempt success rate of tracheal intubation during sedated tracheal intubation versus tracheal intubation under general anesthesia. The hypothesis was that sedated intubation would be associated with a lower first-attempt success rate and more complications than general anesthesia.
Published research Perioperative Medicine Paediatric anaesthesiaMarch 2022Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study
Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic.
Published research Perioperative Medicine COVID-19 Paediatric anaesthesiaAugust 2022Remote after-care using smartphones: A feasibility study of monitoring children's pain with automated SMS messaging
Monitoring children's recovery postoperatively is important for routine care, research, and quality improvement. Although telephone follow-up is common, it is also time-consuming and intrusive for families. Using SMS messaging to communicate with families regarding their child's recovery has the potential to address these concerns. While a previous survey at our institution indicated that parents were willing to communicate with the hospital by SMS, data on response rates for SMS-based postoperative data collection is limited, particularly in pediatric populations.
Published research Perioperative MedicineFebruary 2023Kids Voices, the perioperative experience of emergency surgery from children's perspectives: A qualitative study
The study aimed to better understand children's emergency perioperative experience, a little researched topic. Current literature shows discrepancies between child and adult perceptions for the same healthcare experience. Acquisition of knowledge from the child's perspective can be utilized to improve perioperative care.
Published research Perioperative Medicine Paediatric anaesthesiaNovember 2022Perioperative intravenous lidocaine use in children
Perioperative pain management impacts patient morbidity, quality of life, and hospitalization cost. In children, it impacts not only the child, but the whole family. Adjuncts for improved perioperative analgesia continue to be sought to minimize adverse side effects associated with opioids and for those in whom regional or neuraxial anesthesia is not suitable.
Published research Perioperative Medicine Paediatric anaesthesiaNovember 2022Direct versus video laryngoscopy with standard blades for neonatal and infant tracheal intubation with supplemental oxygen: a multicentre, non-inferiority, randomised controlled trial
Tracheal intubation in neonates and infants is a potentially life-saving procedure. Video laryngoscopy has been found to improve first-attempt tracheal intubation success and reduce complications compared with direct laryngoscopy in children younger than 12 months.
Published research Perioperative Medicine Paediatric anaesthesiaOctober 2022Anaesthesia related mortality data at a Tertiary Pediatric Hospital in Western Australia
Anaesthesia related mortality in paediatrics is rare. There are limited data describing paediatric anaesthesia related mortality. This study determined the anaesthesia related mortality at a Tertiary Paediatric Hospital in Western Australia.
Published research Perioperative Medicine Paediatric anaesthesiaSeptember 2022Consumer research priorities for pediatric anesthesia and perioperative medicine
Consumer-driven research is increasingly being prioritized. Aim: Our aim was to partner with consumers to identify the top 10 research priorities for pediatric anesthesia and perioperative medicine. The ACORN (Anesthesia Consumer Research Network) was formed to collaborate with children and families across Australia.
Published research Perioperative Medicine Paediatric anaesthesiaAugust 2022Isoelectric Electroencephalography in Infants and Toddlers during Anesthesia for Surgery: An International Observational Study
Intraoperative isoelectric electroencephalography (EEG) has been associated with hypotension and postoperative delirium in adults. This international prospective observational study sought to determine the prevalence of isoelectric EEG in young children during anesthesia.
Published research Perioperative Medicine Paediatric anaesthesiaMay 2022Penicillin allergy SHACK: Survey of hospital and community knowledge
Penicillin allergy accounts for the majority of all reported adverse drug reactions in adults and children. Foregoing first-line antibiotic therapy due to penicillin allergy label is associated with an increased prevalence of infections by resistant organisms and longer hospitalisation.
Published research Perioperative Medicine Allergy Paediatric anaesthesiaAugust 2021Prior administration of chocolate improves the palatability of bitter drugs: The Choc-with-Med study
The paediatric population has a low adherence and acceptance rate of unpalatable medicines. This study aimed to determine whether eating chocolate immediately prior to drug administration would help to mask the bitter taste of a drug. The difference in taste masking efficacy between white, milk and dark chocolate was a secondary measure outcome.
Published research Perioperative MedicineJune 2021A survey of the global impact of COVID-19 on the practice of pediatric anesthesia: A study from the pediatric anesthesia COVID-19 Collaborative Group
Pediatric anesthesiology has been greatly impacted by COVID-19 in the delivery of care to patients and to the individual providers. With this study, we sought to survey pediatric centers and highlight the variations in care related to perioperative medicine during the COVID-19 pandemic, including the availability of protective equipment, the practice of pediatric anesthesia, and economic impact.
Published research Perioperative Medicine COVID-19 Paediatric anaesthesiaJuly 2021Pediatric Airway Management in Times of COVID-19-a Review of the Evidence and Controversies
This review summarizes and provides a comprehensive narrative synthesis of the current evidence on pediatric airway management during the COVID-19 pandemic.
Published research Perioperative Medicine COVID-19 Paediatric anaesthesiaFebruary 2022Developmental respiratory physiology
Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia.
Published research Perioperative Medicine Paediatric anaesthesiaFebruary 2022Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in pediatric anesthesia—Part 1 patient and surgical factors
Pediatric surgery cases are increasing worldwide. Within pediatric anesthesia, perioperative respiratory adverse events are the most common precipitant leading to serious complications.
Published research Perioperative Medicine Paediatric anaesthesiaDecember 2021Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia-related risk and treatment options
Perioperative respiratory adverse events are the most common cause of critical events in children undergoing anesthesia and surgery. While many risk factors remain unmodifiable, there are numerous anesthetic management decisions which can impact the incidence and impact of these events, especially in at-risk children.
Published research Perioperative Medicine Paediatric anaesthesiaFebruary 2022Clinical utility of preoperative pulmonary function testing in pediatrics
Perioperative respiratory adverse events pose a significant risk in pediatric anesthesia, and identifying these risks is vital. Traditionally, this is assessed using history and examination. However, the perioperative risk is multifactorial, and children with complex medical backgrounds such as chronic lung disease or obesity may benefit from additional objective preoperative pulmonary function tests.
Published research Perioperative Medicine Paediatric anaesthesiaFebruary 2022Aerosolized drug delivery in awake and anesthetized children to treat bronchospasm
Bronchospasm is a common respiratory adverse event in pediatric anesthesia. First-line treatment commonly includes inhaled salbutamol. This review focuses on the current best practice to deliver aerosolized medications to awake as well as anesthetized pediatric patients and discusses the advantages and disadvantages of various administration techniques.
Published research Perioperative Medicine Paediatric anaesthesiaFebruary 2022Anesthetic considerations in children with asthma
Due to the high prevalence of asthma and general airway reactivity, anesthesiologists frequently encounter children with asthma or asthma-like symptoms. This review focuses on the epidemiology, the underlying pathophysiology, and perioperative management of children with airway reactivity, including controlled and uncontrolled asthma.
Published research Perioperative Medicine Paediatric anaesthesiaFebruary 2022COVID-19 implications for pediatric anesthesia: Lessons learnt and how to prepare for the next pandemic
COVID-19 is mainly considered an “adult pandemic,” but it also has strong implications for children and consequently for pediatric anesthesia. Despite the lethality of SARS-CoV-2 infection being directly correlated with age, children have equally experienced the negative impacts of this pandemic.
Published research Perioperative Medicine COVID-19 Paediatric anaesthesiaFebruary 2022Atelectasis and lung recruitment in pediatric anesthesia: An educational review
General anesthesia is associated with development of pulmonary atelectasis. Children are more vulnerable to the development and adverse effects of atelectasis. We review the physiology and risk factors for the development of atelectasis in pediatric patients under general anesthesia.
Published research Perioperative Medicine Paediatric anaesthesiaApril 2022Impact of airway and a standardized recruitment maneuver on CT chest imaging quality in a pediatric population: A retrospective review
When performing computerized tomography chest imaging in children, obtaining high quality, motion-free images is important in the accurate diagnosis of underlying pathology. General anesthesia is associated with the development of atelectasis, which can impair accurate diagnosis by obscuring or altering the appearance of the lung parenchyma or airways.
Published research Perioperative Medicine Paediatric anaesthesiaApril 2022Parents' perspectives towards paediatric confectionary masked medications: a qualitative study
The availability of age-appropriate, taste-masked oral solid medications for the paediatric population is currently inadequate. We have developed a novel chocolate-based drug delivery platform to taste-mask bitter drugs commonly utilised in the hospital setting, but there is limited evidence regarding parent's perspectives on these medications.
Published research Perioperative Medicine Paediatric anaesthesiaJanuary 2022Procedural anesthesia and sedation for children undergoing diagnostic and medical procedures — A review of postprocedural pain, nausea, and vomiting by questionnaire-based survey
Sedation and anesthesia are widely used to relieve pain and ensure cooperation during elective diagnostic and medical procedures in the pediatric population. However, there is currently limited evidence about the recovery trajectory following deep sedation or general anesthesia for such procedures in children.
Published research Perioperative Medicine Paediatric anaesthesiaSeptember 2021Error traps in pediatric difficult airway management
Difficult airway management in children is associated with significant morbidity. This narrative review on error traps in airway management aims to highlight the common pitfalls and proposes solutions to optimize best practices for pediatric difficult airway management. We have categorized common errors of pediatric difficult airway management into three main error traps.
Published research Perioperative Medicine Paediatric anaesthesiaJanuary 2022Comparison of two measures of behavior change in children after day surgery
A contemporary, well-validated instrument for the measurement of behavior change in children after general anesthesia is lacking. The Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) has been developed as an updated version of the original Post Hospitalization Behavior Questionnaire (PHBQ) to better reflect the current patient population and modern anesthetic practices.
Published research Perioperative Medicine Paediatric anaesthesiaOctober 2021Prescribing in a pediatric hospital setting – Lost in translation?
To determine parental understanding of directions on common pediatric prescription pharmacy labels and to identify enablers and barriers that affect interpretation of these labels.
Published research Perioperative MedicineOctober 2021HPLC-UV assay of tramadol and O-desmethyltramadol in human plasma containing other drugs potentially co-administered to participants in a paediatric population pharmacokinetic study
Multimodal analgesia is employed in paediatric pain management to maximise analgesia and minimise side effects. Tramadol is dosed at 1–1.5 mg/kg to treat severe pain in children but the assay for tramadol in plasma samples for pharmacokinetic and toxicology studies does not often consider concurrently administered medications.
Published research Perioperative Medicine Paediatric anaesthesiaSeptember 2021"Cannot intubate, cannot oxygenate": A novel 2-operator technique for cannula tracheotomy in an infant animal model-a feasibility study
Evidence regarding optimal management of the "Cannot Intubate, Cannot Oxygenate" (CICO) scenario in infants is scarce. When inserting a transtracheal cannula for front of neck access direct aspiration to confirm intratracheal location is standard practice.
Published research Perioperative MedicineAugust 2021Lessons from COVID-19: A reflection on the strengths and weakness of early consensus recommendations for pediatric difficult airway management during a respiratory viral pandemic using a modified Delphi method
The authors recognized a gap in existing guidelines and convened a modified Delphi process to address novel issues in pediatric difficult airway management raised by the COVID-19 pandemic. The Pediatric Difficult Intubation Collaborative, a working group of the Society for Pediatric Anesthesia, assembled an international panel to reach consensus recommendations on pediatric difficult airway management during the COVID-19 pandemic using a modified Delphi method.
Published research Perioperative Medicine COVID-19September 2021Prenatal Exposure to General Anesthesia and Childhood Behavioral Deficit
Exposure to surgery and anesthesia in early childhood has been found to be associated with an increased risk of behavioral deficits. While the US Food and Drug Administration (FDA) has warned against prenatal exposure to anesthetic drugs, little clinical evidence exists to support this recommendation.
Published research Autism Research Subsite: Autism & Related Disorders Subsite: CliniKids Perioperative MedicineJuly 2021Peri-operative steroid management in the paediatric population
Patients with adrenal insufficiency are at risk of adrenal crisis, a potentially life-threatening emergency in the peri-operative period due to their attenuated ability to mount a cortisol response.
Published research Diabetes and Obesity Perioperative MedicineJuly 2021More than half of front-line healthcare workers unknowingly used an N95/P2 mask without adequate airborne protection: An audit in a tertiary institution
Front-line staff routinely exposed to aerosol-generating procedures are at a particularly high risk of transmission of severe acute respiratory syndrome coronavirus. We aimed to assess the adequacy of respiratory protection provided by available N95/P2 masks to staff routinely exposed to aerosol-generating procedures.
Published research Perioperative MedicineJanuary 2021Prenatal Exposure to General Anesthesia and Childhood Behavioral Deficit
Exposure to surgery and anesthesia in early childhood has been found to be associated with an increased risk of behavioral deficits. While the US Food and Drug Administration (FDA) has warned against prenatal exposure to anesthetic drugs, little clinical evidence exists to support this recommendation. This study evaluates the association between prenatal exposure to general anesthesia due to maternal procedures during pregnancy and neuropsychological and behavioral outcome scores at age 10.
Published research Perioperative MedicineMay 2021An assessment of opioids on respiratory depression in children with and without obstructive sleep apnea
Obstructive sleep apnea is a risk factor for respiratory depression following opioid administration as well as opioid-induced hyperalgesia. Little is known on how obstructive sleep apnea status is associated with central ventilatory depression in pediatric surgical patients given a single dose of fentanyl.
Published research Perioperative MedicineMay 2021Carbon dioxide monitoring in children—A narrative review of physiology, value, and pitfalls in clinical practice
Continuous capnography has been recognised as an essential monitoring device in all anesthetized patients, despite which airway device is in use, regardless of their location, as a measure to improve patient safety. Capnography is the non-invasive measurement of a sample of the exhaled carbon dioxide which has multiple clinical uses including as a method to confirm placement of a tracheal tube and/or to assess ventilation, perfusion and metabolism.
Published research Perioperative MedicineJune 2021Pediatric airway management
Children are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are therefore key to the practice of pediatric anesthesia. The goal of this review is to highlight recent publications (2019-2021) aimed to advance pediatric airway safety and to highlight a proposed simple, pediatric-specific, universal framework to guide clinical practice.
Published research Perioperative MedicineMarch 2021Impact of a revised postoperative care plan on pain and recovery trajectory following pediatric tonsillectomy
A previous cohort of adenotonsillectomy patients at our institution demonstrated moderate-severe post-tonsillectomy pain scores lasting a median (range) duration of 6 (0-23) days and postdischarge nausea and vomiting affecting 8% of children on day 1 following surgery. In this subsequent cohort, we evaluate the impact of changes to our discharge medication and parental education on post-tonsillectomy pain and recovery profile.
Published research Perioperative MedicineFebruary 2021The impact of surgical cancellations on children, families, and the health system in an Australian paediatric tertiary referral hospital
Reasons for elective surgery cancelations and their impact vary from one institution to another. Cancelations have emotional and financial implications for patients and their families. Our service has a particularly broad and geographically diverse patient population; hence, we sought to examine these impacts in our service.
Published research Perioperative MedicineJanuary 2021Gender Balance in Anesthesiology: Is a Change of Societal Mindset Needed?
With great interest, we are following the discussion on Speaker Gender Representation and Trends in Authorship. While it is indeed very popular and important to look at speaker representation, authorship, or board membership by gender, the underlying reasons for the unequal gender representation are not as easy to determine. Counting numbers on panels or boards may also not add up to real representation.
Published research Perioperative MedicineJanuary 2021Perioperative pediatric tonsillectomy analgesia: A single-center review of practice and cost-effectiveness analysis
Tonsillectomy is one of the most common pediatric surgeries and results in considerable postoperative pain. Insufficiently managed pain is costly, risks physiological and psychological consequences with multi-modal analgesia widely recommended to minimize opioid-based agents. We determined adherence to multi-modal analgesia guidelines and assessed cost-effectiveness. We undertook a cross-sectional cohort study at a tertiary pediatric institution in Perth, Western Australia, retrospectively identifying selected patients undergoing tonsillectomy over two discrete periods of 6-week duration.
Published research Perioperative MedicineJanuary 2021An observational study of hypoactive delirium in the post-anesthesia recovery unit of a pediatric hospital
Hypoactive delirium is present when an awake child is unaware of his or her surroundings, is unable to focus attention, and appears quiet and withdrawn. This condition has been well-described in the intensive care setting but has not been extensively studied in the immediate post-anesthetic period. The aim was to determine if hypoactive emergence delirium occurs in the recovery unit of a pediatric hospital, and if so, what proportion of emergence delirium is hypoactive in nature.
Published research Perioperative MedicineJanuary 2021A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry
The design of a videolaryngoscope blade may affect its efficacy. We classified videolaryngoscope blades as standard and non-standard shapes to compare their efficacy performing tracheal intubation in children enrolled in the Paediatric Difficult Intubation Registry.
Published research Perioperative MedicineDecember 2020Assessment of different techniques for the administration of inhaled salbutamol in children breathing spontaneously via tracheal tubes, supraglottic airway devices, and tracheostomies
Perioperative respiratory adverse events account for a third of all perioperative cardiac arrests, with bronchospasm and laryngospasm being most common. Standard treatment for bronchospasm is administration of inhaled salbutamol, via pressurized metered dose inhaler. There is little evidence on the best method of attaching the pressurized metered dose inhaler to the artificial airway during general anesthesia. The aim of this study is to investigate the best method to deliver aerosolized salbutamol via pressurized metered dose inhaler to the lungs of an anesthetized child.
Published research P4 Respiratory Health for Kids Perioperative MedicineJanuary 2021The role of fit testing N95/FFP2/FFP3 masks: a narrative review
For healthcare workers performing aerosol-generating procedures during the COVID-19 pandemic, well fitted filtering facepiece respirators, for example, N95/FFP2 or N99/FFP3 masks, are recommended as part of personal protective equipment. In this review, we evaluate the role of fit checking and fit testing of respirators, in addition to airborne protection provided by respirators. Filtering facepiece respirators are made of material with sufficient high filter capacity to protect against airborne respiratory viruses.
Published research Infectious Diseases Perioperative MedicineOctober 2020Fit testing of N95 or P2 masks to protect health care workers
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has many similarities to severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). While reported morbidity and mortality from COVID-19 are lower than from SARS and MERS, many health care workers have been infected (up to 15% of health care workers in Victoria).
Published research Infectious Diseases Perioperative MedicineDecember 2020Assessment of different techniques for the administration of inhaled salbutamol in children breathing spontaneously via tracheal tubes, supraglottic airway devices, and tracheostomies
Perioperative respiratory adverse events account for a third of all perioperative cardiac arrests, with bronchospasm and laryngospasm being most common. Standard treatment for bronchospasm is administration of inhaled salbutamol, via pressurized metered dose inhaler. There is little evidence on the best method of attaching the pressurized metered dose inhaler to the artificial airway during general anesthesia. The aim of this study is to investigate the best method to deliver aerosolized salbutamol via pressurized metered dose inhaler to the lungs of an anesthetized child.
Published research P4 Respiratory Health for Kids Perioperative MedicineAugust 2020Anaesthesia, pain and recovery profiles in children following dental extractions
The aim of this prospective cohort study was to describe the anaesthetic practices, rates of postoperative pain and the recovery trajectory of children having urgent dental extractions at our institution.
Published research P4 Respiratory Health for Kids Perioperative MedicineAugust 2020The plural of anecdote is not data, please mind the gap
The COVID-19 pandemic introduced challenges to everyone in society but particularly so to every aspect of medical practice. It is bewildering how quickly the profession has had to respond to rapidly changing clinical landscape. Our well-established methods involve collecting and analyzing data to generate an evidence base which is then disseminated and implemented into routine clinical practice.
Published research P4 Respiratory Health for Kids Perioperative MedicineJuly 2020What’s inside the box? Or shall we think outside the box?
With the deadly and highly transmissible SARS-CoV-2 virus causing the COVID-19 pandemic, there is global concern about the danger of contaminating healthcare workers (HCW), particularly during airway management of infected patients.
Published research P4 Respiratory Health for Kids Perioperative MedicineMarch 2020Preoperative identification of children at high risk of obstructive sleep apnea
Obstructive sleep apnea poses as an anesthetic challenge, and it is a well-known risk factor for perioperative adverse events
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