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Anita Honkanen - One of the best experts on this subject based on the ideXlab platform.
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Practice Characteristics of Board-certified Pediatric Anesthesiologists in the US: A Nationwide Survey
Cureus, 2019Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Anita HonkanenAbstract:Introduction We conducted a survey to describe the practice characteristics of anesthesiologists who have passed the American Board of Anesthesiology (ABA) Pediatric Anesthesiology Certification Examination. Methods In July 2017, a list of anesthesiologists who had taken the ABA Pediatric Anesthesiology Certification Examination (hereafter referred to as "Pediatric anesthesiologists") was obtained from the American Board of Anesthesiologists (theaba.org). Email contact information for these individuals was collected from departmental rosters, email distribution lists, hospital or anesthesia group profiles, manuscript author contact information, website source code, and other publicly available online sources. The survey was designed using Qualtrics (Qualtrics, Provo, Utah; Seattle, Washington), a web-based tool, to ascertain residency/fellowship training history and current practice characteristics that includes: years in practice, clinical work hours per week, primary hospital setting, practice type, supervision model, estimated percentage of cases by patient age group, and percentage of respondents who cared for any patient undergoing a fellowship-level index cases within the previous year. The invitation to complete the survey included a financial incentive - the chance to win one of twenty $50 Amazon gift cards. Results There were 3,492 anesthesiologists who had taken the Pediatric Anesthesiology Certification Examination since 2013. Surveys were sent to those whom an email address was identified (2,681) and 962 complete survey responses were received (35.9%, 962/2,681). Over 80% (785) of respondents completed a Pediatric Anesthesiology fellowship. Of these, 485 respondents (50.4%) work in academic practice, 212 (22.0%) in private practice, 233 (24.2%) in private practice and have academic affiliations, and 32 (3.3%) as locum tenens or in other practice settings. The majority of respondents (64.3%) in academic practice work in freestanding children's hospitals. Pediatric anesthesiologists in academic practice and private practice with academic affiliations reported caring for a greater number of younger children and doing a wider variety of index cases than respondents in private practice. Conclusion The extent to which Pediatric anesthesiologists care for Pediatric patients - particularly young children and those undergoing complex cases - varies. The variability in practice characteristics is likely a result of differences in hospital type, anesthesia practice type, geographic location, and other factors.
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the Pediatric Anesthesiology workforce projecting supply and trends 2015 2035
Anesthesia & Analgesia, 2017Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Daniel Miller, Anita HonkanenAbstract:BACKGROUND:A workforce analysis was conducted to predict whether the projected future supply of Pediatric anesthesiologists is balanced with the requirements of the inpatient Pediatric population. The specific aims of our analysis were to (1) project the number of Pediatric anesthesiologists in the
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The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015–2035
Anesthesia & Analgesia, 2017Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Daniel Miller, Anita HonkanenAbstract:BACKGROUND:A workforce analysis was conducted to predict whether the projected future supply of Pediatric anesthesiologists is balanced with the requirements of the inpatient Pediatric population. The specific aims of our analysis were to (1) project the number of Pediatric anesthesiologists in the
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simulation in Pediatric Anesthesiology
Pediatric Anesthesia, 2012Co-Authors: James J Fehr, Anita Honkanen, David J MurrayAbstract:Summary Simulation-based training, research and quality initiatives are expanding in Pediatric Anesthesiology just as in other medical specialties. Various modalities are available, from task trainers to standardized patients, and from computer-based simulations to mannequins. Computer-controlled mannequins can simulate Pediatric vital signs with reasonable reliability; however the fidelity of skin temperature and color change, airway reflexes and breath and heart sounds remains rudimentary. Current Pediatric mannequins are utilized in simulation centers, throughout hospitals in-situ, at national meetings for continuing medical education and in research into individual and team performance. Ongoing efforts by Pediatric anesthesiologists dedicated to using simulation to improve patient care and educational delivery will result in further dissemination of this technology. Health care professionals who provide complex, subspecialty care to children require a curriculum supported by an active learning environment where skills directly relevant to Pediatric care can be developed. The approach is not only the most effective method to educate adult learners, but meets calls for education reform and offers the potential to guide efforts toward evaluating competence. Simulation addresses patient safety imperatives by providing a method for trainees to develop skills and experience in various management strategies, without risk to the health and life of a child. A curriculum that provides Pediatric anesthesiologists with the range of skills required in clinical practice settings must include a relatively broad range of task-training devises and electromechanical mannequins. Challenges remain in defining the best integration of this modality into training and clinical practice to meet the needs of Pediatric patients.
Joseph D Tobias - One of the best experts on this subject based on the ideXlab platform.
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etomidate in Pediatric Anesthesiology where are we now
Saudi Journal of Anaesthesia, 2015Co-Authors: Joseph D TobiasAbstract:Etomidate is an intravenous anesthetic agent released for clinical use in the United States in 1972. Its popularity in clinical practice is the result of its beneficial effects on intracerebral dynamics with limited effects on hemodynamic function. These properties have made it a safe and effective anesthetic induction agent in both adult and Pediatric patients with altered myocardial performance, congenial heart disease, or hypovolemia. However, recent concern has been expressed regarding its effects on the endogenous production of corticosteroids and the impact of that effect on patient outcomes. The following manuscript reviews clinical reports regarding etomidate use in the Pediatric population and discusses recent concerns regarding its effects on corticosteroid metabolism and the implications of such effects for clinical use.
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Pediatric airway anatomy may not be what we thought: implications for clinical practice and the use of cuffed endotracheal tubes
Pediatric Anesthesia, 2014Co-Authors: Joseph D TobiasAbstract:Summary One of the long held tenets of Pediatric anesthesia has been the notion that the Pediatric airway is conical shape with the narrowest area being the cricoid region. However, recent studies using radiologic imaging techniques (magnetic resonance imaging and computed tomography) or direct bronchoscopic observation have questioned this suggesting that the narrowest segment may be at or just below the glottic opening. More importantly, it has been clearly demonstrated that the airway is elliptical in shape rather than circular with the anterior–posterior dimension being greater than the transverse dimension. These findings coupled with the development of a new generation of cuffed endotracheal tubes (ETTs) with a thin, polyurethane cuff have caused a transition in the practice of Pediatric Anesthesiology with an increased use of cuffed ETTs, even in neonates and infants. The following article reviews the historical data leading to the assumption that the Pediatric airway is conical as well as the more recent imaging and direct bronchoscopic observational studies which refute this tenet. The transition to the use of cuffed ETTs is discussed and potential advantages presented in both the operating room and the intensive care unit. Issues regarding the monitoring of intracuff pressure and techniques to limit potential morbidity related to a high intracuff pressure are outlined.
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An in vitro and in vivo validation of a novel monitor for intracuff pressure in cuffed endotracheal tubes
Pediatric Anesthesia, 2014Co-Authors: Archana S. Ramesh, Senthil G. Krishna, William T. Denman, Joseph D TobiasAbstract:Summary Background The clinical practice of Pediatric Anesthesiology has changed with increasing use of cuffed endotracheal tubes (cETTs) in infants and children. To limit the risk of tracheal mucosal damage, regular monitoring of intracuff pressure (CP) is necessary. This study evaluates the efficacy and accuracy of a novel syringe device that provides a digital readout of the CP. Methods The study was conducted in two phases. In phase 1, an in vitro study, cETTs of sizes 4.0, 5.0, and 6.0 mm ID were placed into polyvinylchloride tubing of appropriate sizes. The cuffs were then inflated, and the CP was measured simultaneously using the syringe device and a manometer. In phase 2, an in vivo study on 200 Pediatric patients, the syringe device and the manometer were simultaneously attached to the pilot balloon to measure the CP following endotracheal intubation. Statistical analysis included linear regression analysis and Bland–Altman comparison. Results Linear regression analysis of the in vitro study demonstrated an R2 value of 0.9989. Bias and precision were −1.92 ± 0.62 with 95% level of agreement (LOA) ranging from −3.13 to −0.72. For the in vivo study, the linear regression analysis demonstrated an R2 value of 0.9943. The bias and precision were −0.53 ± 0.68 with 95% LOA ranging from −1.86 to 0.81. Conclusion The study has demonstrated clinically acceptable correlation between the CPs obtained from the standard manometer and the syringe device both in vitro and in vivo. This device is a simple, reliable, portable, and affordable method to monitor CP.
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Can the Intracuff Pressure Be Estimated by Palpation of the Pilot Balloon
Icu Director, 2013Co-Authors: Jason Bryant, Joseph G. Werner, Earl Moss, Joseph D TobiasAbstract:Background. Over the past 5 years, there has been a change in the clinical practice of Pediatric Anesthesiology with a transition to the use of cuffed instead of uncuffed endotracheal tubes in infants and children. However, there has been limited attention to techniques to ensure a safe intracuff pressure. We sought to determine the accuracy of estimating endotracheal tube intracuff pressure by palpation of the pilot balloon by anesthesiologists, anesthesia residents, Pediatric anesthesia fellows, certified nurse anesthetists, and student nurse anesthetists. Methods. A tracheal simulation model was constructed with 3 different diameters of polyvinylchloride tubing. Three different-sized endotracheal tubes (4.0, 5.0, and 6.0 mm) were then placed into the tubes and the cuffs inflated to various pressures. Each participant was given 3 different scenarios of cuff pressure for each endotracheal tube size for a total of 9 scenarios per practitioner. By feeling the pilot balloon, the anesthesia provider was aske...
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Cuffed Endotracheal Tubes in Infants and Children A Technique to Ensure an Acceptable Intracuff Pressure
Icu Director, 2013Co-Authors: Joseph D Tobias, Julie Rice, Kris R. Jatana, Senthil Gopalakrishnan, Charles A. Elmaraghy, Meredith MerzAbstract:Background. Over the past 5 to 10 years, there has been a change in the clinical practice of Pediatric Anesthesiology with a transition to the use of cuffed instead of uncuffed endotracheal tubes (ETTs) in infants and children. When such tubes are used in clinical practice, it is imperative to ensure that the intracuff pressure is ≤30 cm H2O. To date, there are limited data regarding techniques to ensure this practice. Methods. Following endotracheal intubation with a cuffed ETT, a stethoscope was placed in the sternal notch and continuous positive airway pressure of 20 to 25 cm H2O held. The fresh gas flow was increased as needed to achieve a gradual rise of the airway pressure. Using a syringe, air was added to the cuff until no air escape or leak was heard. The intracuff pressure was checked using a handheld manometer (Posey Cufflator Endotracheal Tube Inflator and Manometer, JT Posey Company, Arcadia, CA). Results. The cohort for the study included 200 patients ranging in age from 6 months to 18 years...
Matthew K. Muffly - One of the best experts on this subject based on the ideXlab platform.
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Practice Characteristics of Board-certified Pediatric Anesthesiologists in the US: A Nationwide Survey
Cureus, 2019Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Anita HonkanenAbstract:Introduction We conducted a survey to describe the practice characteristics of anesthesiologists who have passed the American Board of Anesthesiology (ABA) Pediatric Anesthesiology Certification Examination. Methods In July 2017, a list of anesthesiologists who had taken the ABA Pediatric Anesthesiology Certification Examination (hereafter referred to as "Pediatric anesthesiologists") was obtained from the American Board of Anesthesiologists (theaba.org). Email contact information for these individuals was collected from departmental rosters, email distribution lists, hospital or anesthesia group profiles, manuscript author contact information, website source code, and other publicly available online sources. The survey was designed using Qualtrics (Qualtrics, Provo, Utah; Seattle, Washington), a web-based tool, to ascertain residency/fellowship training history and current practice characteristics that includes: years in practice, clinical work hours per week, primary hospital setting, practice type, supervision model, estimated percentage of cases by patient age group, and percentage of respondents who cared for any patient undergoing a fellowship-level index cases within the previous year. The invitation to complete the survey included a financial incentive - the chance to win one of twenty $50 Amazon gift cards. Results There were 3,492 anesthesiologists who had taken the Pediatric Anesthesiology Certification Examination since 2013. Surveys were sent to those whom an email address was identified (2,681) and 962 complete survey responses were received (35.9%, 962/2,681). Over 80% (785) of respondents completed a Pediatric Anesthesiology fellowship. Of these, 485 respondents (50.4%) work in academic practice, 212 (22.0%) in private practice, 233 (24.2%) in private practice and have academic affiliations, and 32 (3.3%) as locum tenens or in other practice settings. The majority of respondents (64.3%) in academic practice work in freestanding children's hospitals. Pediatric anesthesiologists in academic practice and private practice with academic affiliations reported caring for a greater number of younger children and doing a wider variety of index cases than respondents in private practice. Conclusion The extent to which Pediatric anesthesiologists care for Pediatric patients - particularly young children and those undergoing complex cases - varies. The variability in practice characteristics is likely a result of differences in hospital type, anesthesia practice type, geographic location, and other factors.
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the Pediatric Anesthesiology workforce projecting supply and trends 2015 2035
Anesthesia & Analgesia, 2017Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Daniel Miller, Anita HonkanenAbstract:BACKGROUND:A workforce analysis was conducted to predict whether the projected future supply of Pediatric anesthesiologists is balanced with the requirements of the inpatient Pediatric population. The specific aims of our analysis were to (1) project the number of Pediatric anesthesiologists in the
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The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015–2035
Anesthesia & Analgesia, 2017Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Daniel Miller, Anita HonkanenAbstract:BACKGROUND:A workforce analysis was conducted to predict whether the projected future supply of Pediatric anesthesiologists is balanced with the requirements of the inpatient Pediatric population. The specific aims of our analysis were to (1) project the number of Pediatric anesthesiologists in the
Rita Agarwal - One of the best experts on this subject based on the ideXlab platform.
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Practice Characteristics of Board-certified Pediatric Anesthesiologists in the US: A Nationwide Survey
Cureus, 2019Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Anita HonkanenAbstract:Introduction We conducted a survey to describe the practice characteristics of anesthesiologists who have passed the American Board of Anesthesiology (ABA) Pediatric Anesthesiology Certification Examination. Methods In July 2017, a list of anesthesiologists who had taken the ABA Pediatric Anesthesiology Certification Examination (hereafter referred to as "Pediatric anesthesiologists") was obtained from the American Board of Anesthesiologists (theaba.org). Email contact information for these individuals was collected from departmental rosters, email distribution lists, hospital or anesthesia group profiles, manuscript author contact information, website source code, and other publicly available online sources. The survey was designed using Qualtrics (Qualtrics, Provo, Utah; Seattle, Washington), a web-based tool, to ascertain residency/fellowship training history and current practice characteristics that includes: years in practice, clinical work hours per week, primary hospital setting, practice type, supervision model, estimated percentage of cases by patient age group, and percentage of respondents who cared for any patient undergoing a fellowship-level index cases within the previous year. The invitation to complete the survey included a financial incentive - the chance to win one of twenty $50 Amazon gift cards. Results There were 3,492 anesthesiologists who had taken the Pediatric Anesthesiology Certification Examination since 2013. Surveys were sent to those whom an email address was identified (2,681) and 962 complete survey responses were received (35.9%, 962/2,681). Over 80% (785) of respondents completed a Pediatric Anesthesiology fellowship. Of these, 485 respondents (50.4%) work in academic practice, 212 (22.0%) in private practice, 233 (24.2%) in private practice and have academic affiliations, and 32 (3.3%) as locum tenens or in other practice settings. The majority of respondents (64.3%) in academic practice work in freestanding children's hospitals. Pediatric anesthesiologists in academic practice and private practice with academic affiliations reported caring for a greater number of younger children and doing a wider variety of index cases than respondents in private practice. Conclusion The extent to which Pediatric anesthesiologists care for Pediatric patients - particularly young children and those undergoing complex cases - varies. The variability in practice characteristics is likely a result of differences in hospital type, anesthesia practice type, geographic location, and other factors.
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the Pediatric Anesthesiology workforce projecting supply and trends 2015 2035
Anesthesia & Analgesia, 2017Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Daniel Miller, Anita HonkanenAbstract:BACKGROUND:A workforce analysis was conducted to predict whether the projected future supply of Pediatric anesthesiologists is balanced with the requirements of the inpatient Pediatric population. The specific aims of our analysis were to (1) project the number of Pediatric anesthesiologists in the
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The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015–2035
Anesthesia & Analgesia, 2017Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Daniel Miller, Anita HonkanenAbstract:BACKGROUND:A workforce analysis was conducted to predict whether the projected future supply of Pediatric anesthesiologists is balanced with the requirements of the inpatient Pediatric population. The specific aims of our analysis were to (1) project the number of Pediatric anesthesiologists in the
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Fifty years of the American Academy of Pediatrics Section on Anesthesiology: a history of our specialty
Pediatric Anesthesia, 2017Co-Authors: Rita Agarwal, Jennifer Riefe, Constance S. HouckAbstract:Summary The American Academy of Pediatrics Section on Anesthesiology and Pain Medicine celebrated its 50th Anniversary in 2015. The Section was one of the first and only subspecialty organizations in Anesthesiology at the time. This special article will focus on the contributions of the Section to the practice of Pediatric Anesthesiology in the areas of advocacy, education and member contributions. In 1986, the Section created the Robert M. Smith Award to honor those members who had made significant advances in the practice of Pediatric Anesthesiology. It is named after one of the Section founders, an influential educator, inventor, and researcher in our field. We will focus the latter part of the article on the Robert M. Smith award winners to illustrate the contributions of the Section and its members to the development of the field of Pediatric Anesthesiology.
Tyler M. Muffly - One of the best experts on this subject based on the ideXlab platform.
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Practice Characteristics of Board-certified Pediatric Anesthesiologists in the US: A Nationwide Survey
Cureus, 2019Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Anita HonkanenAbstract:Introduction We conducted a survey to describe the practice characteristics of anesthesiologists who have passed the American Board of Anesthesiology (ABA) Pediatric Anesthesiology Certification Examination. Methods In July 2017, a list of anesthesiologists who had taken the ABA Pediatric Anesthesiology Certification Examination (hereafter referred to as "Pediatric anesthesiologists") was obtained from the American Board of Anesthesiologists (theaba.org). Email contact information for these individuals was collected from departmental rosters, email distribution lists, hospital or anesthesia group profiles, manuscript author contact information, website source code, and other publicly available online sources. The survey was designed using Qualtrics (Qualtrics, Provo, Utah; Seattle, Washington), a web-based tool, to ascertain residency/fellowship training history and current practice characteristics that includes: years in practice, clinical work hours per week, primary hospital setting, practice type, supervision model, estimated percentage of cases by patient age group, and percentage of respondents who cared for any patient undergoing a fellowship-level index cases within the previous year. The invitation to complete the survey included a financial incentive - the chance to win one of twenty $50 Amazon gift cards. Results There were 3,492 anesthesiologists who had taken the Pediatric Anesthesiology Certification Examination since 2013. Surveys were sent to those whom an email address was identified (2,681) and 962 complete survey responses were received (35.9%, 962/2,681). Over 80% (785) of respondents completed a Pediatric Anesthesiology fellowship. Of these, 485 respondents (50.4%) work in academic practice, 212 (22.0%) in private practice, 233 (24.2%) in private practice and have academic affiliations, and 32 (3.3%) as locum tenens or in other practice settings. The majority of respondents (64.3%) in academic practice work in freestanding children's hospitals. Pediatric anesthesiologists in academic practice and private practice with academic affiliations reported caring for a greater number of younger children and doing a wider variety of index cases than respondents in private practice. Conclusion The extent to which Pediatric anesthesiologists care for Pediatric patients - particularly young children and those undergoing complex cases - varies. The variability in practice characteristics is likely a result of differences in hospital type, anesthesia practice type, geographic location, and other factors.
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the Pediatric Anesthesiology workforce projecting supply and trends 2015 2035
Anesthesia & Analgesia, 2017Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Daniel Miller, Anita HonkanenAbstract:BACKGROUND:A workforce analysis was conducted to predict whether the projected future supply of Pediatric anesthesiologists is balanced with the requirements of the inpatient Pediatric population. The specific aims of our analysis were to (1) project the number of Pediatric anesthesiologists in the
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The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015–2035
Anesthesia & Analgesia, 2017Co-Authors: Matthew K. Muffly, Rita Agarwal, David Scheinker, Tyler M. Muffly, Mark Singleton, Daniel Miller, Anita HonkanenAbstract:BACKGROUND:A workforce analysis was conducted to predict whether the projected future supply of Pediatric anesthesiologists is balanced with the requirements of the inpatient Pediatric population. The specific aims of our analysis were to (1) project the number of Pediatric anesthesiologists in the