AnesthesiaExam Podcast

Pediatric Anesthesia Considerations in the Orthopedic Patient 0

May 17, 2023

Introduction: Providing anesthesia for pediatric orthopedic patients poses unique challenges for anesthesiologists. The approach must consider the psychological development of the child and the prevalence of respiratory infections. Pain management, management of concomitant diseases, and risk reduction for adverse events are crucial aspects of anesthetic care. This blog post will review the perioperative concerns specific to pediatric orthopedic procedures, discuss pain control methods used, and highlight anesthetic considerations for certain surgeries.

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Select Pediatric Perioperative Concerns:

Upper Respiratory Tract Infections (URI): Pediatric patients presenting for orthopedic surgery with current or recent URIs pose a challenge for anesthesiologists and surgeons. Children commonly experience URIs with symptoms like a runny nose, cough, and fever. While the viral infection may reside in the nasopharynx, the lower respiratory tract remains sensitive for up to 6 weeks after URI symptoms have resolved. This increased sensitivity puts patients at risk for perioperative complications like laryngospasm, bronchospasm, and oxygen desaturation. Delaying surgery for 6 weeks after URI resolution is often impractical, as another URI is likely to occur. For elective surgery, severe symptoms and complications warrant postponing surgery, but clear nasal discharge in an otherwise healthy patient may proceed with elective surgery. Clinical decision-making becomes challenging for cases falling between these extremes. Factors such as patient age, comorbidities, prior cancellations, surgery complexity, and urgency are considered when deciding whether to postpone surgery. If elective surgery is delayed, most clinicians would wait 2 to 4 weeks after URI symptom resolution.
Anxiety in the Pediatric Patient: Pediatric patients undergoing orthopedic surgery often experience varying levels of anxiety and distress. Preoperative stressors can include unfamiliar environments, procedures, hunger, fear of pain, and separation from parents. Certain risk factors contribute to preoperative anxiety, such as ages 1 to 5 years, shy temperament, prior negative medical experiences, high cognitive levels, and parental anxiety. Unaddressed anxiety can lead to postoperative behavioral changes, including generalized anxiety, separation anxiety, aggression, and nighttime crying. It can also result in higher pain scores and increased pain medication requirements after surgery. Strategies to mitigate preoperative anxiety include presurgical preparation programs involving site visits, videos, books, and child-life interventions. Allowing parental presence during anesthesia induction can help alleviate separation anxiety. Pharmacologic interventions like oral midazolam can improve compliance and reduce negative behavioral changes in the short term.

Anesthetic Management for Orthopedic Procedures:

Anesthetic Considerations for Select Pediatric Orthopedic Surgeries: Scoliosis Surgery: Anesthetic concerns during scoliosis surgery include optimizing neuromonitoring signals, managing blood loss, preventing positioning-related injuries, and minimizing the risk of postoperative visual loss.
Pain Management: Pain control for pediatric orthopedic patients involves a multimodal pharmacologic approach to minimize opioid requirements. This approach includes non-opioid analgesics, local anesthetics, and regional anesthesia techniques. Regional anesthesia, such as peripheral nerve blocks and caudal anesthesia, is particularly valuable for postoperative pain control. Recent studies have confirmed the safety of regional anesthesia in the pediatric population.

Pediatric orthopedic surgeries present unique challenges for anesthesiologists. Effective management of preoperative anxiety, careful consideration of upper respiratory tract infections, and appropriate pain control strategies are essential for successful outcomes. Anesthesiologists must tailor their approach to the specific needs of pediatric patients undergoing orthopedic procedures to ensure their safety and well-being.

Reference

Wu JP. Pediatric Anesthesia Concerns and Management for Orthopedic Procedures. Pediatr Clin North Am. 2020 Feb;67(1):71-84. doi: 10.1016/j.pcl.2019.09.006. PMID: 31779838; PMCID: PMC7172179.

Anesthesiology Board Review Newsletter

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The End of the Public Health Emergency. How Does this Affect your Practice? 0

Apr 27, 2023

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Join digital health leader and Upside Health CEO Rachel Trobman and PainExam.com founder Dr. David Rosenblum in a conversation about the impact of the end of the public health emergency in May could have on your pain management practice. We'll specifically discuss the changes to telehealth and remote patient monitoring. The webinar will close with one of Upside Health's clients outlining the launch and successes of RTM in their practice and be available for Q&A.

Course Calendar

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San Juan, PR

For up to date Calendar, Click Here!

For Board Prep go to www.AnesthesiaExam.com

For more questions Email Rachel Trobman at Rachel@upside.health

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Ultrasound Guided Cervical Disc PRP Injections 0

Apr 12, 2023

Regenerative Medicine Journal Club

Dr. Rosenblum reviews a case report discussing Platelet Rich Plasma Intra-discal Injection using ultrasound and fluoroscopy. The author mentions use of ultrasound to avoid the Internal jugular vein, carotid artery, phrenic nerve, esophagus and neural structures. The author mentions mixing lidocaine with PRP and Dr. Rosenblum comments on his experience and knowledge of the technique. Dr. Rosenblum mentions the risk of disci tis.

Course Calendar

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Register to our Free Upcoming Practice Management Webinar on April 24th

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

For up to date Calendar, Click Here!

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References

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The MOTION Study: Minimally Invasive Lumbar Decompression 0

Mar 29, 2023

The MOTION Study: Minimally Invasive Lumbar Decompression

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Journal Club. Minimally Invasive Lumbar Decompression (mild® Procedure) with Conventional Medical Management vs. Conventional Medical Management Alone.

Descripton of Procedure, Safety, Technique, study outcome, personal experience with this minimally invasive technique that interventional pain physicians are using to treat neurogenic claudication related to ligamentum flavum hypertrophy.

Dr. Rosenblum discusses spinal stenosis pathophysiology and neurogenic claudication. Dr. Rosenblum also mentions upcoming courses and webinars:

Upcoming Courses and Workshops!

Course Calendar

Practice Management Webinar: The End of the Public Health Emergency. What’s Changed and what Opportunities Remain!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- July 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- August 19th, 2023

For up to date Calendar, Click Here!

References

Timothy R Deer, MD, Shrif J Costandi, MD, Edward Washabaugh, MD, Timothy B Chafin, MD, Sayed E Wahezi, MD, Navdeep Jassal, MD, Dawood Sayed, MD, The MOTION Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild® Procedure: One-Year Results, Pain Medicine, Volume 23, Issue 4, April 2022, Pages 625–634, https://doi.org/10.1093/pm/pnac028

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PRP and the Nerve 0

Mar 21, 2023

Biologics and the Peripheral Nerve.

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Dr. Rosenblum discuss his upcoming talk at the Appalachian Region Spine and Pain Meeting: Incorporating Ultrasound into a Spine and Pain Practice on April 14-16 2023 and the topics he plans to include: Ultrasound Guided Knee therapies, cluneal nerve, caudal, brachial plexus and more!

Today’s podcast focuses on the risk and benefits of performing PRP injection onto a nerve. Dr. Rosenblum discusses:

Possible fibrosis of the ulna nerve after using PRP for partial ulnar collateral ligament tears

Best Time for PRP Injection after Nerve Regeneration

Alpha 2-macroglobulin (what is it?)

PRP for moderate to severe carpal tunnel syndrome

Featured Courses!

May 25, 2023 Private Pain Group Ultrasound Course- NYC (Sold out)

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

see the full schedule for our July and August US IPM Courses!

References

Robert G. Thompson, Kendall Bradley, Gary M. Lourie,

Ulnar nerve dysfunction at the elbow after platelet-rich plasma treatment for partial ulnar collateral ligament injuries,JSES Reviews, Reports, and Techniques,Volume 1, Issue 1,2021,Pages 41-44,ISSN 2666-6391,

Si-Ru Chen, Yu-Ping Shen, Tsung-Yen Ho, Tsung-Ying Li, Yu-Chi Su, Yu-Ching Chou, Liang-Cheng Chen, Yung-Tsan Wu,One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial,Archives of Physical Medicine and RehabilitationVolume 102, Issue 5,2021,

Pages 951-958,ISSN 0003-9993,https://doi.org/10.1016/j.apmr.2020.12.025.

Rehman, A.A., Ahsan, H. and Khan, F.H. (2013), Alpha-2-macroglobulin: A physiological guardian. J. Cell. Physiol., 228: 1665-1675. https://doi.org/10.1002/jcp.24266

Muhammad Pandunugrahadi, Komang Agung Irianto, Oen Sindrawati, "The Optimal Timing of Platelet-Rich Plasma (PRP) Injection for Nerve Lesion Recovery: A Preliminary Study", International Journal of Biomaterials, vol. 2022, Article ID 9601547, 7 pages, 2022. https://doi.org/10.1155/2022/9601547

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Comparing BMAC with PRP (Leukocyte Rich vs Poor) for Knee Pain 0

Mar 11, 2023

Knee Osteoarthritis and Regenerative Pain Medicine

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Dr. Rosenblum reviews the latest evidence comparing Bone Marrow Aspirate and Platelet Rich Plasma for knee pain. He also reviews the latest publication by Di Martino et al’s study which compared Leukocyte-rich PRP vs. Leukocyte-poor PRP in the treatment of knee osteoarthritis.

Upcoming Courses

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

References

El-Kadiry, A.EH., Lumbao, C., Salame, N. et al. Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study. BMC Musculoskelet Disord 23, 23 (2022). https://doi.org/10.1186/s12891-021-04910-5

Hede, Kris, et al. "Combined bone marrow aspirate and platelet-rich plasma for cartilage repair: two-year clinical results." Cartilage 13.1_suppl (2021): 937S-947S.

Anz AW, Plummer HA, Cohen A, Everts PA, Andrews JR, Hackel JG. Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 2 Years: A Prospective Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):618-629. doi:10.1177/03635465211072554

Di Martino A, Boffa A, Andriolo L, et al. Leukocyte-Rich versus Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Trial. The American Journal of Sports Medicine. 2022;50(3):609-617. doi:10.1177/03635465211064303

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Carpal Tunnel Syndrome 0

Feb 25, 2023

Carpal Tunnel Syndrome

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Diagnosis, Pathophysiology, Clinical Findings and Management of the Carpal Tunnel Syndrome

In this episode, we will be discussing Carpal Tunnel Syndrome, a common condition that affects millions of people worldwide. But before we dive into the topic, we want to tell you about a great opportunity to advance your medical knowledge through the NRAP Academy CME courses offered on our website.

Discussion on Carpal Tunnel Syndrome:

Carpal Tunnel Syndrome is a condition that occurs when the median nerve, which runs from the forearm to the hand, becomes compressed or squeezed at the wrist. This compression can lead to pain, numbness, and tingling in the hand and arm, which can be debilitating.

There are many causes of Carpal Tunnel Syndrome, including repetitive hand movements, wrist injuries, pregnancy, and medical conditions such as diabetes and thyroid disorders. Treatment options for Carpal Tunnel Syndrome range from non-invasive approaches like rest, ice, and wrist splints to more invasive treatments like surgery.

It's important to diagnose and treat Carpal Tunnel Syndrome early to prevent long-term damage to the median nerve. A proper diagnosis can be made through a physical exam and imaging tests like an electromyography (EMG) or nerve conduction study (NCS).

Don't forget to check out the NRAP Academy CME courses offered on our website, www.painexam.com/events page, to continue your medical education and enhance your patient care.

NRAP Academy Events

Hands on Training for medical professional looking to enhance your knowledge and skills in pain management? Offering courses are designed to help you stay up-to-date with the latest advances in pain management and to help you improve patient outcomes. Visit our website, www.painexam.com/events page, to learn more about the courses available and to sign up today.

References

Sevy JO, Varacallo M. Carpal Tunnel Syndrome. [Updated 2022 Sep 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/

Sevy JO, Varacallo M. Carpal Tunnel Syndrome. 2022 Sep 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28846321.

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Post Herpetic Neuralgia: Interventions and Evidence 0

Jan 31, 2023

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Dr. Rosenblum discuss a challenging case and reviews the pathology, treatment and evidence for interventional pain in the the treatment of Post Herpetic Neuralgia.

Discussed in this podcast:

Intrathecal injection of methylprednisolone

Dorsal Root Ganglion

Paraveterbral Nerve Block

Stellate Ganglion Block

Spinal Cord Stimulation

Botulinum Toxin Injection

And more!

Course Calendar

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Puerto Rico- Feb. 10, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Regenerative Pain Medicine Course NYC- May 13

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

References

Lin, Chia-Shiang, et al. "Interventional treatments for postherpetic neuralgia: a systematic review." Pain physician22.3 (2019): 209.

https://www.painphysicianjournal.com/current/pdf?article=NjMwMg%3D%3D&journal=120

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Ultrasound Guided Spine and Interventions- Cluneal Nerve, Stellate Ganglion, Facet, Caudal and more! 0

Jan 10, 2023

David Rosenblum, MD, creator of PainExam.com, AnesthesiaExam.com, PMRExam.com, NRAP Academy and International Pain Academy Co-Founder presents an excerpt from Grand Rounds Given on January 2, 2023 to the Metropolitan Hospital Physical Medicine and Rehabilitation Department.

Reflect on Ultrasound Guided Interventional Spine Procedures and Claim CME Credit

Agenda:

Ultrasound Guided Cluneal Nerve Blocks
Ultrasound Guided Stellate Ganglion Block
Ultrasound Guided Facet Joint Injection
Ultrasound Guided Medial Branch Blocjks
Ultrasound Guided Sacroiliac Joint Inejction
Ultrasound Guided Caudal Epidural Injections

Dr. Rosenblum offers live regional anesthesia, regenerative medicine, board review and interventional pain management CME courses in NY and around the world. For more information, go to www.NRAPpain.org or PainExam.com/events

Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Great Neck Office 516 482 7246

Upcoming Courses and Workshops!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

NRAP: NYC Regional Anesthesia and Pain Ultrasound CME Workshop Registration, Sat, Dec 3, 2022 at 7:30 AM | Eventbrite

For up to date Calendar, Click Here!

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Updates to the 2023 Physician Fee Schedule + New Chronic Pain Management Codes 0

Dec 21, 2022

Rachel Trobman, CEO of Upside Health and David Rosenblum, MD discuss updates to the 2023 Physician Fee Schedule + New Chronic Pain Management Codes, Remote Patient Monitoring and more!

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Upcoming Courses and Workshops!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

NRAP: NYC Regional Anesthesia and Pain Ultrasound CME Workshop Registration, Sat, Dec 3, 2022 at 7:30 AM | Eventbrite

For up to date Calendar, Click Here!

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CDC Opiate Prescribing Guidelines- An update by Larry Kobak Esq. 0

Dec 15, 2022

1 CME Available

What you need to know: The Updated CDC Clinical Practice Guideline for Prescribing Opioids for Pain

Monday, November 21 at 6:00 pm EDT

NYSPS Legal Briefs

New 2022 CDC Guidelines on

OPIOID USE FOR TREATMENT OF PAIN

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The Guidelines state very clearly: “Nonopioid therapies are preferred for subacute and chronic pain.” If you are using opioids for subacute or chronic pain, which including both terms, means treating pain for 1 month or more, your chart must contain some justification for the use of opioids. This is an extremely important matter. Appropriate reasons, such as a prior treater, attempted various nonopioid treatments of some kind that failed. There must be a very good reason why opioids were tried. It must be documented.

Larry Kobak, Esq.

Senior Counsel

Frier Levitt

ATTORNEYS AT LAW

101 Greenwich Street, Suite 8B

New York, NY 10006

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Failure of the Intrathecal Drug Delivery System: Pain and Anesthesia Board Review 0

Nov 30, 2022

Journal Club where David Rosenblum, MD reviews the possible complications related to an intrathecal pump. Discussed in this podcast:

Intrathecal pump malfunction, disconnect, granuloma, infection, MRI compatibility, related malfunctions, and evaluation of pump failure.

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Upcoming Workshops

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

For up to date Calendar, Click Here!

For Anesthesia Board Review, go to AnesthesiaExam.com

Reference

Delhaas EM, Huygen FJPM. Complications associated with intrathecal drug delivery systems. BJA Educ. 2020 Feb;20(2):51-57. doi: 10.1016/j.bjae.2019.11.002. Epub 2019 Dec 12. PMID: 33456930; PMCID: PMC7807963.

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Interosseous PRP for Knee OA 0

Nov 16, 2022

Regenerative Pain Medicine in Knee OA- The Interosseous Injection of BMAC and PRP

In anticipation of NRAP Academy’s upcoming Regenerative Medicine Course, Dr. Rosenblum reviews interosseous injections of PRP and Bone Marrow Aspirate in the treatment of Knee Osteoarthritis.

Dr. Rosenblum reviews key points and quotes Delgado et al in the below article.

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Upcoming Courses and Workshops!

Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022

Regenerative Interventional Pain Course NYC- Jan, 28, 2023

Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023

Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023

For up to date Calendar, Click Here!

Reference

Delgado D, Garate A, Vincent H, Bilbao AM, Patel R, Fiz N, Sampson S, Sánchez M. Current concepts in intraosseous Platelet-Rich Plasma injections for knee osteoarthritis. J Clin Orthop Trauma. 2019 Jan-Feb;10(1):36-41. doi: 10.1016/j.jcot.2018.09.017. Epub 2018 Sep 28. Erratum in: J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1169-1171. PMID: 30705529; PMCID: PMC6349647.

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Should intervertebral disc degeneration be treated with mesenchymal stem cells? 0

Nov 8, 2022

A review of the evidence

David Rosenblum, MD reviews the description and evidence provided by Loibi et al in the published article referenced below. Dr. Rosenblum discusses personal experiences with treating back pain with regenerative medicine procedures. Discussed in this podcast:

Patient selection

Pathophysiology

Environment of the disc and it’s impact on MSCs

Risks and safety concerns of Intervertebral mesenchymal stem cell transplantation

Pain relief and recommendations for MSC injection into the disc in patients suffering from discogenic pain

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Course Calendar

Pain Management Board Review and Refresher, June 10-12, 2023- NYC Location TBA

Reserve a spot!

References

Loibl, M, Wuertz-Kozak, K, Vadala, G, Lang, S, Fairbank, J, Urban, JP. Controversies in regenerative medicine: Should intervertebral disc degeneration be treated with mesenchymal stem cells? JOR Spine. 2019; 2:e1043. https://doi.org/10.1002/jsp2.1043

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The Glossopharyngeal Nerve Revisited 0

Oct 27, 2022

The Glossopharyngeal Nerve Revisited-

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Glossopharyngeal Neuralgia, Anatomy, Pathophysiology, Diagnosis, and Treatment-

Dr. Rosenblum reviews Neuralgia and Compression of CN IX pathology, discusses the management, treatment and more. David Rosenblum MD, pain physician in Great Neck, Long Island discusses the different approaches to treating patients with medications and interventional pain procedures such as nerve blocks, neurolysis and radiofrequency lesioning...

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IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 30, 2022

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Ultrasound Block Course applicable in Pediatric Anesthesia for Orthopedic Procedures includes:

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