What IS Anesthesiology
Members of the anesthesiology research department have significantly contributed to the national and international pediatric anesthesia body of literature. Contributions include:
- Developing and validating the “Children’s Hospital of Eastern Ontario Pain Score” or “CHEOPs” that is cited to be one of the standard tools to measure in-hospital pain in young children.
- Establishing the association between ketorolac and the increased risk for post tonsillectomy bleeding. This research influenced practice in Canada.
- Identifying effective drug combinations for the reduction of post-operative nausea and vomiting, a problem that was the number one reason for unexpected admissions in the pediatric ambulatory surgery setting.
Since 2005 the department has steadily increased its academic pursuits and output over each successive year.
Close affiliation with the highly regarded Ottawa Hospital/University of Ottawa high-fidelity simulation center and the Academy for Innovation in Education (AIME) have enabled them to benefit from the simulation revolution, particularly in the pediatric realm, as a means to study how to ensure competency of healthcare workers.
The group’s clinical research focus is based primarily on post- operative pain management and functional recovery as well as the diagnosis and perioperative management of patients with obstructive sleep apnea (OSA).
A research committee has been set up in the department, and it liaises with the University of Ottawa Department of Anesthesiology research committee.
Modeling adult COX-2 cerebrospinal fluid pharmacokinetics to inform pediatric investigation
Transfer of unbound COX-2 inhibitors from plasma to CSF compartment can be described with a delayed effect model using an equilibration rate constant to collapse observed hysteresis. An additional transfer factor was required to account for passage across the blood-brain barrier. Use of a target concentration strategy for dose and consequent plasma (total and unbound) and CSF concentration prediction could be used to inform pediatric clinical studies.
Paediatric adenotonsillectomy, part 1: surgical perspectives relevant to the anesthetist
Obstructive sleep apnoea is a systemic inflammatory disease with multiple end-organ effects, increased sensitivity to opioids and reported pain. The anaesthetic technique should be adjusted accordingly and can be informed by preoperative overnight oximetry, an increasingly accepted diagnostic tool for OSA. Residual symptoms of oSDB/OSA after AT imply severe baseline disease and/or an underlying medical complexity.
Paediatric adenotonsillectomy, part 2: considerations for anaesthesia
The perioperative anaesthetic care of a child undergoing AT is evolving. Perioperative risk stratification is becoming less reliant on PSG as overnight pulse oximetry is an increasingly acceptable alternative. Validated paediatric questionnaires to diagnose OSA or predict critical PRAEs are being developed. These are likely to incorporate objective measures, such as overnight pulse oximetry, to improve performance of the tools. Preparation is required to address the unique airway challenges inherent in the child undergoing AT. Increased pain and sensitivity to opioid-induced respiratory depression in the child with OSA compel using a multimodal opioid-sparing analgesic technique.
Predictors of postoperative respiratory complications in children undergoing adenotonsillectomy
Prediction modeling concurrently evaluating comorbidities and polysomnography metrics identified cardiac disease, airway anomaly, and young age as independent predictors of PRAEs. These findings suggest that medical comorbidity and age are more important factors in predicting PRAEs than PSG metrics in a medically complex population.