Utilizing humidified high-flow nasal cannula (HHFNC) to prevent oxygen desaturation in premature neonates with retinopathy of prematurity (ROP) undergoing indirect diode laser photocoagulation therapy
Retinopathy of prematurity (ROP) is a vaso-proliferative disease affecting the developing retinal vessels of premature infants, potentially leading to retinal detachment and blindness. Known major risk factors for developing ROP are low gestational age, hyperoxia, and mechanical ventilation. The gold standard of ROP treatment is laser photocoagulation of the non-vascularized retina under anesthesia.

General anesthesia in premature infants is associated with significant risks, including apnea, arterial blood oxygen desaturation, potential exposure to high inspired oxygen concentrations, and risks related to tracheal intubation. Tracheal intubation to provide mechanical ventilation in neonates has been associated with rare but potentially severe undesired consequences.

HHFNC therapy opens the airway and alveoli through the generation of distending pressure, reduces nasopharyngeal dead space, reduces work of breathing, and heats and humidifies inspired gas, allowing for apneic oxygenation while preventing collapse of the distal airways. There is good evidence that the application of HHFNC in the neonatal population to provide non-invasive respiratory support to prevent hypoxemia is both safe and feasible in the NICU, during anesthesia induction and intraoperative period to facilitate ear, nose and throat (ENT) and general surgery. HHFNC enables the neonate to breathe spontaneously under total intravenous anesthesia (TIVA) and could reduce or eliminate the need for tracheal intubation, mechanical ventilation, and the iatrogenic administration of high oxygen concentrations. More recently, HHFNC has been shown to promote regression of high-risk pre-threshold ROP.

Anesthetic Outcomes During Epilepsy Surgery using Electrocorticography (ECoG)
About one-third of people with epilepsy will eventually develop intractable seizures which are refractory to medical management. Electrocorticography (ECoG), a form of neuromonitoring, is considered to be the gold standard for assessing neuronal activity in patients with epilepsy, and is widely used for presurgical planning and intraoperatively to guide surgical resection of the lesion and epileptogenic zone. Anesthetic agents can impact the accuracy of electrocorticography during surgery.

We are currently conducting a prospective audit of 25 sequential Epilepsy surgery cases using ECoG to describe our institutional experience. Specifically, we are looking at the anesthetic technique being used, the quality of the ECoG being captured, and the one year seizure outcomes after epilepsy surgery.

Erector Spinae Plane (ESP) block for pain control after pyeloplasty surgery
Pyeloplasty is a surgical procedure used to correct a condition called ureteropelvic junction (UPJ) obstruction. Ureteropelvic junction (UPJ) obstruction is a blockage at the point where part of the kidney attaches to one of the tubes to the bladder (ureters). This blocks the flow of urine out of the kidney. One out of every 1500 babies is born with UPJ obstruction. Pain after pyeloplasty surgery is most severe in the first 24-48 hours after surgery.

The erector spinae plane (ESP) block is a paraspinal fascial plane block done under ultrasound guidance to inject local anesthetic between the tip of the transverse process of the thoracic or lumbar vertebra and the anterior fascia of the erector spinae muscles. The block targets the dorsal and ventral rami of the thoracic and abdominal spinal nerves to provide analgesia for multiple types of surgical procedures including pyeloplasty. Potential benefits of ESP blocks are improved post-operative analgesia, a reduction in the amount of post-operative opiates required, and decreased post-op nausea and vomiting.