During the Fifth Pediatric Anesthesia Neurodevelopmental Assessment Symposium, experts and stakeholders met to present and discuss recent advances made in the study of neurodevelopmental outcomes after exposure to anesthetic drugs in infants and children. This article summarizes the update of 5 ongoing clinical studies: General Anesthesia compared to Spinal Anesthesia, Toxicity of Remifentanil and Dexmedetomidine, Mayo Anesthesia Safety in Kids, the University of California San Francisco human cohort study, and Columbia University Medical Center Neonatal Magnetic Resonance Imaging study. The purpose of this summary is to discuss the contributions and limitations of these studies, how they fit into the published literature, and what questions remain to be answered.

Case: We present 2 cases of life-threatening intraoperative anaphylaxis to the bovine flowable gelatin matrix during pediatric spinal deformity surgery for kyphoscoliosis. Both patients had no known bovine or gelatin allergies. Anaphylaxis occurred shortly after pressurized injection into the first cannulated pedicle tract and was successfully treated with epinephrine, diphenhydramine, and methylprednisolone infusion. The allergic reaction was confirmed with tryptase levels and serum-specific immunoglobulin E for beef, pork, bovine collagen, and porcine collagen. Conclusion: In patients with beef, pork, or gelatin intolerance, a significant atopic history or childhood vaccine reaction, preoperative allergy consultation, and testing should be performed to prevent this life-threatening complication.

Columbia University’s Papper Symposium, a virtual event held on March 20, 2021, was dedicated to the coronavirus disease-2019 (COVID-19) pandemic. This article summarizes a lecture by Dr. Roberta Hines, Nicholas M. Greene Professor of Anesthesiology and Department Chair and Chief of Anesthesiology at Yale-New Haven Hospital titled “The impact of COVID-19 on trainees: lessons learned and unanticipated opportunities,” in addition draws from experiences at Columbia University Irving Medical Center and a focused review of the literature on the toll of the pandemic on trainee well-being and mental health. Early research has demonstrated that rates of burnout and acute stress were higher among health care providers who cared for COVID-19 patients than those who did not and that COVID-19 frontline health care providers are at high risk for common psychological disorders, including depression, anxiety, and post-traumatic stress disorder. Trainees working on the frontlines may be at particularly high risk for these mental health disorders and are less likely to access resources available to them. Program directors and hospital graduate medical education leaders should be aware of the threats to physiological and psychological safety and take action to prevent further detrimental effects. The rates of burnout and mental health disorders among trainees are expected to rise as a result of the pandemic, making screening programs and increased access to mental health treatment an essential feature of all residency and fellowship programs.

Malignant hyperthermia (MH) is a rare pharmacogenetic disorder triggered by volatile anesthetics and succinylcholine, most often linked to pathogenic variants in RYR1, CACNA1S, and STAC3. The advent of next-generation sequencing (NGS) has transformed MH diagnostics, offering new opportunities for perioperative risk assessment as caffeine–halothane contracture testing declines. However, challenges remain, including incomplete penetrance, variable pathogenicity of variants, limited access to functional confirmatory testing, and cost. Genetic testing also raises important questions. What is the clinical utility of finding a variant of unknown significance? What are the broader implications of MH susceptibility beyond the operating room? Emerging evidence connects MH susceptibility loci to exertional heat illness (EHI), exertional rhabdomyolysis (ERM), and heat-related mortality, highlighting the need for a broader framework for genetic risk assessment. This review synthesizes historical advances, current consensus, and future directions concerning MH to guide anesthesiologists and perioperative clinicians in leveraging molecular diagnostics for personalized care and improved patient safety.

An abstract is unavailable. This article is available as a PDF only.

Malignant hyperthermia (MH) is a rare pharmacogenetic disorder triggered by volatile anesthetics and succinylcholine, most often linked to pathogenic variants in RYR1, CACNA1S, and STAC3. The advent of next-generation sequencing (NGS) has transformed MH diagnostics, offering new opportunities for perioperative risk assessment as caffeine-halothane contracture testing declines. However, challenges remain, including incomplete penetrance, variable pathogenicity of variants, limited access to confirmatory testing, and cost. Genetic testing also raises important questions. What is the clinical utility of finding a variant of unknown significance? What are the broader implications of MH susceptibility beyond the operating room? Emerging evidence connects MH susceptibility loci to exertional heat illness and heat-related mortality, highlighting the need for a broader framework for genetic risk assessment. This review synthesizes historical advances, current consensus, and future directions concerning MH to guide anesthesiologists and perioperative clinicians in leveraging molecular diagnostics for personalized care and improved patient safety.