by Raeford E. Brown Jr., M.D., FAAP,
and Rita Agarwal, M.D., FAAP
The Academy has coordinated a response to a recent
Food and Drug Administration (FDA) warning that
cautions health care practitioners about the possibility
of developmental problems associated with repeated or
prolonged use of anesthetics in children younger than 3
years of age. The agency is requiring warning labels on
all anesthetic agents and sedatives, including propofol,
midazolam and all volatile anesthetic agents.
An FDA Drug Safety Communication highlights
the abundant animal data from more than a decade
concerning suspected toxicities when these agents are
used during surgeries or procedures lasting longer than
three hours or when administered multiple times to
children younger than 3 and pregnant women in their
third trimester. Laboratory studies of multiple species,
including primates, demonstrate that prolonged use
and multiple anesthetics or sedations have been associated with developmental anomalies of cognition and
memory and cell death in the developing brain.
The findings cited in the warning are not new. They
have been discussed by three FDA advisory committees
since 2007. However, concerns have arisen recently
that not all practitioners using these medications for
sedation or surgical anesthesia in children are aware of
these findings, reducing their ability to make informed
decisions concerning the risks and benefits of proce-
dures requiring sedation or anesthesia. In addition, lack
of awareness reduces the clinician’s ability to educate
families and get informed consent.
The Academy, led by the Section on Anesthesiology
and Pain Medicine and the Committee on Drugs, coordinated a response that aimed to place this warning
in the perspective of recent controlled trials in humans
and multiple epidemiological studies of large homogeneous populations. These studies demonstrate no developmental problems in children exposed to a single,
short anesthetic or sedation.
The response cautions parents and clinicians of the
risks of delaying needed surgery and diagnostic procedures. Until additional information is available from
the many ongoing studies in animals and humans, parents and providers should weigh the risks and benefits
of each contemplated procedure prior to proceeding.
In addition to the Academy, numerous other profes-
sional organizations endorsed the response, including
the American Society of Anesthesiologists, the Interna-
tional Anesthesia Research Society, Society for Obstet-
ric Anesthesia and Perinatology, Society for Pediatric
Anesthesia, Congenital Cardiac Anesthesia Society, Pe-
diatric Anesthesia Leadership Council and the Society
for Pediatric Pain Medicine.
Dr. Brown is chair-elect
and Dr. Agarwal is chair
of the AAP Section on
Anesthesiology and Pain
Medicine Executive Committee.
• AAP response to the FDA Drug Safety Communication,
• FDA Drug Safety Communication, http://bit.ly/2ieL3YQ
AAP responds to FDA warning on anesthesia use in children
Dr. Brown Dr. Agarwal
from the AAP Department of Community,
Chapter and State Affairs
AAP chapters are engaging pediatric residents in
advocacy and leadership opportunities, increasing the
likelihood of retaining trainees as members throughout
Following are some of the strategies chapters are using to engage residents.
Advocacy in action
The Mississippi Chapter involved residents in its
summer enrichment program, Ground Zero: Twenty
Days in the Delta. The program addressed food insecurity, literacy, nutrition, physical activity, asthma
education and management, and access to care in an
impoverished community in the Mississippi Delta.
Community involvement and sustainability were major components of the effort.
Through an AAP Healthy People 2020 grant, the
program educated children on nutrition, healthy
food choices and cooking strategies. It also increased
awareness of summer school meal programs for children in need. Mississippi Chapter resident members
volunteered during the event, where 855 meals were
prepared and served to local children.
The Mississippi Chapter also holds a Capitol Day
for residents to gain legislative advocacy experience,
including a role-playing opportunity with retired pediatricians portraying immunization-hesitant parents.
Preparing future leaders
For over a decade, the Nebraska Chapter has been
providing practical resources and career support to
residents. The chapter hosts a one-day retreat for sec-
ond-year residents, offering sessions not typically cov-
ered in school curricula. Speakers lecture on medical
malpractice, quality improvement, choosing a practice
type, building a CV, interviewing tips, contract nego-
tiation and financial planning.
In addition, the chapter designed programming to
enhance residents’ experience at its annual and fall
meetings in 2015. As a result, more than 25 residents
and medical students (approximately 56% of resident
membership) attended the meetings.
The chapter also encourages residents to assume
leadership positions on the executive committee and
other committees, and to attend events offering free
continuing medical education (CME).
The chapter saw a 6% increase
in resident membership from 2014
“Resident engagement has been
one of the chapter’s top priorities,”
said chapter President Arwa Nasir, M.D., FAAP. “In addition to
the Resident’s Retreat, free CME
and AAP Legislative Conference
sponsorship we provide, our state’s chief residents are
ex officio chapter board members and participate in
meetings, phone conferences and emails related to the
business and advocacy efforts of the chapter.”
Member benefits focused on residents
Some chapters create benefits uniquely designed for
California Chapter 3 presents an annual Resident
of the Year award and funds two $50 resident book
awards on a monthly basis.
In West Virginia, the chapter holds a yearly Resident
Research Competition, and the top four abstracts (two
original research and two case reports) are presented
orally at the chapter’s spring meeting.
The Kentucky Chapter provides toolkits to graduating residents that show the value of AAP membership
and emphasize the importance of national and chapter
Ongoing engagement of residents
Many chapters cite resident outreach as an ongoing
recruitment priority as well as a retention challenge.
Some chapters provide resident membership at little
or no cost, pay all or a portion of national AAP resident dues, or offer free attendance
at the AAP National Conference &
“Chapters that offer valuable benefits to trainees on an ongoing basis
are building stronger relationships
with them in the long term,” said
Christian D. Pulcini, M. D., M. Ed.,
M.P.H., chair of the AAP Section on
Pediatric Trainees. “These efforts are appreciated and
will ensure that trainees stay involved and engaged with
the AAP at every level.”
• For more information, contact Allison Buckley, in the
AAP Division of Chapter and District Relations, at 847-
434-7892 or firstname.lastname@example.org.
• Find chapter websites at http://bit.ly/2ie2UA3.
Chapters prioritize resident engagement, involvement opportunities