Present at meeting: Brian Anderson, Isabelle Constant, Andrew Davidson, Jerrold Lerman, Keira Mason, Neil Morton, Quirino Piacevoli, James Roelofse, Marina Sammartino, Vivian Yuen

Dr Piacevoli noted that the Pediatrics is relevant to the World SIVA. There is a need for a safer way to use drugs, especially those that do not have pediatric labelling. It was decided by the Executive Committee at this Berlin meeting, that a Safety Commission would be formed (Chairman: Paul Barach) - to evaluate and substantiate the safety of TIVA and TCI. The Pediatric Committee will work with the Safety Committee to further these goals.

The Food and Drug Administration has agreed and committed to sending one of their Board Members to participate in every World SIVA Meeting. This participation will help to expedite innovation and meet important goals in quality and safety. Since the World SIVA is a Public Utility Society- so all proposals may be appropriately forwarded to government- WHO etc.

Dr Roelofse noted that research interests listed on the World Siva Pediatric biography section is an important item. Each member will create a paragraph of their research interest. The Pediatric Committee link of World SIVA will be posted on the main World SIVA website and will no longer be limited to members only.

Creating a Pediatric Syllabus for future meetings. Reviewing the attendees for the 2 pediatric sessions in Berlin there were on:
April 24th session- 120 attendees April 25th session- 40 attendees
This attendee representation is significant, in that it represents attendance of 15-20% of all registrants. The total registrants for the conference was 700, in addition to 100 faculty.

Neil Morton suggested that for future pediatric sessions: The faculty who do TIVA will introduce and lead case presentations in order to generate open discussion- This session would be an Open Forum interactive opportunity for attendees- Dr. Lerman suggested that this could be a panel of 3-4 people with each discussing how they would managespecific case scenarios. A total of the “top 6 case scenarios”, 20 minutes each, could be presented. Dr. Roelofse suggested that the faculty could present the case and subsequently lead and guide an open discussion on different management options. Other options could include asking the audience to propose challenging scenarios that would like to discuss amongst attendees. Dr. Roelofse stresses, and the Committee agreed that these scenarios be case presentations for both ANESTHESIA AND SEDATION scenarios. Dr. Morton also suggested discussions involving future “new innovation/developments”- for example, patient controlled sedation. Dr. Piacevoli also discussed the interest amongst attendees regarding pain management. Dr. Morton- agreed and suggested that a case scenario include pain management. Dr. Lerman, proposed an example of the cognitively challenged child and the challenges in assessing and treating pain.

Dr. Davidson suggested that if 2 sessions continues to be help for Pediatrics, there could be a clinical and theory session

Dr. Piacevoli suggested workshops and possible a lecture on Pain Management in the Pediatric Patient

Dr. Lerman suggested Problem Based Learning Session where each Pediatric Committee member could introduce a case in small group (8 person?) sessions.

Dr. Piacevoli- pediatric simulation workshops can take up to 4 years to develop a require special expertise. For example, currently there are 5 models for propofol. Dr. Morton suggested the TIVA trainer as a good introductory tool. Dr. Mason suggested that Drs Heinrichs and Absalom could be potential faculty for introducing propofol, TIVA, TCI in a workshop format. Dr. Lerman reiterated that in the United States, there is limited familiarity with the TCI concept, application and practicality. Dr. Piacevoli pointed out that a challenge is that it is not possible to apply adult derived TCI models to the pediatric population and that an important area of development should be in the development of pediatric simulator sessions. Currently METI is more appropriate than the Laerdahl model for TIVA/TCI.

Dr. Davidson suggested that a pediatric lecture be incorporated into the plenary session. For example, Dr. Anderson’s talk on pediatric TCI models could be a future plenary lecture. Other possible plenary lectures could include the Outcome Measures, TIVA and TCI.

In Summary, Dr. Lerman feels that with appropriate infrastructure and planning, the Pediatric Committee should support a syllabus which includes research, clinical/didactic lectures and pediatric simulation.

The Pediatric Committee unanimously agreed that Dr. Roelofse would represent the Committee and work toward initiating contact with countries which are in need of assistance to develop sedation-related training. This is a significant project and we all agreed that Dr. Roelofse expertise will be critical in supporting our mission. Dr. Piacevoli and the Committee agreed that Dr. Roelofse should contact the WFSA and WHO in order to set up a coordinated mission to introduce sedation training to countries in need.
Dr. Morton discussed his experience in setting up training programs with foreign countries and stressed that the key to success is the competency of the trainers. Dr. Morton will share the UK guidelines for sedation with us. The Committee discussed and supported the idea of using the World SIVA website as a repository to share sedation guidelines and training materials from world wide sites.
Dr. Mason explored with the Pediatric Committee whether there was an interest in introducing sedation training in a formal way to the United States, similar to Dr. Roelofse’s efforts in England. The Committee agreed that for the near future, this project was overly ambitious.

Dr. Morton supports a themed issue of Pediatric Anesthesia and feels that this is an appropriate time to introduce a themed issue on TIVA/TCI. Dr. Mason will complete a one page summary of World SIVA and Pediatric Committee. This summary will be included at the beginning of the Review Article. This Summary as well as the review article will help to increase interest in World SIVA, Pediatric TCI/TIVA and the general goals of the committee. Each speaker will present a lecture summary that follows the Pediatric Anesthesia format (no more than 3000 words per author). The deadline will be August. Dr. Davidson volunteered to contribute a review on neuromonitoring.

We will forward possible members to Dr. Quirino for review

Is pediatric Committee interested in establishing webased database? This also would be a large undertaking, and we will work with Dr. Barach and the Safety Committee in order to explore this goal. We agree that we would need a robust way to capture outcomes. We explored a POCA registry

Dr. Davidson stressed the importance of defining objectives for TIVA in children. Where are we heading ?
Dr. Lerman suggests a TIVA study or randomized trial. Outcomes could include short versus long term benefits. Would this be a valuable study?
Dr Davidson asked- if there are advantages of TCI/TIVA in adults, should we be offering it to children more? How could this question be answered. An objective could include- ways in which TIVA could be made more user friendly/popular for children. Dr. Davidson expressed a need and interest in assembling a core group of people to explore the optimal propofol TCI algorithm for children. How could this algorithm be derived and tested? The Committee expressed unanimous support for this objective. Dr. Davidson discussed the Open TCI initiative website and will contact individuals to invite them to participate. Dr. Mason will discuss with Dr. Minto ways in which pediatric data may be incorporated . Dr. Davidson will be the Pediatric Committee representative who will lead the initiative for TCI Propofol in Pediatrics.
Dr. Mason suggested that TIVA, TCI and long term outcome in neonates be reviewed
Dr. Sammartino would like to consider the use of TIVA in developing countries.
Dr. Yuen is interested in collecting data which could be markers for the Propofol Infusion Syndrome.