Background: Pediatric anesthesiology has been greatly impacted by COVID-19 in the delivery of care to patients and to the individual providers. With this study, we sought to survey pediatric centers and highlight the variations in care related to perioperative medicine during the COVID-19 pandemic, including the availability of protective equipment, the practice of pediatric anesthesia, and economic impact. Aim:The aim of the survey was to determine how COVID-19 directly impacted pediatric anesthesia practices during the study period. Methods: A survey concerning four major domains (testing, safety, clinical management/policy, economics) was developed. It was pilot tested for clarity and content by members of the Pediatric Anesthesia COVID-19 Collaborative. The survey was administered by email to all Pediatric Anesthesia COVID-19 Collaborative members on September 1, 2020. Respondents had six weeks to complete the survey and were instructed to answer the questions based on their institution's practice during September 1 -October 13, 2020.Results: Sixty-three institutions (100% response rate) participated in the COVID-19 Pediatric Anesthesia Survey. Forty-one hospitals (65%) were from the United States, and 35% included other countries. N95 masks were available to anesthesia teams at 91% of institutions (n = 57) (95% CI: 80%-96%). COVID-19 testing criteria of anesthesia staff and guidelines to return to work varied by institution. Structured simulation training aimed at improving COVID-19 safety and patient care occurred at 62% of institutions (n = 39). Pediatric anesthesiologists were economically affected by a reduction in their employer benefits and restriction of travel due to employer imposed quarantine regulations. Conclusion:Our data indicate that the COVID-19 pandemic has impacted the testing, safety, clinical management, and economics of pediatric anesthesia practice. Further investigation into the long-term consequences for the specialty is indicated. | 721 SONERU Et al.

Background:The laryngeal mask airway (LMA) Supreme (LMAS) is a sophisticated, second-generation supraglottic airway device, with an improved seal, and gastric access. It is a capable device for use in more complex procedures and in younger children. No study has been able to analyze a large pediatric sample of patients to assess how the LMAS is being utilized. In this retrospective audit, we evaluated the use of the LMAS in routine clinical practice. In addition to this, utilization of LMAS performance test was evaluated. Methods: A retrospective audit was performed of a major tertiary children's hospital's electronic medical record database to identify all children in whom the LMAS was utilized for airway management over a two-year period. In addition to demographic data, we collected the following LMAS data: size of the LMAS, the number of insertion attempts, volume of air injected into the cuff, the cuff pressure, and the oropharyngeal leak pressure. We also recorded the performance of tests for proper position and function, the mode of lung ventilation, the use of muscle relaxants and use of any alternative airway devices. Results: The LMAS was used in 418 children accounting for only 4% of all LMA usage and only 0.6% of all usage for general anesthesia. The first-attempt placement success rate was 96.4% (382/396). Five of 418 (1.2% ) insertions were reported as failures. Mechanical ventilation was used in only 26% of cases with a vast majority (74% ) breathing spontaneously. Cuff pressure was measured in 74/418 (18% ) of cases. Oropharyngeal leak pressures were measured in 90/418 (21.5% ) cases. Maneuvers performed to verify correct placement and performance of the LMAS were rarely performed. Use of the LMAS for invasive procedures occurred in only 5 cases (1.2%). Conclusions: This study shows the LMAS to be highly successful in the hands of various cadres of anesthesia providers at a major tertiary hospital and performs reliably well. Our data reveals many areas of potential improvement for use of the LMAS in the pediatric population, as a device capable for usage in more invasive surgical procedures, younger patients, and mechanical ventilation.

Although the majority of research and clinical interventions focused on posttraumatic stress disorder (PTSD) centers on traumatic memories, recent literature suggests the importance of considering emotionally laden memories more broadly among trauma-exposed individuals. Specifically, trauma-exposed individuals have difficulties retrieving positive and negative memories, and interventions focused on enhancing the retrieval of both traumatic and positive memories benefit overall well-being. These findings led to the development of a novel Processing of Positive Memories Technique (PPMT) for PTSD. As the next step in treatment development, PPMT was piloted among 12 trauma-exposed community members seeking therapeutic or assessment services at a university psychology clinic. In this study, we summarize participants' quantitative and qualitative feedback on the content, format, and feasibility of PPMT. Next, we outline proposed formative changes that are critical to the iterative refinement of PPMT, based on the obtained feedback to enhance its scalability, feasibility, and effectiveness. Within clinical practice, PPMT, as implemented in this study, may be feasible, and there may be potential benefits to incorporating positive memory processing using PPMT.