Pediatric Anesthesia

For Residents: Introduction

The CA-2 rotation in Pediatric Anesthesiology consists of one to two months of concentrated exposure to the pediatric patient. It is not possible to learn all there is to know about Pediatric Anesthesiology in this brief time. However, it is an opportunity to familiarize yourself with the basics of the subspecialty and to become more comfortable caring for these patients.

The CA-3 rotation consists of two to three months. During this time you will be able to acquire a more in-depth understanding of the pediatric patient and their special needs in the operating room. Your responsibilities will include acting as a consultant to the pediatric surgeons for the evaluation of those patients that may require a more extensive work-up prior to surgery and anesthesia.

A Pediatric Manual is available and should be obtained from Jean Namakajo in KCC 8-22 prior to the start of the rotation. It is designed as a supplement to your operating room experience and perioperative discussions. In it you will find a list of educational objectives based in part upon the ABA/ASA In-Training examination Content Outline. This is followed by a recommended reading list. The list will guide you through appropriate sections in the recommended texts, as well as, reprints of pertinent journal articles. The cited text, A Practice of Anesthesia for Infants and Children, 3rd edition, by Cote, et al., may be borrowed from the Educational Resource Center for the duration of your rotation. You must return the book at the end of the rotation. Tables of normal laboratory values and vital signs are included, as well as a guide to setting up the operating room.

We look forward to working with you and hope that you have an enjoyable and educational experience.

For Residents: Helpful Hints

You are about to embark on your month-long endeavor in pediatric anesthesia. We look forward to working with you.

The following are some helpful hints to help make the month more productive:

  1. Please sign out a copy of A Practice of Anesthesia for Infants and Children by Cote 3rd edition, et al. from the ERC.
  2. Please ensure that the operating room is set up by 7:30 a.m.
  3. It is important to speak with your attending the night before to discuss the cases for the next day. This is true even if the patients are DAS or Ambulatory, in order to review the salient features about the case(s).
  4. Although, in general, you are not expected to see pre-ops on your post-call day or Sundays, it is expected that you be aware of your cases so that you may prepare adequately for them. For major cases, you are expected to pre-op your own case even if you are post-call. If you are not sure what constitutes a major case, please discuss it with your attending.
  5. A list of topics for discussion with your attendings during the month is provided. This list can be used to ensure these important topics are covered.

For Residents: Topics for Discussion

  • Child with a Runny Nose
  • Fetal to Neonatal Circulation
  • Malignant Hyperthermia
  • Pediatric Physiology
  • Prematurity
  • Obstructive Sleep Apnea
  • Fluid Management
  • Pre-induction and Induction Techniques

For Residents: Educational Objectives

  1. Understand the anatomy and physiology related to the pediatric patient and as compared to the adult patient.
  2. Preoperative Evaluation
    1. To be able to elicit an adequate history and identify specific anesthetic problems during the preoperative evaluation.
    2. To be able to perform an appropriate anesthesia-related physical exam.
    3. To interpret laboratory tests and when necessary take appropriate action.
    4. Decide whether to premedicate the patient and be able to order the appropriate drug(s) and dosages.
    5. To write appropriate NPO orders.
  3. Intraoperative Considerations
    1. Identifying and understanding various pediatric anesthesia circuits.
    2. Prepare equipment and drugs necessary to monitor, anesthetize, and care for the pediatric patient.
    3. Acquire knowledge of the pharmacology and dosages of drugs commonly used in pediatric anesthesia.
    4. To be able to induce anesthesia utilizing various techniques.
    5. To be able to administer general and regional anesthesia and know the indications for each.
    6. To be able to calculate maintenance, deficit, and replacement fluids and be able to choose the appropriate fluid therapy.
  4. Postoperative Considerations
    1. To anticipate what problems may occur post-operatively, to recognize them, and be able to appropriately treat them.
    2. To decide what monitoring is necessary post-operatively.
    3. To be able to write appropriate post-operative orders.
    4. To be able to plan and implement appropriate post-operative pain management.
  5. To understand the pathophysiology of specific disease entities and to know the anesthetic considerations of each.
    1. Prematurity
    2. Retinopathy of Prematurity
    3. Respiratory Distress Syndrome
    4. Apnea - Central and Obstructive
    5. Tracheoesophageal Fistula
    6. Diaphragmatic Hernia
    7. Abdominal Wall Defects (Gastroschisis/Omphalocele)
    8. Necrotizing Enterocolitis
    9. Pyloric Stenosis
    10. Epiglottitis/Croup
    11. Difficult Airway (e.g. Treacher-Collins, Pierre-Robin)
    12. Full Stomach
    13. Foreign Body Aspiration
    14. Malignant Hyperthermia
    15. Sickle Cell Anemia
    16. Upper Respiratory Infection
    17. Patient with Congenital Heart Disease for Non-cardiac Surgery
  6. To be able to resuscitate the neonate and the pediatric patient.