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Pediatric Anesthesiology ServiceTABLE OF CONTENTS
CLINICAL SERVICESThe Division of Pediatric Anesthesiology provides consultations for complicated pediatric patients requiring elective and emergency surgery, anesthesia or sedation required for imaging (MRI and CT scans), interventional radiology and cardiology, as well as postoperative and chronic pain control. The faculty who sub-specialize in pediatric anesthesiology listed in the following section work in close collaboration with pediatric surgeons of all subspecialties. In the past and present, children and their families have been cared for within the two main operating room suites at Strong Memorial Hospital located on the 2nd floor and basement levels, where family waiting rooms, areas to be prepared for the surgery by nurses (Strong Surgical Center/SSC), to see the anesthesiologists and OR nurse (PreAnesthesia), and to recover following the surgery (Post Anesthesia Care Unit/PACU and SSC) in the operating room are all located.Children are evaluated initially by the surgeon and may be referred to the Preoperative Evaluation Center (PEC) for more detailed testing or evaluation by a member of the anesthesiology team. Information to prepare for surgery is provided at these visits and often by phone calls from the nurses in the SSC and from an anesthesiologist or resident the night prior to surgery. Children who are having uncomplicated procedures and are otherwise quite healthy may often be seen the day of the surgery by the anesthesiology team. Attention is given to the child's overall condition, the specific procedure, any other disease processes or medicines being taken, the level of anxiety in the child (and parents), pre-operative timing of when the child can eat normally, and when clear liquids such as water, apple juice, or soda may be taken a number of hours prior to the planned surgery that may vary depending on the child's status. In many, but not all cases, a parent may accompany the child to the operating room for the anesthetic induction by face mask or intravenous administration. If a child is quite anxious, the planned surgery of sufficient length, and no contraindications present, an oral sedative just prior to surgery may greatly reduce anxiety in the child. As soon as the child is asleep, the parent will be escorted to the family waiting room. Following completion of the surgery, the child will be brought to the PACU to awaken and then to the SSC to rejoin the family. In mid-2006, a newly constructed Pediatric Surgical Suite at SMH will allow parents to be with their children throughout their post-operative recovery in an area designed specifically for children. The types of anesthesia that may be provided for the child will vary from light to heavy sedation, to general anesthesia induced by anesthetic gases or intravenous agents. At times, the placement of a regional anesthetic by placement of needle or catheter to inject local anesthetics may provide complete relief of pain on awakening in addition to reducing the amount of other anesthetics that must be provided to maintain the child unconscious or deeply sedated during the procedure. Post-operatively, attention to treatment of the child's pain is important to reduce anxiety and facilitate interactions with the family. As in preparation for surgery and during the surgery, this may involve oral, intravenous, or continuation of regional nerve blocks or neuroaxial (spinal or epidural) anesthetics that were placed in the OR prior to or immediately after surgery. A specialized Anesthesiology Pain Team will consult on all patients with regional anesthesia or difficult to control pain issues. Children who have required prolonged major surgery may often be transferred directly from the OR to the Pediatric Intensive Care Unit (PICU), or if a newborn to the Neonatal Intensive Care Unit (NICU) where care will be transferred to pediatricians specialized in intensive care. MEDICAL STAFFThe Division of Pediatric Anesthesiology includes the faculty listed below; all have training specifically in caring for children with experience on the faculty level ranging from 2-30 years. Fellows have completed the standard training of 4 years to become an anesthesiologist, but then take 1-2 years more training focused exclusively on children. They all work as a team, helping each other whenever difficult or problematic issues arise. While 6 pediatric anesthesiologists are listed below, we continue to recruit more, and in addition have had the good fortune to develop a highly successful collaborative relationship for the last three years with an outstanding group of pediatric anesthesiologists from Buffalo, who enjoy working in the academic environment of the University of Rochester, and contribute two fully trained and experienced pediatric anesthesiologists each week day to our roster. This enables us to address the needs of children in the OR and in out-of OR sites for imaging or invasive procedures requiring sedation or anesthesia.
Pediatric cardiac surgery for congenital heart disease for the northern tier of NY State is predominantly centered at Golisano Children's Hospital. Two of the members of the Cardiovascular Anesthesia Division, devote a substantial portion of their clinical time to caring for this group of pediatric patients who often require highly complex surgical procedures. Drs. Michael Eaton and Janine Shapiro, based in the Cardiovascular Anesthesia team, are integrated as additional members of the Division of Pediatric Anesthesiology. The members of the Division of Pediatric Anesthesiology communicate with our highly respected pediatric surgical colleagues before, during, and after surgery, because it is best for patient care, and because we share common interests in continuously evaluating how we can do things better. CLINICAL FACILITIES AND RESOURCESGolisano Children's Hospital, embedded within Strong Memorial Hospital, provides a child-family friendly environment for pediatric inpatients. A 52 bed Neonatal ICU is part of Golisano Children's Hospital. A new 24 bed Pediatric ICU opened in 2004 that will enhance pre- and post-operative care for complex cases. In response to generous donations from local business and individual donors, we a modern Pediatric Surgical Suite, designed specifically for children and their families will open in mid-2006 adjacent to the basement ORs. This area will allow families to be with their children not only prior to anesthesia induction and surgery, but now immediately after surgery as they awaken in the PACU designed specifically for children. All the nurses, anesthesiologists, and surgeons working in this new facility will be there because they want to care for children and their families. All of us who care for children requiring surgery or invasive procedures such as endoscopies, are tremendously pleased that we shall soon be able to continue providing a high level of care but now in a wonderful family friendly environment. We believe that the opening of the Pediatric Surgical Suite will be welcomed by the community locally, but also regionally, increasing our patient volume and facilitating the recruitment of young pediatric anesthesiologists who would like to raise their families in Rochester. Anesthetics for pediatric cases in 2004 numbered 6,052, a 7% increase from 2003. Pediatric surgeons and specialists at Strong Memorial Hospital perform the following types of surgeries: cardiac with and without cardiopulmonary bypass, non-cardiac intra-thoracic (intracavitary), neuro-intracranial (excluding shunts), intra-abdominal (intracavitary; excl. inguinal hernia), solid organ transplant (kidney, heart, liver, and lung), major orthopedic surgery (scoliosis, tumors, hip reparis), craniofacial (cleft lip palate), airway surgery (including T&A), and neonatal emergencies (neonates less than 1 month age, and prematures less than 45 weeks PCA) - tracheoesophageal fistua, gastroschisis and/or omphalocele, diaphragmatic hernia, necrotizing enterocolitis and bowel obstruction. EDUCATIONAn extensive description of the educational programs including detailed descriptions of the curricula, descriptions of rotations for residency and fellowship training, and methods for assessment of learning in Pediatric Anesthesiology can be found on this web site by following the links below: |
