In my career, I’ve found that what most parents ask about anesthesia relates to what to expect after surgery, when the real question should be, "Is it safe?" Fortunately, anesthesia is safe. Medicine has seen dramatic increases in the safety of anesthesia in the last 30 years, despite the increase in more complex surgeries. In a healthy child, the risk of problems with anesthesia is lower than the risk you take riding in a car.
There are several reasons for this. First, experience and research have given us a better understanding of the differences between children and adults. Children have different body proportions, physiology, and cardiac and respiratory systems. A child responds quickly to medication or dropping body temperature after being wheeled into a cool operating room.
Patients are better prepared for surgery these days because we are better at identifying underlying problems, which is what differentiates risk between patients. With more sophisticated care and surgical preparation, we can ensure that children are optimally prepared before they enter the operating room. The development of advanced monitoring systems for use during surgery has reduced the risk even more.
In my view, one of the main reasons for safety improvements is the continual refinement of the most important monitor of all: the eye of the trained pediatric anesthesiologist, who can monitor conditions and respond to changes instantly.
At Children’s, we place a premium on the highest level of training. What sets us apart from most is that our staff anesthesiologists are board-certified in anesthesiology with additional extensive subspecialty training in pediatric anesthesia. Our training program, one of the nation’s largest, includes up to seven fellows each year who train in a range of environments—from the operating room to the outpatient clinic, where they administer anesthesia to children undergoing cardiac catheterization, or MRI or CT scans.
You might say that our training never ends since we are continually evaluating and making improvements. We meet regularly to identify individual or systems-based problems and outline uniform practices. This helps ensure that if a problem occurs during surgery, anyone in our department knows the proper steps to take.
Children’s also leads in the innovative practice of regional pain relief. My colleague Santhanam Suresh, MD, is nationally recognized for utilizing techniques such as an epidural catheter, caudal block, or a specific nerve block, to supplement or replace general anesthesia for a surgical procedure or in the management of chronic pain problems. Our chronic pain service’s multidisciplinary approach incorporates traditional and complementary medicine, so a patient might receive not only medications, but also massage and acupuncture. Their work and research is changing the way anesthesiology is practiced.
All in all, I find my work quite satisfying. By contributing to the growth and development of a child, we affect the future. And I’m of the opinion that people dedicated to the care of children tend to be happy people.
The pain management program is supported by the John and Kathleen Schreiber Foundation.