Children's Hospital at Dartmouth-Hitchcock continues to evolve and expand in order to meet the demands of a very active surgical and pain management program: over 2,500 anesthetics have been performed during the past fiscal year for children 18 years of age or under.
The Pediatric Anesthesiology subsection is at the forefront of these efforts and has continued to show national leadership in providing innovative solutions for difficult anesthesia and sedation cases. While all members of the Dartmouth-Hitchcock Department of Anesthesiology provide anesthesia for children, the Pediatric Anesthesiology section consists of a core group of anesthesiologists who have a unique commitment to perioperative pediatric care. This group provides anesthesia in the CHaD operating suites, pediatric and neonatal ICUs, and delivers sedation for procedures performed literally anywhere in the Medical Center through the CHaD PainFree Program.
A multidisciplinary effort
As part of a multidisciplinary effort with the post-operative nursing personnel and the pain service, the section has increased the overall use of regional anesthesia techniques (including epidural, caudal, and spinal modalities) for both operative anesthesia and postoperative pain management. Over ninety percent of pediatric urology surgical patients now receive a regional anesthetic of some type. The Pediatric Anesthesia division remains intimately involved in the management of postoperative pain for inpatient pediatric patients. The team rounds daily on patients with postoperative pain control issues and provides consultation for pediatric inpatients who have special pain control needs—notably those with malignancies or other chronic diseases.
The Pediatric Anesthesiology section continues to actively support the Pediatric Intensive Care Unit (PICU) and the Intensive Care Nursery (ICN) at CHaD. Staff and residents from the Pediatric Anesthesiology department provide comprehensive airway management expertise as well as pain/sedation consultation for these units on a continuous basis. In addition, members of the pediatric anesthesiology team have served as primary attending staff in the PICU.
Research projects in the areas of perioperative pain control and anesthesia emergence phenomena in children are ongoing. In addition, we have received generous support from the National Patient Safety Foundation, Agency for Health Care Research, and the NIH to pursue studies of safety and efficacy involving the delivery of sedation services for children, and ongoing funding to evaluate the ability of various providers to rescue patients from critical events related to sedation care using pediatric patient simulation technology.
Members of the section also produce a newsletter regarding pediatric sedation that is delivered online to over 3,000 pediatricians and anesthesiologists around the world. In the past year members of the team have presented work in this area to the ASA annual meeting, the Society for Pediatric Anesthesia winter meeting, the Post Graduate Assembly, and several national meetings on patient safety.
Besides these clinical and research efforts, the pediatric anesthesiology section continues to serve a clinical teaching role for medical students, pediatric residents, and anesthesiology residents. The staff takes pride in providing an aggressive curriculum that addresses both the physiological and emotional considerations for the perioperative and operative care of the pediatric patient and family.