Pediatric Anesthesia

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Who's Who?
  • Rotation Education Director: Christine Mai, M.D.
  • Division Leader: Erik Shank, M.D.
  • Rotation Coordinator: Mary Charlotte Buck
  • Pedi Faculty: Drs. Tony Anderson, Dave August, Som Bhattacharya, Sebastian Bienia, Pepper Denman, Lucy Everett, Gennadiy Fuzaylov, Paul Firth, Nick Goudsouzian, Mike Leeman,  Christine Mai, Jeeva Martyn, Alex Moore, Jay Roberts, Julia Rosenbloom, Erik Shank, Pico Tuason, and Audie Zibaitis
Orientation
  • On the first day of your rotation, you will have a simulation orientation in the Simulation Learning Lab from 3-5 pm.
  • On the first Tuesday of the month there is a short training session for new residents covering pumps and Computerized Physician Order Entry at Shriner’s. If you miss this, you will not be able to learn at Shriner’s until your second month.
Case/Room Assignments
  • We use Rhinos and look at Case Log numbers (see ACGME Requirements below), but if you are in your last rotation and need cases (usually less than 3 months of age), please remind Dr. Christine Mai AND request those assignments via Rhinos.
  • As a practical point, since our schedule is often made by around noon the day before, any Rhinos requests that are posted later in the day may simply not be noticed in time to take them into account.
Day to Day Preparation
  • Please review your patients’ information in EPIC, and discuss with your attending in advance. Let the attending know if it is your first time in a particular location.
  • We frequently have a lot of relatively short cases; please anticipate what you will need and try to set up in advance (IVs, airway devices, medications, etc.) to minimize turnover times. It is also useful to calculate your drug and fluid doses in advance.
  • We try to start the huddle 10 minutes before the first scheduled case (e.g., 7:35 for 7:45 start). We also try to bring the subsequent patient to the induction room 30 min prior to end of the prior surgery, so that one member of the anesthesia team evaluate them ahead of time.
  • Check the schedule carefully: on certain days, cases actually start at 7:30, not 7:45 or 8:00.
Call
  • Pedi call is home call, except Sundays and holidays.
    • The on-call resident should finish any late cases and inpatient pre-ops, and leave a room set up for a basic pediatric case.
    • On Sundays and holidays, you are in-house from 7 AM to 7 PM, and then on home call from 7 PM to 7 AM the next day. When in-house, you will be prioritized to do pediatric cases. If there are no pediatric cases, you will be assigned to other cases.
  • For straightforward cases at night, the in-house team may cover without calling you back.
  • If you do get called in (or stay very late), the 10-hour rule applies. That is, you should have 10 hours off in between shifts (e.g., if you stay until 10 PM, you should not come in the next day before 8 AM).
    • If you are here after midnight, you are excused from duty for the following day. For this reason, we generally assign you to a location with one-to-one staffing on the post-call day.
    • If you stay past midnight or will need to come in late due to on-call duties, you must do the following:
      1. Before you leave the hospital, go to the Gray Desk and add yourself to the “sick” list for the next day. This is how the Staff Administrator will know. It does NOT count as a sick day for you.
      2. Send an email to 1) the attending with whom you were scheduled to work, 2) the #24000 attending (‘pedi team leader’), and 3) Mary Charlotte Buck. This will help our own team coordinate any scheduling issues the next day.
    • NB: The goal of home-call is to improve residents’ capture rate for pedi cases while decrease burden of in-house call. The downside is that you cannot count on being off the day after call so please coordinate any personal needs (e.g., physician appointments) with the Chief residents, and also with Dr. Erik Shank (via Mary Charlotte Buck, the day-to-day pediatric rotation scheduler).
Shriner's Burn Institute
MRI
  • As part of the pediatric rotation, you will take care of patients in the MRI environment.
  • Schedule
    • Mondays and Tuesdays, we are usually in the 1.5T scanner (toward the back, 67 PR).
    • Wednesdays and Fridays, we are usually in the 3T scanner (toward the front, 62 PR).
      • Note that patients with a vagal nerve stimulator can only be done in the 1.5T. Always discuss any issues/concerns with the MRI techs and your attending.
    • Equipment
      • There is an MRI compatible anesthesia machine, which is significantly different from the OR machines. Please ask your attending to review it with you prior to using.
      • MRI-compatible laryngoscope handles are indicated with a yellow stripe and must contain lithium batteries. We are working to transition to a labeling system where these will say “MRI compatible” – however, please be aware that there is always potential for mislabeling or for the wrong batteries to have been put in the handle. So, check all equipment with the hand magnet (available in MRI) before moving anything into the scanner.
      • If any equipment is needed, notify the offsite tech (2-3415).
ACGME Requirements
  • 100 patients less than 12 years of age, inclusive of:
    • 20 patients less than three years of age, inclusive of:
      • 5 patients less than three months of age
  • At least two months of pediatric anesthesia
Didactics

  • XXX Coming soon XXX.