Pediatric Anesthesia Services

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The approach to anesthetic care of the pediatric patient varies widely in the United States. In some communities, care is concentrated in specialty pediatric hospitals or tertiary care hospitals with a commitment to pediatrics.

In other communities, pediatric surgery and anesthesia may be distributed among many different general hospitals and freestanding surgical centers.

Routine pediatric surgery has such as bilateral myringotomy with tubes (BMT), adenotonsillectomy, hemiorhapy, hydrocelectomy and orchidopexy are among the many pediatric procedures that have been and will continue to be safely performed in community hospitals and freestanding surgical centers. Even in these routine procedures, it is incumbent on the anesthesiologist to be knowledgeable about and plan for the special requirements of these pediatric patients.

Challenges include pain control and potentially altered respiratory drive in the adenotonsillectomy patient, pain control in BMT patients without intravenous access, and control or prevention of postoperative nausea and vomiting.

Perhaps the most difficult challenge facing anesthesiologists in these circumstances is maintaining the technical skills necessary for safe care of pediatric patients. Nothing can substitute for recent and continuous experience in airway management and obtaining intravenous access in pediatric patients, especially the very small child. Most pediatric anesthesiologist would agree that it is not acceptable to rely on the skills of non physicians in these areas as a matter of routine. Recognizing these limitations, the anesthesiologists and the policy makers for the institution must examine the local circumstances and plan accordingly. The goal is to match the type of case to be performed with the skills of the personnel involved. It may be appropriate in some facilities to limit the assigning of very small or sick children to pediatric anesthesiologists who are skilled and comfortable with the pediatric patient.