Pediatric Anesthesia

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Welcome to the UCSF Pediatric Anesthesia Department Homepage         

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Our division provides outstanding clinical care during over 7000 anesthetics for infants and children annually. In addition to working in the main operating rooms in the UCSF Moffitt-Long Medical Center, we anesthetize children in the UCSF ambulatory surgery center and in non-operating room (NORA) locations, such as radiology and radiation oncology. On this website, we present information about our pediatric anesthesia faculty, surgeons, nurses, and other staff, the resident rotation, and the ACGME-accredited pediatric fellowship. We include an approach to common surgeries, as well as information for families.

For the Residents

 

Welcome to the Pediatric Anesthesia Rotation. Our division is committed to your education in pediatric anesthesia during your entire residency, but especially during this one-month rotation. We aim to dramatically expand your skills and experience in the care of infants and children. In addition to the core rotation, consider extending your expertise in the perioperative care of pediatric patients by doing a selective with us during your CA-3 year.

To enhance your learning during this rotation, we have scheduled didactic sessions each Monday and Thursday at 6:30am in OR 22. We also schedule an additional didactic session on Tuesday afternoons. The schedule of speakers and topics for both teaching forums will be emailed to you prior to the start of your rotation.

We aim to diversify your experience on the rotation as much as possible by ensuring that you provide care to neonates, infants, and children during a wide variety of procedures, including general, urologic, otolaryngologic, orthopedic, and plastic surgery. Additionally, you may have the opportunity to provide anesthesia in out of operating room locations, such as MRI and interventional radiology. The ACGME requires that you care for 100 patients <12 years, 20 patients <3 years, and 5 patients <3 months during your residency training. Because you will also rotate at Children's Hospital in Oakland, you should aim to complete 50% of these numbers during the UCSF rotation. If you seem to be deficient in any area, please alert us. We find, however, that most residents exceed these numbers easily.

During your rotation, you will not take weekday call in the main operating rooms. However, our days can be long, our schedule is often changing, and we have frequent add-on cases. Please be flexible. We adhere to the ACGME work-hour guidelines strictly and you should expect to be relieved in the evenings to meet these limits.

Your performance on the pediatric anesthesia rotation will be evaluated by your attendings, as well as nurses and a surgeon. This is known as a multisource (360) evaluation.

We look forward to working with you!

Below you will find important resident links:

Resident Rotation Schedule
Mission Bay E1 Residents
Goals & Objectives
Pedi Reference Card
Pediatric Rotation Wiki: a great source for reference articles, chapters, and handouts on specific topics in pediatric anesthesia

For Families

We understand that having a child undergo a medical procedure or surgery is a very stressful situation. Below you will find answers to frequently asked questions regarding the anesthesia for your child's procedure.

What is general anesthesia?
General anesthesia is a state of unconsciousness caused artificially by medications. Patients under a general anesthetic are very deeply asleep and do not feel pain.

What are the risks of anesthesia?
Generally speaking, anesthesia is quite safe. An anesthesia provider will be with you child at all times during the surgery to make sure that his/her heart is beating well, that his/her blood pressure is good, and that he/she is breathing properly. Although complications from anesthesia are quite rare, they can occur. Common side effects include nausea and/or vomiting, a sore throat, or skin irritation. Less common complications, such as serious allergies, broken/chipped teeth, pneumonia, or death can occur, but are very rare. 

Can my child eat before surgery?
No. Having a food or liquid in the stomach can be very dangerous to a person who is undergoing anesthesia. When anesthesia starts, it is possible for this food or liquid in the stomach to go into the lungs and cause pneumonia. Our current rules are that children are to stop eating by midnight the night before the surgery. They can drink clear liquids (water, apple juice, Gatorade) up to 2 hours before arriving at the hospital. Failure to follow these rules will result in your child's surgery getting delayed or cancelled. Special considerations are made for infants less than 6 months of age. 

Will I be able to be with my child when he/she falls asleep?
Maybe. This depends on the type of surgery, as well as your child's age and other medical problems. If you are unable to be with your child when he/she goes to sleep, we may be able to give him a medication in the preoperative area to make him/her quite sleepy and less anxious. In general, children less than one year of age do not require premedication or a parent present for the beginning of anesthesia, as they have not yet developed stranger anxiety. 

Will I be there when my child wakes up?
Because all children respond to anesthesia differently, predicting exactly when a child will wake up is impossible. We make every effort to have parents in the recovery room before their child is completely awake. 

What will my child be like when he/she wakes up from anesthesia?
Children react to and recover from anesthesia differently. Not uncommonly, children can be cranky, and sometimes quite disoriented or confused after anesthesia. Also following surgery, you child may be in pain. Under guidance of the anesthesiologists, recovery room nurses will help manage your child's pain before you leave the recovery room. 

What is a caudal anesthetic?
A caudal anesthetic is a type of epidural anesthesia (see below) that involves putting local anesthesia (numbing medicine) and/or morphine into the space outside the spine in the area of the child's sacrum ("tailbone") to help eliminate pain after your child's surgery. This anesthetic technique is especially useful in urologic and certain general surgeries. A caudal involves a single shot after your child is asleep. If a caudal is appropriate for your child, your anesthesiologist will talk to you more about this option on the day of surgery. 

What is an epidural anesthetic?
An epidural anesthetic is most commonly considered to reduce pain after large, painful surgeries. The procedure involves finding the epidural space with a small needle, and placing a catheter into the epidural space. The needle is removed, but the catheter is left in place to deliver local anesthetic (and possibly other pain medications) during and after the surgery. Pain specialists supervise care of all patients with epidurals post-operatively, to adjust the medications. If your child is a candidate for an epidural, your anesthesiologist will talk with you more about this option on the day of surgery. 

What is a nerve block?
A nerve block is frequently used for orthopedic procedures and involves placing local anesthesia (numbing medicine) on nerves to reduce pain after a surgery. If your child is a candidate for a nerve block, your anesthesiologist will talk with you more about this option on the day of surgery.

Fellowship

Pediatric Fellowship Program

The UCSF Pediatric Anesthesia Fellowship is a 12 month, ACGME-accredited program offering an outstanding clinical fellowship experience. Our boutique program currently accepts two fellows per year. Because of the small program size, fellows are able to tailor their year to maximize learning. Qualified and interested fellows can extend their training to include an additional advanced year fellowship in research or pediatric cardiac anesthesia.

Clinical Rotations
Each fellow will do 13 4-week rotations. Fellows will have clinical exposure at both the UCSF Benioff Children’s Hospital-San Francisco and the UCSF Benioff Children’s Hospital-Oakland. Rotations include:

  • Pediatric Cardiac Anesthesia (2 Blocks)
  • Integrated Pain and Palliative Care (1 Block)
  • ICU--Neonatal, pediatric or pediatric cardiac (1 Block)
  • General Operating Rooms (split between San Francisco and Oakland Campuses)

Each fellow is allocated 20 days of vacation and 5 days of meeting time during their fellowship year.

Didactics
Fellows have the opportunity to participate in a fellow lecture series, weekly case conferences, journal clubs, mock-oral boards, and QI meetings. Additionally, fellows are given the opportunity to lead resident didactic sessions to create their own educational portfolio during the year.

Scholarly Project
All fellows are given non-clinical time to participate in a scholarly project during their fellowship year. Past projects have included case reports, book chapters, retrospective studies, and basic science investigations. 

Application Process
Appointed fellows must have completed an ACGME-accredited anesthesiology residency (or equivalent) and possess a full and unrestricted license to practice medicine in the State of California (an absolute requirement).

Our fellowship program participates in the ERAS application and the NRMP fellowship match.

Completed applications are reviewed in the order that they are received. The fellowship application deadline is June 1.

Fellowship Application
Register online with the Electronic Residency Application Service (ERAS).

Additional documentation necessary to support your application is found here:
https://www.aamc.org/download/471894/data/pediatricanesthesiologyextendedquestions.pdf

Details regarding current match deadlines can be found at:
http://www.nrmp.org/fellowships/anesthesiology-match/

For information on obtaining a California medical license please contact:
California Medical Board -1430 Howe Avenue Sacramento, CA 95825 (916) 263-2499
http://www.mbc.ca.gov/

For further inquiries, please contact:
Fellowship Coordinator
513 Parnassus Avenue, S455E
San Francisco, CA 94143
(415) 476-9734
Marie.Hollero@ucsf.edu

 

Techniques

Below you will find a list of some of the surgeries that you will encounter during your rotation. The anesthetic techniques for several of the commonly encountered surgeries are included but serve only as a reference rather than the "correct" approach. That is, anesthetic plans are individually tailored to the patient, and in addition, details for monitoring, specific drugs, etc, may vary among the attending anesthesiologists. Medicine is an ever-changing science. Please consult other reference materials to confirm dosing and the latest data about appropriate techniques. Of note, in some cases, the FDA may not have yet approved the specific techniques/drug dosing suggested here.

Cleft lip

Cleft palate

Congenital Diaphragmatic Hernia

Craniosynostosis

Lung Isolation in Infants Children

Fetal Surgery Cases

Fetal Surgery-Myelomeningocele Repair

Fetal Surgery-Twin-Twin Transfusion Syndrome

Posterior Spinal Fusion

Pyeloplasty

Pyloric Stenosis

Neuraxial Anesthesia in Infants and Children

Tonsillectomy and/or Adenoidectomy

Tracheoesophageal Fistula

Vertebral Body Stapling