The Division of Pediatric Anesthesia operates within the Department of Anesthesia and has a four-fold mission: to provide pediatric anesthesia care that exceeds community standards and incorporates all currently available technologies and techniques; to educate residents through hands-on patient care as well as didactic lectures; to afford opportunities for clinical research in pediatric anesthesia techniques, outcomes, pharmacology, and other germane issues; and to serve as a resource for the hospitals of NYU Medical Center and their Administration regarding the provision of sedation to children outside the operating room.
As parents and other medical consumers become increasingly educated, the subspecialty of pediatric anesthesia has gained increasing recognition. A plethora of studies has shown superior pediatric surgical outcomes when the anesthesia for those surgeries is provided by a pediatric anesthesiologist. As a result, parents are requesting service from members of the division directly or through their referring surgeon. Widespread access to the Internet has also increased awareness of parents regarding the importance of pediatric anesthesia, and NYU Medical Center has responded by identifying members of the Division on its "NYU Kids Health" website. Information about training, experience and access to pediatric anesthesia staff is included on the site.
The American Board of Anesthesiology does not currently offer certification in the Practice of Pediatric Anesthesia. Instead, the Board acknowledges qualification for the provision of Pediatric Anesthesia through successful completion of an accredited fellowship in Pediatric Anesthesia or its equivalent experience.
Clinical opportunities for the practice of pediatric anesthesia abound in pediatric surgical subspecialties at Tisch and Bellevue Hospitals. All pediatric subspecialties are represented, including Ear, Nose, and Throat, Plastics, Orthopedics, General, Ophthalmologic, Neurologic and Cardiovascular Surgery. Additionally, Pediatric Anesthesia services are available to practitioners in the Divisions of Pediatric Dentistry, Pediatric Oncology, and Pediatric Radiology. Cases are distributed along a spectrum of illness severity, from healthy ASA I patients in the Day Surgery setting, to trauma patients presenting emergently at Bellevue, to sicker ASA III and IV patients reflecting the nature of tertiary care at Tisch Hospital. Neonatal and Pediatric intensive care units operate at both Tisch and Bellevue and further supplement clinical exposure to pediatric surgical and medical illness.
The Division has experienced approximately ten percent growth each year in the past three years. Rapid growth in service utilization is most apparent for anesthesia performed outside the operating room. It has become the standard of care to maximize the comfort of children undergoing painful diagnostic procedures, such as bone marrow aspiration and lumbar puncture.
Numerous opportunities for clinical research exist in the division, although our current focus remains on optimizing patient care. Funding for research in the pharmacology of induction agents and muscle relaxants has been made available through several pharmaceutical companies.
Pediatric Anesthesia as a Resource
The Division of Pediatric Anesthesia serves as an important resource for the dissemination of information and protocol development for sedation of children by non-anesthesia practitioners. The Director of the Division also sits on the Children's Services Council, an interdisciplinary committee headed by the Chief of Pediatric Surgery. This Council seeks to identify deficiencies in the care of children at Tisch Hospital so that these deficiencies can be eliminated. Members of the Council are currently touring freestanding children's hospitals on the East Coast to garner ideas for improvements in pediatric care as well as ideas for making the hospital environment more "child-friendly." Lastly, the Division is collaborating with Child Life services to improve pre-surgical orientation and preparation for patients and their families.
For many years, there were no pediatric subspecialists within the anesthesia department. Now, however, increased availability of the service has led to increased consultation and utilization. Members of the Division are being consulted to assist with patient care management in the ICUs, especially for acute and chronic pain issues, airway management and sedation. Members of the Division also advise physicians in the Emergency and Radiology Departments on matters of sedation and airway management.