A new training program for physicians who specialize in the care of infants and children under anesthesia begins this summer at the Medical College of Georgia at Augusta University and AU Health System.
The new, one-year pediatric anesthesiology fellowship, one of 60 in the country and the second in Georgia, will train one fellow per year.
Pediatric anesthesia fellowship programs, open to graduates of traditional four-year anesthesiology residencies, offer specialized clinical training and knowledge in the perioperative care of patients from neonates up to 21-years-old.
“That matters for optimal patient care,” Dr. Ellen Basile, chief of pediatric anesthesiology at the Children’s Hospital of Georgia and program director of the new fellowship, says of the additional training. “Children aren’t just little adults. There is some exposure to pediatrics during a general anesthesia residency program, but additional fellowship training ensures the best possible care for our littlest patients.”
Fellows are trained in issues specific to children, like how to recognize a laryngospasm — when a patient’s vocal chords shut and air cannot move in or out — for instance. The condition can occur at any time, but is most common during induction or emergence from anesthesia. “Children have much more reactive airways than adults,” Basile explains. “We are well trained to recognize when a laryngospasm happens and how to intervene. While still an emergency, it’s so common that we see it on a day-to-day basis.”
Other examples of issues specific to children under anesthesia include differences in anatomy — infants have relatively large tongues that can contribute to airway obstruction and they breathe through their noses and have narrow, easily blocked nasal passages. Babies and infants also have less developed temperature regulation mechanisms and tend to lose heat under anesthesia, requiring additional help to maintain body temperature. The rapid development and growth of infants and children’s brains and organ systems mean that there are differences in the way their bodies uptake, distribute, metabolize and eliminate anesthetics and related drugs that must be taken into account.
Children may also experience stress at the thought of being “put to sleep” for a surgery or procedure, Basile says. “For that reason, almost all of our pediatric patients receive a mask inhalation induction, so we don’t stick them (with an IV) while they’re awake. That’s radically different from adults preparing for surgery.”
“In pediatrics, we do a lot more procedures under anesthesia, things that an adult would never require anesthesia for,” she adds. Examples include CT scans and MRI’s or lumbar punctures for hematology/oncology patients. In children, those procedures are often done under anesthesia, both for their comfort and to keep them still.
Fellows in the new program will participate in 12 clinical rotations over the year, training in things like treatment of acute pain and anesthesia in general pediatric surgery, in a pediatric intensive care unit and in cardiac settings. They also will participate in weekly department grand round lectures, a weekly fellow lecture, a monthly Pediatric Quality Improvement Conference, as well as a quarterly journal club.
Dr. Osama Elazzouny, a graduate of Alexandria University in Egypt who just completed his anesthesiology residency at Hamad Medical Corporation in Qatar, joins MCG and Children’s as the first fellow this September.
Pediatric anesthesiology met the criteria for recognition as a subspecialty by the Accreditation Council for Graduate Medical Education in 1997. Every pediatric anesthesiologist who practices at Children’s has completed a pediatric anesthesia fellowship program, Basile says.