Summer 2006

UCSF Pediatric Anesthesiologists Set the Bar for Care

Charles Caudwell, M.D., Ph.D.

UCSF pediatric surgical teams have made a commitment to set the standard in Northern California for use of board-certified pediatric anesthesiologists during surgery, they say.

"There are many situations in which having an anesthesiologist who is also board-certified in pediatrics can make a huge difference for children," says Charles Cauldwell, M.D., Ph.D., chief of the Division of Pediatric Anesthesiology at UCSF Benioff Children's Hospital. UCSF Benioff Children's Hospital staff have also put together an innovative program to prepare children and their families for the stresses of surgery.

Anesthesiologists at UCSF Benioff Children's Hospital have long been leaders in establishing new procedures in pediatric medicine. In 1969, UCSF anesthesiologist George Gregory, M.D., developed the concept of using continuous positive airway pressure to keep alveoli from collapsing in the lungs of premature infants. Later, anesthesiologist John Severinghaus, M.D., and engineer Freeman Bradley developed a practical electrode to measure carbon dioxide partial pressure in arterial blood, and built a machine that offered rapid, real-time measurement of blood gases and pH. William H. Tooley, M.D., and Roderic H. Phibbs, M.D., then made the use of this machine a routine part of neonatal care.

Cauldwell points out that there are many ways in which pediatric anesthesia is different from anesthesia in adults. "Some of the differences are, of course, related to size. But there are qualitative differences, as well," he says.

"Adults are mostly able to cooperate and follow directions that you can't expect in children, especially in the very young," Cauldwell says. Pediatricians confront that difference every day in general practice, but it's up to the pediatric anesthesiologist to provide a medical solution for hospital procedures. For instance, MRI and other scans require patients to lie very still for a long time. "With no medicine, most adults can stay still long enough to have an MRI scan," Cauldwell says. "You can't expect that of children, and we have one person on staff who does nothing but radiology sedation for children."

In addition, children's level of fear and their perception of discomfort or pain during a procedure are higher than for adults. MRI machines are loud and claustrophobic, so even if a child is old enough to stay perfectly still in most situations, he or she might be scared of being inside the machine for an extended period.

Pediatric anesthesiologists also are able to use their knowledge of alternative methods to achieve the same sedative effect.

Since many kids are terrified of needles, Cauldwell and other pediatric anesthesiologists put kids to sleep with a mask much more often than they do with adults. "We might also give a child sedation with a mask first, and then put in an IV line, which would be done in the opposite order in adults," he says.

The qualitative differences inherent in pediatric anesthesiology are most marked in children under 2 years of age. "Metabolism and oxygen consumption are higher in very young children, which brings about a number of positive and negative effects of anesthetics," Cauldwell says. "They turn blue faster, respond negatively to anesthetics faster, and wake up and go to sleep faster. One of the big differences is that infants are less sensitive to the anesthetic effects of the sedative drugs, but more sensitive to the side effects."

Like other pediatric specialists, pediatric anesthesiologists by nature and training see the family as an integral part of the process. "Because we have seen a lot of children, we are comfortable making greater efforts to accommodate the whole family unit, and comfortable taking more flexible approaches to sedation," Cauldwell says.

After surgery, pediatric anesthesiologists try to get patients to the recovery room as soon as possible, and are sensitive to the need of family members to be present when children come out of sedation. The pediatric anesthesiologists at UCSF Benioff Children's Hospital are also aggressive about using local anesthetics when surgery is performed, so that the child is more comfortable on waking up, Cauldwell says.

The result is that kids are more comfortable, families are happier and outcomes are better, which is why the field is growing fast and pediatric anesthesiologists are in high demand. "Anyone finishing a pediatric anesthesiology fellowship has no problem finding a position," Cauldwell says.

For more information, contact Dr. Cauldwell at (415) 502-6620.

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