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Finished With Month One Of Pediatric Anesthesia

I’m done with my first of three consecutive months of pediatric anesthesiology as a CA-2 resident. In four weeks, I’ve come to appreciate the nuances of perioperative care with neonates, infants, and children of all ages undergoing a myriad of procedures ranging from craniotomies to ear tube placements.

Accuvein meets my hand
Accuvein meets my hand

Pediatric anesthesiologists are faced with an interesting dichotomy of personalities – those of anxious parents and hard-to-predict children. We use all sorts of distraction techniques and games to put our pediatric patients at ease before surgery. Riding to the O.R. in a wagon while playing colorful games on an iPad and listening to Disney music? Yeah, that’s just a small sample of what I recently did. It’s a fun work environment since people are just so much nicer at a pediatric hospital! 馃檪

Now here’s a small聽list of random stuff I’ve learned.

  • Bubble gum scented聽masks are the聽best way to perform an inhalational induction. 馃槈
  • Peripheral access can be ridiculously hard聽in the 6 – 18 month old range. They’re puffy in all the wrong places! 馃榾
  • Increased oxygen requirements +聽decreased functional residual capacity = ultra fast desaturation while intubating. Get that tube IN! 馃槸
  • Be sympathetic to the fact that kids are uber parasympathetic.聽Be mindful of聽increasing vagal tone (either directly or indirectly)
  • Everything is mg/kg or mcg/kg.
  • Premedication is a beautiful thing.聽The intramuscular聽route of medication administration is, also, a beautiful thing.
  • Deep extubation is awesome! I’ll blog about this at some point in the near future.
  • Unfortunately, crying is super nonspecific.
  • Best way to establish rapport with a child is to help them beat a level on Angry Birds.
recurrent-laryngeal-nerve-endotracheal-tube
NIM EMG endotracheal tube

I’ve recently been on a long stretch of pre-call, on call, and post-call days. Quite frankly, most days I come home tired but satisfied and eager to learn more the next shift. Fatigue has definitely set in, but I’m still very happy on this rotation!

Also, I’ve now rotated at every clinical site at our program. Once I start my final year of residency in July, I’ll be revisiting many of the same places and already have an idea of what to expect. 馃檪

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