PGY-3 (CA-2)

First Day Of Pediatric Anesthesia

Although I’ve rotated through different disciplines (trauma, neuro, cardiothoracic, regional, obstetrics/gynecology, pain management), my patients were all adults who could communicate with me. I knew the first day of this rotation would be chaotic with the orientation process, but I was more fearful about dealing with children. What if I hurt them?! What if I don’t know what to do?! And what is all this “mg/kg” dosing?!

The first rule of pediatric ANYTHING – kids are not small adults. Their physiology is different. Anesthetic considerations and techniques are different. Some of them can’t even tell you where it hurts. Fortunately, I’m going to be working in one of the nation’s best pediatric hospitals alongside a huge faculty base of extraordinary, board-certified pediatric anesthesiologists and surgeons who are all heavily invested in patient care.

Let me delve into our call resident responsibilities:

The “1st call resident” stays in the hospital from noon to 7 AM on the weekdays and 7 AM – 7 AM the next morning on the weekends. During this time, he or she will hold a pager and respond to questions about patients on the pain management service and emergent airways around the hospital.

The “2nd call resident” arrives at the normal time (~ 5:30 AM on weekdays, 7 AM on weekends), does his or her assigned operating room cases, holds the aforementioned pager until the 1st call resident arrives at noon, and stays until only one operating room is running a case. This resident could, theoretically, stay till 7 AM the next morning depending on the case load (ie, if two operating rooms are always running around-the-clock).

Texas Children’s Hospital pre-op

I pulled the short straw this morning and returned to my apartment around 3 AM after the ultimate trial-by-fire as the 2nd call resident yesterday. In retrospect, it forced me to learn very quickly! Where is all the equipment located? How are all the drugs arranged? What’s the workflow and turnover process like? WHO IS EVERYONE? I saw myself becoming more and more efficient throughout the night and early morning… and it was only my first day on this rotation. Only up from here, right? 🙂

Let’s not forget the patients and their families! There’s something incredibly dynamic about establishing rapport with the parents/caretakers in a professional, reassuring manner and then turning to their child to talk about Spongebob or the Avengers. I’m a nerd with a huge variety of interests, so I’ve always enjoyed finding common ground with my patients. It really puts them at ease… especially when the “Spiderman doctor” can help them beat level 96 on Candy Crush. 😀

I’m hoping to continue learning about all the nuances to perform safe pediatric anesthetics in a myriad of different clinical environments ranging from major surgeries to minor procedures like lumbar punctures under sedation. At this point, I’m keeping my head above water… until I’m the 1st call resident tomorrow. 😯

More to come from a groggy-eyed resident on Monday morning!

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