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Anesthesiology Residency Program

Pediatrics Anesthesia Rotation


The goal of the pediatric anesthesia division at Albany Medical Center is to not only provide excellent peri-operative care for all pediatric patients having surgery, but also serve as a resource to other areas of the hospital where children are cared for. 

 

Our center has the only children’s hospital in northeastern New York State and additionally has the only level 4 Neonatal ICU in the region.  Between the 50+ NICU beds (with more to be built in the next few years) and 17 beds in our state-of-the-art PICU, we are constantly presented with a steady stream of critically ill children who (unfortunately) require surgical intervention.   

 

Approximately 4000 pediatric patients receive anesthesia each year at our institution and all major pediatric subspecialties are represented including:

 

Pediatric Cardiothoracic surgery
Pediatric Cardiology
Pediatric General Surgery
Pediatric Urology
Pediatric Orthopedics
Pediatric ENT
Pediatric Gastroenterology
Pediatric Neurosurgery
Pediatric Ophthalmology
Pediatric Physical Medicine & Rehabilitation
Pediatric Plastic Surgery
Pediatric Interventional Radiology

 

Dr. Melissa Ehlers, Chief Pediatric Anesthesiologist
Dr. Melissa Ehlers

As a resident, you can expect to care for low-risk pediatric patients on a random basis during your CA-1 year, a more intensive Pediatric Anesthesia month during your CA-2 year, and then most residents elect to do another three months of Pediatric Anesthesia during their CA-3 year. During these months you can expect to be mainly assigned each day to one of our four pediatric fellowship-trained anesthesiologists. We have put together a curriculum specific for both the CA-2 and CA-3 years which consists of topics to be discussed on an informal basis in the ORs (see below), a written exam at the end of the CA-2 rotation, and then assembly of a portfolio of cases as well as an oral exam (similar to the Oral Board Exam you will be expected to take to attain Board Certification) at the end of the CA-3 rotation.


All of these requirements are modeled to not only provide you with the skills and knowledge necessary to care for a wide range of pediatric patients, but also prepare you for the written and oral boards. 

 

CA-2 topics:

Basic physiology of infants and children vs. adults

Down Syndrome – anesthetic implications

Pyloric Stenosis

Open eye injuries/ Retinopathy of Prematurity/ Oculo-cardiac Reflex

Tonsillectomy/Adenoidectomy and Re-op for tonsillar bleed

IV fluid/glucose requirements in children

Pediatric NPO guidelines

Post-op implications/treatment of vomiting, pain, and apnea

Spinal/Caudal anesthesia – techniques, complications, indications

Policy on Child abuse

Pre-operative sedation – methodology and reasoning

Discharge criteria for infants

Review of PALS

 

CA-3 topics:

Respiratory tract infections – when to cancel, when not to

Epiglottitis/Croup

Necrotizing Enterocolitis

Gastroschisis/Omphalocele

Newborn/NALS resuscitation

Malignant Hyperthermia

Tracheo-esophageal fistula/ VATER/VACTERL

Congenital Diaphragmatic Hernia

Sickle-Cell Disease

ASD/VSD

PDA ligation & physiology

Tetralogy of Fallot

Anterior mediastinal mass

 

Some other unique features of our division:

  • A separate well-equipped pediatric PACU which is staffed by specially trained pediatric PACU nurses
  • We offer a pediatric fellowship year for those residents interested in further sub-specialization
  • An active pediatric anesthesia research group which is always looking for resident participation as investigators/co-investigators
  • Numerous opportunities to hone and improve your own teaching skills while working with medical students doing one-week rotations on our service
  • A well-established post-operative pain management program with regional blocks and intravenous analgesia

The division of pediatric anesthesia is committed to providing first-rate teaching opportunities to all residents rotating with us as well as serving as role models of excellence in pediatric anesthesia and patient care.

A typical day in the life of a Pediatric Anesthesiology resident
Our day usually starts at 6:30am.  The first task it to set up the operating room and make sure that all necessary equipment of different types and sizes is ready and available for all cases during that day.  Since most of the pediatric patients do not have pre admission testing prior to their surgery, the second task is to meet the patient and their family in the pro-op holding area, obtain history and physical and discuss anesthetic plan. Each plan of care is always discussed and supervised by a pediatric anesthesiologist.  For most general anesthesia cases, patients are pre-medicated with PO anti-anxiety medication if they are old enough, and are escorted to the OR by they parents.  If there are no contraindications anesthesia is induced via mask inhalation, and then peripheral IV access is established. 

Working at a center that provides state of the art PICU and NICU offers exposure to complex medical problems in infants and children when surgery is needed.  Every day during pediatric rotation is a unique day with new challenges and learning experiences. Today is one of the busiest days because we are in the ENT room, scheduled to have nine patients for tonsilectomies and adenoidectomies.  These cases are very intense because they are fast with quick OR turn over.  During these cases we have to be very vigilant about the airway, post-op pain, nausea and vomiting, and possible bleeding.  Days like today not only prepare us for the real world but also reinforce skill and expertise needed for pediatric patients. 

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