Rotation Logistics

Rotation Goals and Objectives

Goals: The overall goal of the pediatric anesthesia rotation is to provide an introduction and understanding of the perioperative care of newborns, infants, and children undergoing a variety of surgical procedures.  During the rotation, residents will acquire knowledge and technical skills pertaining to pediatric anesthesiology.  

Objectives: Objectives for the pediatric anesthesia rotation are listed by ACGME core competencies.  Please see attachment below for the core competencies. 

Pediatric anesthesia goals and objectives

Case Assignments 

The residency ACGME requirements are for 100 patients less than 12 years of age. Within this patient group, 20 children must be less than three years of age, including 5 less than three months of age.  

Please email Michaela Mitrano (mmitrano@mgb.org) with any case request that you may have within 1-2 days.  We will try to honor as many requests as possible.  If you are in your last pedi rotation and need specific cases (usually infants), please remind Dr. Diana Liu or keep an eye on the schedule and request those assignments .  As a practical point, since our schedule is often made by around noon the day before, any case requests that are posted later in the day may simply not be noticed in time to take them into account.

General Service Information

Locations:

• ORs 1, 2 and 3 (White 3)

• Pedi Endo Rooms 1 and 1A (Blake 4)

• Pedi MRI (Ellison 2)

• Pedi IR (Ellison 2)

• Shriners ORs 1, 2 and 3 (Shriners Hospital for Children)

• Pedi Oncology (Yawkey 10)

• Proton Radiation (Yawkey Basement)

Pedi Surgery Block Time:

• Pediatric General Surgery

• Pediatric Neurosurgery

• Pediatric OMFS

• Pediatric Dentistry

• Pediatric Orthopedic Surgery

• Pediatric Urology

• Pediatric Dermatology

Pediatric Regional Anesthesia:

• Blocks are done by the pediatric team (often under general anesthesia) unless we decide to ask the block service to perform the block 

• Common types of blocks performed: epidurals, caudal epidurals, femoral blocks, adductor canal blocks 

NPO times:

• clears (water, gatorade, pedialyte): 2hrs

• breast milk: 4hrs

• formula or light meal: 6hrs

• heavy meal: 8hrs

Daily Preparation

Please review your patients' medical history in EPIC, and discuss your perioperative plan with your attending the night before. If you have an inpatient, go evaluate and consent the parents prior to discussing the plan with your attending. Let your attending know if it is your first time in a particular location or your first time caring for an infant. 

We frequently have a lot of relatively short cases; please anticipate what you will need and try to set up in advance (IVs, airway devices, medications, etc.) to minimize turnover times. It is also useful to calculate your drug and fluid doses in advance. Most attendings will want dose-ready syringes of atropine and succinylcholine available for neonatal cases.

There is an ongoing effort to improve efficiency in the Pediatric ORs. We try to huddle 10 minutes before the first scheduled case (e.g., 7:35 for 7:45 start). Check the schedule carefully: on certain days, cases actually start at 7:30, not 7:45 or 8:00.

Click here for: OR set-up for neonates

Pedi Call 

Pedi call is home call, except during the day on Sundays. On weekdays, the on-call resident should finish any late pedi rooms and inpatient pre-ops, and leave a room set up for a basic pediatric case. For straightforward cases at night, the in-house team may be able to cover them without calling you back. However, if you do get called in (or stay very late), the 10-hour rule applies.  That is, if you are here past 8 pm, you should have a 10 hour rest period; if you are here after midnight, you are excused from duty for the following day.  For this reason, we generally assign you to a location with one-to-one staffing on your post-call day.  The goal of home-call is to improve residents' capture rate for pedi cases and decrease the call burden. The downside is that you cannot count on being off the day after call so please coordinate any personal needs (MD appts, etc.) with the chief residents, and also with Dr. Som Bhattacharya (via Anna Litra, the day-to-day pedi scheduler).

If you stay past midnight or will need to come in late due to on-call duties, please do the following:

1. Before you leave the hospital, go to the Gray desk and add yourself to the "sick" list for the next day. This is how the Staff Admins will know you are post-call.

2. Send an email to the staff with whom you were supposed to work, and to the next day's #24000 attending ('pedi team leader'). This will help our team coordinate any scheduling issues the next day. 

Shriners Hospital for Children

During your pediatric anesthesia rotation, you will be spending some time at the Shriners Hospital for Children where you will take care of infants and children with acute burns, and children scheduled for plastic surgeries and airway surgeries.  When you are at Shriners, you are encouraged to attend morning rounds (7am) for the educational benefit and to learn about the acute patients. 

Rotating at the Shriners Hospital is an invaluable opportunity to utilize a different type of anesthesia machine, use a different brand of LMA, review a different electronic medical record and experience a different OR work flow. You are not expected to pre-op the night before; instead, you should arrive early to look up your patients and pre-op with your attending the morning of. Please review the following prior to your first day at the Shrine:

Typical Day at the Shrine

GE Anesthesia Machine

If you finish early in whatever location you are in (including Shriners Hospital), you are expected to report to the more busy locations (MGH OR, GI, etc) and offer to help with breaks.  

Please review the Shriners' Handbook and rotation goals and objectives.

SBI handbook

Shriner Hospital Anesthesia Residency Rotation Program Goals and Objectives

MRI Safety

The pediatric rotation includes cases in the Ellison 2 MRI scanners. It is important that you are aware of the safety issues in that environment.

On Wednesdays and Fridays, we have cases in the 3T scanner (62 PR) which is the scanner closer to the hallway in the paired "fishbowl" area. On Mondays and Tuesdays, we are usually in the 1.5T (67 PR). Patients with a vagal nerve stimulator can only be done in the 1.5T. If a patient has any prosthetic equipment, please discuss with the MRI techs regarding compatibility. 

There is an MRI compatible anesthesia machine. Although the machine meets current standards, the ventilator is significantly different from the OR machines (Drager Fabius vs Drager Atlan). Please ask your attending to review it with you prior to using.

MRI-compatible laryngoscope handles are indicated with a yellow stripe and must contain lithium batteries. Please be aware that there is always potential for mis-labeling or for the wrong batteries to have been put in the handle. Therefore, it is the responsibility of the clinician to check all equipment w/ the hand magnet (available in MRI) before moving anything into the scanner. Magnetic material can become projectile and result in injuries to staff or patients.

Please do not take any separate equipment to the MRI areas, particularly laryngoscopes, handles, glidescopes, C-MACs and ultrasound machines. If it is inadequately stocked, please notify the offsite anesthesia techs (2-3415) and if you have ongoing problems please let us know. Also please don't remove the handles from the MRI area (it is very expensive if they get mis-processed). 

International Mission Trips

Surgeons, anesthesiologists, CRNAs and residents from the pediatric surgery/anesthesia departments are committed to promoting global health through education, patient care and research. We have provided services to multiple countries including Colombia, Philippines, and Uganda. Surgical cases include cleft lip and cleft palate repairs. Feel free to learn more by talking to the staff the following staff:

Dr. Fuzaylov, Dr. Nichols: Colombia

Dr. Firth: Uganda 

Dr. Tuason: Philippines 

Dr. Bhattacharya: Africa/South America

Fellowship Logistics 

Please click here for fellowship logistics