A Taste of Pediatrics

We occasionally get to do pediatric cases at Santa Clara Valley and so I had a couple days of anesthetizing kids. It's completely different, and fun. Since I haven't had my formal pediatric anesthesia rotation, the attendings supervise very closely and teach a lot. I've done simple mask anesthetics for ear exams and mass excisions in 5 year olds. It's fun because they bring their stuffed animals to the operating room and we reward them with stickers. They are generally pretty sociable (and become even more so after midazolam syrup which gives them the affect of being drunk) but still very different than adults. We flavor the masks with cherry or bubblegum chapstick, we try to avoid placing an IV if possible, and we induce anesthesia with inhaled gas.

The most challenging pediatric case so far, however, has been a two week old baby with a congenital defect in her abdominal wall. The surgeons had to try to reduce the patient's abdominal contents and repair the defect. The newborn arrived in an incubator and was so small I was hesitant to touch her. It can be a little hard working with these children; the patient had a nasogastric tube, central line, peripheral IV, EKG leads, and probably one or two more lines and tubes from her body. I had to recalibrate in my mind what normal vital signs were. We had to work to keep her warm. The intubation was tough; I used a tiny Miller 0 blade and managed to see vocal cords. I learned to limit my IV fluids, to calculate doses precisely, and to move slowly and gently when permitted but quickly and decisively when required. The patient made it back to the ICU safe and sound.