Pediatric Anesthesiology Rotations

General and advanced Pediatric Anesthesia -  up to 6 months

Fellows will be assigned to surgical cases that span the spectrum from private practice-like fast turnover cases to kidney transplants. The complexity of the cases assigned to the fellow will be tailored to the fellow’s needs. After the first 2 months in the pediatric OR, the fellow is encouraged to sit down with the fellowship director or the fellow’s mentor to insure that the assignment mix meets the fellow’s needs. During the last 4 weeks of the fellow’s rotation the emphasis will change from hands on anesthesia to medical supervision of anesthesia providers.

Pediatric Cardiac Anesthesia – 2 month rotation

The pediatric cardiac anesthesia rotation involves intense training for a wide spectrum of congenital heart defects.  The workload is both challenging and rewarding.  Fellows are expected to become adept at advanced airway skills, cardiopulmonary bypass, vascular access, and emergency preparedness.  Essential knowledge base includes pediatric physiology, and how this physiology is altered in congenital heart disease, advanced pharmacology, transfusion medicine, and cardiac lesions associated with known congenital syndromes.

Pediatric Critical Care Unit - 1 month rotation

Each fellow will spend a minimum of 2 weeks on the Cardiac Critical Care service to participate in pre-surgical, immediate post-surgical, and sub-acute post-surgical management of children with congenital heart disease. During this rotation, the fellows will be able to participate in the immediate post-operative admission and care of surgical cases (both cardiac and non-cardiac). In addition, the Anesthesia fellows will also concentrate on procedural skills and sedation/pain management during this time.

Neonatal Intensive Care Unit - 2 week rotation

During the NICU rotation, responsibilities include making daily NICU rounds with the NICU staff. The fellows are not expected to follow specific patients or write notes or orders. The rotation provides an opportunity to observe and study the medical issues inherent in the care of these neonates. Specifically, this rotation provides an opportunity for our rotating fellows to familiarize themselves with ventilator strategies and fluid management that are sometimes different from those used by anesthesiologists in the operating room. It is imperative the fellow understand high frequency jet and oscillator ventilation. This rotation provides an opportunity to gain a better understanding of the medical care of these patients outside the OR. The rotation affords the fellow an opportunity to share knowledge with the NICU staff as well as the pediatric anesthesia perspective dealing with sedation in the NICU, post-operative epidural analgesia, and intraoperative fluid management.

 Pain Service - 1 month rotation

Under the leadership of Dr. Andrew Franklin, and collaborating with divisional nursing and physician staff, pediatric anesthesia fellows gain experience in managing perioperative pain, acute pain associated with various medical and surgical conditions, and chronic pain in infants, children, adolescents, and young adults. In conjunction with the Pediatric Pain Service nurse and attending on service, fellows also provide first-call coverage of the Pediatric Pain Service. In this capacity, fellows are the initial contact in providing ongoing analgesia for patients receiving continuous regional anesthesia, most commonly via epidural catheters placed by other anesthesia staff in the operating room. Fellows assist in developing the complete analgesic regimen for such patients, and follow these patients daily until continuous regional anesthesia is discontinued. While providing first-call coverage of the Pediatric Pain Service, fellows are also the initial contact at Children’s Hospital for consultative assistance in the management of children with acute pain secondary to a wide range of medical and surgical conditions. In this context, fellows gain experience in assessment of the role for various non-pharmacologic analgesic modalities, management of potentially complex pharmacologic regimens including non-opioid, opioid, and adjuvant agents. In addition, the fellow will engage in provision of numerous interventional procedures including peripheral nerve block and epidural blood patch.

Experience with management of chronic pain in pediatric patients is gained from working with Pediatric Pain Service nurse and physician staff in the Pediatric Pain Clinic. This clinic is the only setting for provision of dedicated out-patient pediatric chronic pain management in all of Middle Tennessee, and one of the few such settings in the entire Southeast. The clinic provides consultative assistance in the management of chronic pain in infants, children, adolescents, and young adults with a wide range of medical and surgical conditions including headache, functional pain, oncologic disease, various neuropathic pain states, and complex regional pain syndromes.

Preoperative clinic (PATCH CLINIC) and PACU –  1 month rotation

Our preoperative clinic is staffed by nurse practitioners to assess complex patients in advance of their upcoming surgery. Early evaluation allows us to identify problems and optimize the patient’s readiness for a procedure prior to their surgery. These patients will also be evaluated by child life. This is an opportunity to learn about and assess patients with rare disorders who require surgical procedures. You will not only be responsible for personally evaluating patients but act as a consultant to the nurse practioners who evaluate patients in the PATCH clinic.

During this rotation, the fellow is also exposed to patient care in the PACU. Our 25 plus bed PACU provides ample opportunity to manage post operative airway problems, pain, nausea, emergence agitation, apnea, airway obstruction and discharge related problems. In both the PATCH clinic and the PACU the Anesthesiologist in Charge will always be available for immediate consultation.

Heart, Kidney and Lung Transplants

Fellows will acquire a basic understanding of the pathology and pathophysiology of various end-stage organ system failures. The fellow will be actively involved in delivering anesthesia to patients receiving these organ transplants. These patients frequently require procedures both prior to and after their organ transplant allowing the fellow to see the full spectrum of organ failure and the patient’s responses to anesthesia after transplantation.

 Supervision – 4 weeks

The majority of the fellowship will be spent providing hands-on anesthesia. During the last month of the fellowship, the fellow will have an opportunity to begin supervising CRNA’s, SRNA’s and residents. Attending faculty remain responsible for approving the anesthesia plan and personally supervising all critical aspects of anesthesia care, consistent with departmental and HCFA policies.