hard core peds anesthetics

[deleted59964]

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anyone here do big pediatric cases?

liver transplants
cardiac surgery
etc?

would be interested to here your insights.

 

[coprolalia]

Have done peds cardiac. It's actually easier than adult cardiac. Mostly, they have pretty good protoplasm. This means you can come off pump without pressors, and extubate in the room.

-copro

 

[deleted59964]

i've seen a fair bit of adult cardiac surgery - but no peds yet

fluid status must change quick with kids?

the idea of that tiny circulating volume getting mixed with pump prime, and circulating around the bypass machine 😱 -- much respect.

here's a question - do some anesthesiologists specialise to the the degree that they only do pediatric cardiac (or other major surgery) ?
would they be more likely to do other pediatric anaesthesia or do adult cardiac ?

thanks - sorry if that's a naive question

 

[proman]

We have a fair number of PICU/peds anesthesia attendings. A few of them concentrate on peds cardiac but most alternate between the PICU and peds GOR.

I would add the big back cases (number 1 case for peds intraoperative arrest) and craniosynostosis cases.

 

[jwk]

We had a triple-board certified doc at Egleston in Atlanta many years ago - anesthesiology, pediatrics, cardiology. He made it all look SOOOO easy.

 

[RAMPA]

We had a triple-board certified doc at Egleston in Atlanta many years ago - anesthesiology, pediatrics, cardiology. He made it all look SOOOO easy.

thats hardcore!

jwk,
by any chance did you ever meet an FMG (from Colombia) turned respiratory therapist at egleston? he worked there a few yrs ago.

 

[Trisomy13]

i've seen a fair bit of adult cardiac surgery - but no peds yet

fluid status must change quick with kids?

the idea of that tiny circulating volume getting mixed with pump prime, and circulating around the bypass machine 😱 -- much respect.

here's a question - do some anesthesiologists specialise to the the degree that they only do pediatric cardiac (or other major surgery) ?
would they be more likely to do other pediatric anaesthesia or do adult cardiac ?

thanks - sorry if that's a naive question

yes. we have a well-known attending here who does almost exclusively peds cardiac cases. valves, transposition of the great vessels, hypoplastic hearts, you name it - all that stuff. it's impressive stuff, to say the least.

 

[dfk]

i agree in similar that i/we work with 3 attendings that do hearts/etc of any manner and they're great. i will admit, with my limited experience amongst the board, that i learn more physiologically by/from the peds than adults. all in all, adults are easier in every aspect COMPARATIVELY to peds.

 

[cubs3canes]

I am resident, CA-2, so limited experience.

Five pedi hearts and 30 adult hearts are in my belt.

In pedi hearts, the lines are more difficult. They have better neuro status and no carotid disease so the chance of post-operative stroke is less.

Overall, they are both very cookie cutter...Sleep then lines then pump then inotropic support then ICU.

One thing is very funny. The congenital heart guys like to come off on Dopamine for support. The dopamine is at low, should not do anything doses..like 3-5 mcg.kg.min. However, when you turn it off, the CO goes to SH**. Maybe the textbooks are right about everything.

They also like nitroprusside for decreasing afterload. This boggles my mind. I really like Nicardipene. They both work, but the nicardipene seems to be safer and easier to use.

At my institution, the adult guys like epi for inotropy.

Cubs