Division of Pediatric Anesthesia
Pediatric Anesthesia
Stony Brook University Hospital continues to evolve and expand in order to meet the demands of very active surgical programs – We are involved in 4,000 cases yearly (involving all pediatric subspecialties).
The Division of Pediatric Anesthesiology provides consultations and services for pediatric patients requiring elective and emergency surgery, anesthesia or sedation required for imaging (MRI and CT scans), interventional radiology and cardiology.
The Pediatric Anesthesiology division actively works with the Pediatric Intensive Care Unit (PICU) and the Neonatal Intensive Care Unit (NICU). Staff and residents from the anesthesiology department provide comprehensive airway management expertise and consultations.
- To promote the health, safety and well being of children who require anesthesia care, who are critically ill or injured or who suffer acute and chronic pain.
- To provide pediatric anesthesia care that exceeds community standards.
- To continuously improve the quality of care.
- Teach and train the most capable and motivated individuals
Our Values: Honesty, Compassion, Safety.
The faculty members who sub-specialize in pediatric anesthesiology work in close collaboration with pediatric care givers of all subspecialties.
The surgeon initially evaluates children. There may be a referral for more detailed preoperative testing or evaluation by a member of the anesthesiology team.
Corresponding to the fasting guidelines, children who are having uncomplicated procedures and are otherwise quite healthy may often be seen the day of the surgery by the anesthesiology team. Attention is given to the child's overall condition, the specific procedure, any other disease processes or medicines being taken, the level of anxiety in the child (and parents). Pre-operative timing of when the child can eat normally, and when clear liquids such as water, apple juice, or soda may be taken a number of hours prior to the planned surgery may vary.
In many, but not all cases, a parent may accompany the child to the operating room for the anesthetic induction by face mask or intravenous administration. If a child is quite anxious, the planned surgery of sufficient length, and no contraindications present, an oral sedative just prior to surgery may greatly reduce anxiety in the child. As soon as the child is asleep, the parent will be escorted to the family waiting room. Following completion of the surgery, the child will be brought to the recovery room to awaken and rejoin the family.
The types of anesthesia that may be provided vary from light to heavy sedation, to general anesthesia induced by anesthetic gases or intravenous agents. At times, the placement of a regional anesthetic by placement of needle or catheter to inject local anesthetics may provide complete relief of pain post-operatively in addition to reducing the amount of other anesthetics that must be provided to maintain the child unconscious or deeply sedated during the procedure.
Post-operatively, attention to treatment of the child's pain is important to reduce anxiety and facilitate interactions with the family. As in preparation for surgery and during the surgery, this may involve oral, intravenous, or continuation of regional nerve blocks or neuroaxial (spinal or epidural) anesthetics.
Children who have major surgery may often be transferred directly from the OR to the Pediatric Intensive Care Unit (PICU), or if a newborn to the Neonatal Intensive Care Unit (NICU) where care will be provided by pediatricians specialized in intensive care.
FAQ
The following section introduces a list of commmon Frequently Asked Questions:
- Pediatric Anesthesia For An Ambulatory And Same Day Procedure
- Anesthesia For Cardiac Procedures
- Anesthesia For Ct And Mri Procedures
Pediatric Anesthesia for an Ambulatory and Same Day Procedure
Who will provide anesthesia?
The division of pediatric anesthesiology at Stony Brook University Hospital provides anesthesia services at the main hospital and at the ambulatory surgery center. A team consisting of our anesthesiologist working with residents and certified nurse anesthetist will care for your child.
May I choose my pediatric anesthesiologist?
Many parents find their doctors through recommendations from their primary doctors or through family and friends. You do have a choice within our team but you must make that choice known in advance. Most of the patients are satisfied with whom they are assigned. Should you have a preference, every effort will be made to honor that request.
What are the different kinds of anesthesia?
There are four main categories of anesthesia; general, regional, monitored anesthesia care and local anesthesia. Regardless of the category of anesthesia your child may receive, special anesthetic agents and techniques will be used to provide a safe and speedy recovery.
- General Anesthesia- the child is not conscious and has complete loss of sensation. This technique involves inducing sleep of the whole body, and the brain.
- Regional Anesthesia- local anesthetic is injected by the anesthesiologist to provide numbness and loss of sensation to a region of the body. This could include spinal anesthesia, epidural anesthesia, upper and lower blocks. Additional intravenous medication may be given to make the child comfortable and drowsy.
- Monitored Anesthesia Care- during this type of anesthesia the surgeon usually injects local anesthetic to the site of surgery to provide numbness and loss of sensation. The anesthesiologist then supplements this with intravenous medication to make the child comfortable and drowsy.
- Local Anesthesia- local anesthetic is injected by the surgeon to provide numbness and loss of sensation to a small area. This technique is rarely performed in the pediatric group.
We sometimes offer a combination of these modalities of anesthesia. The reasonable choices available for the surgery will be discussed with the anesthesiologist before the surgery.
May I request the type of anesthesia for my child?
Yes, in certain situations. Some operations can be performed using a choice of different anesthetic types. Your anesthesiologist will discuss available options with you after reviewing the medical history. Your preference will be discussed so that the most appropriate anesthetic plan is made.
Will my child receive any sedatives before surgery?
We now realize that many children need less sedation when calm, assured and confident parents help them through the stress of a procedure or hospitalization. In spite of parents' reassurances, however, some children still may require medicine to calm them before a procedure. This medication may be given by mouth or injection. The time and type of such premedication will vary and will be determined by the anesthesiologist.
What are the risks of anesthesia?
No procedure is without some degree of risk, which your anesthesiologist will discuss with you prior to the procedure. Fortunately, serious and major complications such as strokes and deaths from general (or other types of) anesthesia are very rare today, despite the fact that more procedures are being performed on sicker and younger patients than in the past. In the last 10 years, the estimated numbers of deaths attributed to anesthesia (for all types of surgical procedures) have dropped significantly to 1 in 250,000. Serious complications such as strokes and prolonged periods of mechanical ventilation have also declined over the past few decades. The increased safety of general anesthesia is due to many factors, including: safer drugs, more extensive training of anesthesiologists, and national standards of care. However, minor problems- most of which are easily treatable- such as nausea and vomiting, sore throat, dizziness, tiredness, headache and pain may occur.
Will the anesthesiologist bill me separately?
You will receive separate bills for different professional services. Stony Brook Anesthesiology, P.C. participates in most health plans. If you have any financial concerns, you may call our anesthesia office, Tel- 631.444.2975.
May I enter the operating room with my child?
There will be circumstances where it is appropriate for a parent to come into the operating room. Studies and experience show that this decision needs to be individualized and discussed between you and your anesthesiologist. There are many situations where other choices are better and possibly even safer. Please do not hesitate to discuss your options.
Why must my child refrain from eating and/or drinking prior to surgery?
The reason for fasting prior to surgery is to reduce the risks of aspirating gastric contents during the surgery. This complication, although rare, is very serious and parents need to strictly follow our recommendations. This has nothing to do with nausea and vomiting after the surgery. We have very clear policies as to specific ages and time periods before surgery when the child must refrain from eating and/or drinking. These are all based on safety standards. We believe that the fasting time should be as short as possible before the surgery.
Home medications?
Generally we request that you give most medications on the morning of surgery. This should be discussed with your surgeon who will contact us with any questions, and refer you for a preoperative consultation if necessary. Medication may be taken with a sip of water on the day of surgery. Please bring in all medications with you on the day of surgery. Some medications will be stopped for the surgery, particularly diabetes medication and blood thinners (rarely seen in the pediatric group). You should bring these medications with you the day of surgery. Please call us with any questions you may have.
Pediatric Anesthesia for Cardiac Procedures
Who will provide anesthesia?
The division of pediatric anesthesiology at Stony Brook University Hospital provides anesthesia services at the main hospital and at the ambulatory surgery center. A team consisting of our anesthesiologist working with residents and certified nurse anesthetist will care for your child.
What role does the pediatric anesthesiologist have in my child's care?
You probably will not get to know your child's anesthesiologist as well as the cardiologist and/or cardiac surgeon. Nonetheless, the anesthesiologist plays many important roles in your child's care before, during, and after the surgery or procedure.
Specifically, the anesthesiologist:
- Continually monitors the vital functions such as breathing, heart rate and rhythm, blood pressure, body temperature, oxygen saturation, fluid and blood needs and makes medical decisions as necessary.
- Ensures the child's safety during surgery by using anesthetics and techniques, which are tailored to the specific medical condition.
- Provides consultation on many aspects of the medical care, including pain management, medications, and airway management.
What is the education and training of a pediatric cardiac anesthesiologist?
A pediatric anesthesiologist is a physician who has completed medical school, at least four years of medical training (a year of internship and three years in an anesthesiology residency program), and usually at least one year of a pediatric anesthesia fellowship program. During this period of education and training the pediatric anesthesiologists becomes very knowledgeable about many areas of medicine, including cardiology, pediatrics, critical care, and pharmacology. The anesthesiologist’s education does not end with the completion of fellowship training, however. Because the field of pediatric cardiac anesthesiology is constantly evolving and expanding, pediatric anesthesiologists continually update their knowledge and skills through regular participation in educational courses and symposia, earning continuing medical education credits as appropriate or required.
Why is there a preoperative interview and what does it consist of?
The preoperative interview has two important purposes:
The first one is to provide the anesthesiologist with essential information about health history so he or she can properly plan and manage the anesthesia and care during and following the surgery or procedure.
The second purpose of the interview is to give you an opportunity to ask questions and voice any concerns you may have.
What will the anesthesiologist need to know?
The anesthesiologist will want to make sure that your child is in the best possible physical condition before surgery. You will be asked important questions about your child's general health, including whether he or she has allergies or asthma, whether there has been any family history of difficulties with anesthesia and what your child's experiences have been with previous anesthetics. During this evaluation, the anesthesiologist will explain the planned anesthetic procedure. The discussion may include whether or not your child will receive anything for sedation before surgery, how the anesthetic will be initiated and maintained, and other pertinent anesthetic details. This is the best time for you and your child to ask questions and express any concerns to the anesthesiologist.
You will also be asked about allergies. Sometimes children react to certain medications in odd ways that are not truly allergic reactions but are "labeled" as such.
When you report that your child is allergic to a medication, you will be asked to describe the reaction so that we can determine if there is a true allergy. It is unusual for children to be allergic to anesthetic drugs. The most commonly encountered allergies are to antibiotics such as penicillin or amoxicillin.
Sometimes significant illnesses may cause problems during some types of surgery and anesthesia. For this reason, the anesthesiologist may feel it is best to postpone surgery. Remember, your child's safety is our first priority.
Will my child receive any medication before surgery?
We now realize that many children need less sedation when calm. Assured and confident parents help them through the stress of a procedure or hospitalization. In spite of parents' reassurances, however, some children still may require medicine to calm them before surgery. This medication may be given by mouth or injection. The time before surgery that such premedication is given will vary. The anesthesiologist will determine the type of medicine used, if any, during the preoperative visit.
How will my child be given anesthesia?
Anesthetic agents can be started in several ways. Most commonly in adults, anesthesia is started by an intravenous injection so the patient becomes unconscious rapidly. This is also a method that can be used for children. Another method of beginning anesthesia is to let your child breathe anesthetic agents until losing consciousness. This is called a mask or inhalational induction. With this approach, your child will be asked to breathe through a "space mask" quietly, and no needle sticks will be performed until after your child is sound asleep. The choice of which method to begin anesthesia will be made by the anesthesiologist based on many factors.
Will my child be asleep during the entire operation?
After inducing general anesthesia, the child will be unconscious during the operation. Be assured that throughout the entire operation, the anesthesiologist continually monitors and adjusts the level of anesthesia.
Even when sedation is used, there might be some recollection of the operating suite.
Will my child receive blood transfusion?
He or she may. At present, blood supply is extremely safe, but the risk is not zero. If you have any specific concerns about this issue, discuss them with the team. Complications include risk for infection and other reactions.
What are the risks of general anesthesia?
No cardiac surgical procedure is without some degree of risk, which your surgeon will discuss with you prior the operation. Fortunately, serious complications such as strokes and deaths from general (or other types of) anesthesia are very rare today, despite the fact that at this time, more cardiac surgery is being performed on younger and sicker patients.
In the last decade, the estimated numbers of deaths attributed to anesthesia (for all types of surgical procedures) have dropped significantly. Serious complications such as strokes and prolong periods of mechanical ventilation, have also declined over the past few decades. The increased safety of general anesthesia is due to many factors, including: safer drugs, more extensive training of anesthesiologists, and national standards of care that reflect current best practices.
What are the side effects of general anesthesia?
Side effects from general anesthesia may occur, but the vast majority are not serious, do not last long, and are treatable. Side effects may include sore throat, headache, back pain, and/or fatigue. Some patients experience nausea or vomiting, but this occurs less frequently than in the past.
When and where will my child wake up after the operation?
This depends on many factors, including the type of surgery, so there is no single answer to that question. Most likely, the child will be awakening in the Pediatric Cardiac Intensive Care Unit.
Pain after the operation?
Some discomfort after a major surgical procedure is to be expected. But strong, effective painkilling drugs are routinely provided to cardiac surgical patients so they can be as comfortable as possible. Patients and families should be reassured to know that the Pediatric Intensive Care Unit staff members are very aware of the importance of effective pain management and very experienced at managing children's pain.
What role does the pediatric anesthesiologist have in my child's care?
You probably will not get to know your child's anesthesiologist as well as the primary service physicians. Nonetheless, the anesthesiologist will plays many important roles in your child's care before, during, and after the MRI procedure.
Specifically, the anesthesiologist:
- ontinually monitors the vital functions such as breathing, heart rate and rhythm, blood pressure, oxygen saturation, and fluid and blood needs and makes medical decisions.
- Ensures the child's safety during the procedure by using anesthetics and techniques, tailored to the specific medical condition.
- Manages pain during the immediate post-procedure period to make the child as comfortable as possible.
Provides consultation on many aspects of the medical care, including medications and airway management.
Why is there a preoperative interview?
The preoperative interview has two important purposes.
The first one is to provide the anesthesiologist with health history so he or she can properly plan and manage your anesthesia and care during and following the procedure.
The second purpose of the interview is to give you an opportunity to ask questions and voice any concerns you may have.
What will the anesthesiologist need to know?
The anesthesiologist will want to make sure that your child is in the best possible physical condition before the procedure. You will be asked about your child's general health, whether there has been any family history of difficulties with anesthesia and what your child's experiences have been with previous anesthetics. During this evaluation, the anesthesiologist will explain the planned anesthetic procedures. The discussion may include whether or not your child will receive anything for sedation before the procedure, and how the anesthetic will be initiated and maintained. This is the best time for you and your child to ask questions and express any concerns to the anesthesiologist.
You will also be asked about allergies. Sometimes children react to certain medications in odd ways that are not truly allergic reactions but are "labeled" as such. When you report that your child is allergic to a medication, you will be asked to describe the reaction so that we can determine if there is a true allergy. It is unusual for children to be allergic to anesthetic drugs or to the MRI contrast agent (injected during the study). The most commonly encountered allergies are to antibiotics such as penicillin or amoxicillin.
Sometimes minor illnesses such as sniffles and colds may cause problems during some types of surgery and anesthesia. For this reason, the anesthesiologist may feel it is best to postpone the procedure. Remember, your child's safety is our first priority.
Will my child receive any medication before the procedure?
We now realize that many children need less sedation when calm, assured and confident parents help them through the stress of a procedure or hospitalization. In spite of parents' reassurances, however, some children still may require medicine to calm them before a procedure. This medication may be given by mouth or injection. The time and type of such premedication will vary and will be determined by the anesthesiologist.
How will my child be given anesthesia?
Anesthetic agents can be started in several ways. Most commonly in adults, anesthesia is started by an intravenous injection so the patient becomes unconscious rapidly. This is also a method that can be used for children. Another method of beginning anesthesia is to let your child breathe anesthetic agents until losing consciousness. This is called a mask or inhalational induction. With this approach, your child will be asked to breathe through a "space mask" quietly, and no needle sticks will be performed until after your child is sound asleep. The choice of which method to begin anesthesia will be made by the anesthesiologist based on many factors.
Will my child be asleep during the entire procedure?
After inducing general anesthesia, the child will not be conscious (aware) during the entire procedure. Be assured that throughout the entire study, the anesthesiologist continually monitors and adjusts the level of anesthesia. Even when sedation is used, there might be some recollection of the MRI suite after the study is over.
What are the risks of general anesthesia?
No procedure is without some degree of risk, which your anesthesiologist will discuss with you prior to the MRI study. Fortunately, serious complications such as strokes and deaths from general (or other types of) anesthesia are very rare today, despite the fact that more procedures are being performed on sicker and younger patients than in the past. In the last 10 years, the estimated numbers of deaths attributed to anesthesia (for all types of surgical procedures) have dropped significantly to 1 in 250,000. Serious complications such as strokes and prolonged periods of mechanical ventilation have also declined over the past few decades. The increased safety of general anesthesia is due to many factors, including: safer drugs, more extensive training of anesthesiologists, and national standards of care.
What are the side effects of general anesthesia?
Side effects from general anesthesia may occur, but the vast majority are not serious, do not last long, and are treatable. Side effects may include sore throat, headache, back pain, and/or fatigue. Some patients experience nausea or vomiting, but this occurs less frequently than in the past.
When and where will my child wake up after the operation?
This depends on many factors, so there is no single answer to that question. Most likely, the child will be awakening in the MRI area immediately after the procedure.
Fasting Guidelines
The reason for fasting prior to surgery is to reduce the risks of aspirating gastric contents during the surgery. This complication, although rare, is very serious and parents need to strictly follow our recommendations. This has nothing to do with nausea and vomiting after the surgery. We have very clear policies as to specific ages and time periods before surgery when the child must refrain from eating and/or drinking. These are all based on safety standards. We believe that the fasting time should be as short as possible before the surgery.
Solids such as solid food, breast milk, formula, bottle milk and unstrained fruit juices:
| Newborn until 6 months: | 4 hr |
| 6 to 36 months: | 6 hr |
| Older then 36 months: | 8 hr |
Clear liquids such as Water, Kool-Aid, Pedialyte, strained juice (like apple juice) and gatorade:
| Newborn until 6 months: | 2 hr |
| Older then 6 months: | 3 hr |
Contact:
Department of Anesthesiology
Stony Brook University
Stony Brook, New York 11794-8480
Tel: 1-631-444-2975
Fax: 1-631-444-2907