The anesthesiologists at St. Louis Children’s Hospital provide care for children of all ages. Our team includes board-certified pediatric anesthesiologists, certified nurse anesthetists, nurse practitioners and pediatric anesthesia fellows.
In the segment, Dr Thomas Cox discusses pediatric anesthesiology and the most common questions parents ask regarding anesthesia.
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Pediatric Anesthesiology: Frequently Asked Questions
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Learn more about Thomas Cox, MD
Thomas Cox, MD
Thomas Cox, MD, is a Washington University pediatric anesthesiologist at St. Louis Children’s Hospital, Chief of the Division of Pediatric Anesthesiology and Professor and Vice Chairman for Education.Learn more about Thomas Cox, MD
Transcription:
Pediatric Anesthesiology: Frequently Asked Questions
Melanie Cole (Host): Each year, millions of young children require surgery and other procedures for various medical conditions or to improve their quality of life. Anesthetic and sedative medications are widely used to help ensure the safety, health and comfort of children undergoing these procedures. The anesthesiologists at St. Louis Children’s Hospital are an integral part of the child’s care team. These specially trained physicians are true experts in keeping children comfortable and relieving any anxiety their parents may have regarding surgical anesthetic. My guest today is Dr. Thomas Cox. He is a Washington University pediatric anesthesiologist at St. Louis Children’s Hospital and the Chief of the Division of Pediatric Anesthesiology and Professor and Vice Chairman for Education. Welcome to the show Dr. Cox. So, explain a little bit about a pediatric anesthesiologist and what’s the additional education that you might require or how does it differ from being an adult anesthesiologist?
Dr. Thomas Cox, MD (Guest): Well Melanie, pediatric anesthesiologists have received some specialty training in the care of pediatric patients both in the operating room as well as the intensive care unit. We receive our foundational training just like any other physician in that we go to medical school, we do an internship in often a general area of medicine and then we do focused training in anesthesiology which is called a residency, not unlike a surgeon who would do a residency in surgery or a pediatrician who would do a residency in pediatrics. What distinguishes pediatric anesthesiologists is that they have done additional focused training just on the care of pediatric patients, in the operating room, intensive care unit as well as addressing children that have different types of pain problems.
Melanie: So, then what are some of the risks? We hear more and more in the media about the risks of anesthesia in children. So, what would you like to let other physicians know about kind of managing those risks and or weighing them against the benefits of the procedure?
Dr. Cox: Well certainly. We never take performing an anesthetic on a child lightly and work with those families as well as the surgeons in assigning an appropriate amount of risk to the anesthetic, also realizing that we don’t take lightly having a surgery performed and realizing that risk benefit, it needs to be an ongoing discussion. So, we help provide context and perspective to families and surgeons. Some children may be at more risk than others. Those that are very young aged such as neonates and those that may have other significant illnesses which need to be taken into consideration in planning the anesthetic, but again, applying appropriate risk to the surgery and anesthetic to that particular patient.
Melanie: Do you have a standard checklist Dr. Cox, to watch for during a procedure? Is there something that is an industry standard that you are on the lookout for?
Dr. Cox: Not unlike our anesthetic management of adult patients; we monitor all aspects of the child’s physiological function and in that I mean their blood pressure, their heart rate, how much oxygen they are receiving in their body, how well we are ventilating them, as well as the anesthetic depth. We have specific monitors that allow us to do this with quite a bit of detail and accuracy.
Melanie: is it usual for children to experience anxiety prior to surgery and how about even that their parents are experiencing; what do you tell other physicians and you know, dealing with the parents directly, what do you tell them about that anxiety and soothing that for them and their children?
Dr. Cox: Well, first of all, we both let children and parents as well as surgeons in the context of being that primary physician for the patient, that anxiety is a very normal part of coming to the hospital but especially in having surgery and an anesthetic. So, first of all, it is getting a sense of why is that child anxious or the parent? Is it a lack of information of the unknown, what to expect? Clearly, there can be anxiety associated with the situation itself, the illness. There also can be anxiety associated with the separation of a child from a parent and going to the operating room. So, in working with nurses, our child life experts, as well as our own interactions with the child and family; we try to get a sense of what is the source of the anxiety and how can we best alleviate that anxiety?
Melanie: So, Dr. Cox, can parents be with their child when they go to sleep?
Dr. Cox: We often provide that opportunity to parents. Often children have anxiety associated with being in hospitals or certainly having surgical procedures. Often, part of that anxiety is associated with being separated from the parent. We certainly want to make sure the parent is appropriately prepared for that because sometimes parents will also have anxiety. Often if a child has a significant medical issue that would make their induction of anesthesia more risky, it is prohibitive to have a family member come back because we really want to be able to focus attention on the child and the issues that could be challenging during the anesthetic induction.
Melanie: And what about post-surgical anesthetic care?
Dr. Cox: The anesthesiologist keeps close observation of children in what we call phase 1 recovery. That is the unit they are cared for immediately after recovering from anesthesia. The nurses in the recovery room are specialists in caring for children during this recovery period. Because waking up from anesthesia has some unpredictable components to it, the anesthesiologist and nurses are very attentive to the child as they recover the function of their airway, their breathing as well as monitoring carefully their vital signs, also making sure when they wake up they are comfortable and if not, we can intervene with pain medications, but as soon as possible, we try to introduce family to the recovery area and that is a decision that is made jointly by the anesthesiologist and the nurse caring for the child.
Melanie: And where else do anesthesiologists work? Speak a little bit about sedation and analgesia for diagnostic and therapeutic procedures.
Dr. Cox: Absolutely. There are many procedures that children must have while they are being cared for in the hospital that are either diagnostic or therapeutic. An example would be a lumbar puncture to get a laboratory study on perhaps a child who is having neurological issues or a bone marrow biopsy. These can be very painful procedures and as such, and not unlike a surgical procedure require an anesthetic, an anesthetic supervised by an anesthesiologist. Anesthesiologists also work closely with our intensive care physicians and many anesthesiologists are intensivists themselves in providing services in the intensive care unit as well as anesthesia for procedures that may be performed in intensive care unit. And additionally, anesthesiologists are experts in pain management. So, through consultation and the care of our patients we would manage pain for children in the hospital either post-surgical or that have been admitted to the hospital primarily because of a pain problem.
Melanie: So, in summary, Dr. Cox, tell other physicians what you would like them to know about the field of pediatric anesthesiology and when to refer to a specialist.
Dr. Cox: Certainly. Pediatric anesthesiologists again, have been specially trained to take care of children who present for surgery or with critical illnesses or with pain management problems. Pediatric anesthesiologists at Children’s Hospital are always available for consultation either with a family member, a parent or with a physician in deciding where is the best venue for their child to be cared for. In many cases, very young children, children with many complicated medical problems are best taken care of in a children’s hospital by pediatric anesthesiologists that have been specifically and specially trained to take care of children.
Melanie: Thank you so much for being with us today, doctor. A physician can refer a patient by calling Children’s direct physician access line at 1-800-678-HELP. That’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital, you can go to www.stlouischildrens.org . That’s www.stlouischildrens.org . I’m Melanie Cole. Thanks so much for listening.
Pediatric Anesthesiology: Frequently Asked Questions
Melanie Cole (Host): Each year, millions of young children require surgery and other procedures for various medical conditions or to improve their quality of life. Anesthetic and sedative medications are widely used to help ensure the safety, health and comfort of children undergoing these procedures. The anesthesiologists at St. Louis Children’s Hospital are an integral part of the child’s care team. These specially trained physicians are true experts in keeping children comfortable and relieving any anxiety their parents may have regarding surgical anesthetic. My guest today is Dr. Thomas Cox. He is a Washington University pediatric anesthesiologist at St. Louis Children’s Hospital and the Chief of the Division of Pediatric Anesthesiology and Professor and Vice Chairman for Education. Welcome to the show Dr. Cox. So, explain a little bit about a pediatric anesthesiologist and what’s the additional education that you might require or how does it differ from being an adult anesthesiologist?
Dr. Thomas Cox, MD (Guest): Well Melanie, pediatric anesthesiologists have received some specialty training in the care of pediatric patients both in the operating room as well as the intensive care unit. We receive our foundational training just like any other physician in that we go to medical school, we do an internship in often a general area of medicine and then we do focused training in anesthesiology which is called a residency, not unlike a surgeon who would do a residency in surgery or a pediatrician who would do a residency in pediatrics. What distinguishes pediatric anesthesiologists is that they have done additional focused training just on the care of pediatric patients, in the operating room, intensive care unit as well as addressing children that have different types of pain problems.
Melanie: So, then what are some of the risks? We hear more and more in the media about the risks of anesthesia in children. So, what would you like to let other physicians know about kind of managing those risks and or weighing them against the benefits of the procedure?
Dr. Cox: Well certainly. We never take performing an anesthetic on a child lightly and work with those families as well as the surgeons in assigning an appropriate amount of risk to the anesthetic, also realizing that we don’t take lightly having a surgery performed and realizing that risk benefit, it needs to be an ongoing discussion. So, we help provide context and perspective to families and surgeons. Some children may be at more risk than others. Those that are very young aged such as neonates and those that may have other significant illnesses which need to be taken into consideration in planning the anesthetic, but again, applying appropriate risk to the surgery and anesthetic to that particular patient.
Melanie: Do you have a standard checklist Dr. Cox, to watch for during a procedure? Is there something that is an industry standard that you are on the lookout for?
Dr. Cox: Not unlike our anesthetic management of adult patients; we monitor all aspects of the child’s physiological function and in that I mean their blood pressure, their heart rate, how much oxygen they are receiving in their body, how well we are ventilating them, as well as the anesthetic depth. We have specific monitors that allow us to do this with quite a bit of detail and accuracy.
Melanie: is it usual for children to experience anxiety prior to surgery and how about even that their parents are experiencing; what do you tell other physicians and you know, dealing with the parents directly, what do you tell them about that anxiety and soothing that for them and their children?
Dr. Cox: Well, first of all, we both let children and parents as well as surgeons in the context of being that primary physician for the patient, that anxiety is a very normal part of coming to the hospital but especially in having surgery and an anesthetic. So, first of all, it is getting a sense of why is that child anxious or the parent? Is it a lack of information of the unknown, what to expect? Clearly, there can be anxiety associated with the situation itself, the illness. There also can be anxiety associated with the separation of a child from a parent and going to the operating room. So, in working with nurses, our child life experts, as well as our own interactions with the child and family; we try to get a sense of what is the source of the anxiety and how can we best alleviate that anxiety?
Melanie: So, Dr. Cox, can parents be with their child when they go to sleep?
Dr. Cox: We often provide that opportunity to parents. Often children have anxiety associated with being in hospitals or certainly having surgical procedures. Often, part of that anxiety is associated with being separated from the parent. We certainly want to make sure the parent is appropriately prepared for that because sometimes parents will also have anxiety. Often if a child has a significant medical issue that would make their induction of anesthesia more risky, it is prohibitive to have a family member come back because we really want to be able to focus attention on the child and the issues that could be challenging during the anesthetic induction.
Melanie: And what about post-surgical anesthetic care?
Dr. Cox: The anesthesiologist keeps close observation of children in what we call phase 1 recovery. That is the unit they are cared for immediately after recovering from anesthesia. The nurses in the recovery room are specialists in caring for children during this recovery period. Because waking up from anesthesia has some unpredictable components to it, the anesthesiologist and nurses are very attentive to the child as they recover the function of their airway, their breathing as well as monitoring carefully their vital signs, also making sure when they wake up they are comfortable and if not, we can intervene with pain medications, but as soon as possible, we try to introduce family to the recovery area and that is a decision that is made jointly by the anesthesiologist and the nurse caring for the child.
Melanie: And where else do anesthesiologists work? Speak a little bit about sedation and analgesia for diagnostic and therapeutic procedures.
Dr. Cox: Absolutely. There are many procedures that children must have while they are being cared for in the hospital that are either diagnostic or therapeutic. An example would be a lumbar puncture to get a laboratory study on perhaps a child who is having neurological issues or a bone marrow biopsy. These can be very painful procedures and as such, and not unlike a surgical procedure require an anesthetic, an anesthetic supervised by an anesthesiologist. Anesthesiologists also work closely with our intensive care physicians and many anesthesiologists are intensivists themselves in providing services in the intensive care unit as well as anesthesia for procedures that may be performed in intensive care unit. And additionally, anesthesiologists are experts in pain management. So, through consultation and the care of our patients we would manage pain for children in the hospital either post-surgical or that have been admitted to the hospital primarily because of a pain problem.
Melanie: So, in summary, Dr. Cox, tell other physicians what you would like them to know about the field of pediatric anesthesiology and when to refer to a specialist.
Dr. Cox: Certainly. Pediatric anesthesiologists again, have been specially trained to take care of children who present for surgery or with critical illnesses or with pain management problems. Pediatric anesthesiologists at Children’s Hospital are always available for consultation either with a family member, a parent or with a physician in deciding where is the best venue for their child to be cared for. In many cases, very young children, children with many complicated medical problems are best taken care of in a children’s hospital by pediatric anesthesiologists that have been specifically and specially trained to take care of children.
Melanie: Thank you so much for being with us today, doctor. A physician can refer a patient by calling Children’s direct physician access line at 1-800-678-HELP. That’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital, you can go to www.stlouischildrens.org . That’s www.stlouischildrens.org . I’m Melanie Cole. Thanks so much for listening.