DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

PEDIATRIC
ANESTHESIA AND
CRITICAL CARE
MEDICINE
Frank H. Kern, M.D., FCCM
Chief, Division of Pediatric
Anesthesia
Associate Director, Pediatric
Critical Care Medicine
Professor of Anesthesiology
Professor of Pediatrics
Pediatric Anesthesia
Frank H. Kern, M.D., FCCM
Chief, Division of Pediatric Anesthesia
Associate Director, Pediatric Critical
Care Medicine
Professor of Anesthesiology
Professor of Pediatrics
Allison K. Ross, M.D.
Section Chief, General Pediatric
Anesthesia
Assistant Professor of Anesthesiology
Members:
Robert L. Coleman, M.D.
Guy deLisle Dear, M.B., FRCA
John B. Eck, M.D.
Thomas O. Erb, M.D., F.M.H.
Brian Ginsberg, M.B., B.Ch.
Scott R. Schulman, M.D.
Clinical responsibilities of the faculty
and staff are to provide comprehensive
care for the pediatric patient.
In 2000 we have been involved
in providing comprehensive pediatric
anesthesia services both in the OR and
at multiple remote anesthetizing sites,
including a regular bone marrow clinic,
endoscopy/bronchoscopy suite and
cardiac catheterization suite. Members
of our division have been actively
involved in planning the Duke Children’s
Hospital which broke ground in March
of 1998 and opened in the spring of
2000. Children specific OR’s, intake
and PACU areas for children have
become an important part of pediatric
anesthetic care at Duke. The pediatric
division has continued to grow in the
services which are provided to children
at Duke and in pediatric anesthesia
research.
Research
Our research efforts have been devoted
to physiology, pharmacokinetics/
dynamics and regional anesthesia.
Physiologic research: Includes cerebral
blood flow, cerebral metabolism
and inflammatory effects of cardiopulmonary
bypass, and cardiorespiratory
interactions.
In the recent past, our section has
described the effects of deep hypothermic
circulatory arrest on cerebral blood
flow and metabolism. Publications
have demonstrated marked differences
in brain blood flow and metabolism between
children undergoing continuous
flow deep hypothermic cardiopulmonary
bypass and children undergoing
deep hypothermic circulatory arrest
and the importance of PaO 2 on cerebral
oxygen utilization during profound
hypothermia. We have also observed
that cerebral blood flow falls linearly
with temperature reduction whereas
metabolism falls exponentially using
alpha stat blood gas regulation. We
have defined a metabolic index for predicting
safe circulatory arrest times
CLINICAL ACTIVITIES
based on metabolic reduction due
to hypothermia. Our group has also
described the effects of CO 2 on cerebral
blood flow during deep hypothermia
in children and we have pioneered the
use of jugular venous saturation as a
monitor for effective cooling of the
brain prior to the institution of circulatory
arrest. In addition, we have
defined the detrimental effects of CPB
and circulatory arrest on respiratory
and myocardial function. While inflammatory
modification of CPB remains the
holy grail in congenital heart surgery,
our efforts at modifying the inflammatory
response through circuit miniaturization,
high dose steroids, inhibition of
inflammatory mediator release are
ongoing projects.
Pharmacokinetics: Our group has
been involved in numerous clinical
research projects involving the pharmacokinetic
and pharmacodynamic
aspects of drugs in children. We have
been involved in Phase 2 and Phase 3
studies of investigational agents. Included
in this list of agents are an intravenous
induction agent, muscle relaxants
and ultrashort acting opioids.
Scott R. Schulman, M.D.
CLINICAL ACTIVITIES 67