DEPARTMENT OF ANESTHESIOLOGY ANNUAL REPORT

CLINICAL ACTIVITIES
Regional Anesthesia: Regional anesthesia
has proven to lessen pain, facilitate
early discharge from the PACU and
minimize the deleterious effects of general
anesthesia in high risk patients.
Examples of the latter include, newborns,
ex-premature infants with respiratory
insufficiency and children with
abnormal respiratory function due to
CNS injury, myopathies, neuropathies
and lung disease. Regional anesthesia
continues to be a fertile area of research
for our group and an important
area for the control of pain in children
undergoing surgery and children with
complex medical problems.
The Pediatric Anesthesia group
has taken part in the International
Cochrane Collaboration in evidencebased
medicine. Our section had been
designated as the section to review
meta-analyses of national clinical trials
in children.
Resident education continues to be
an important aspect of teaching in the
department. In addition to hands on
training and didactic lectures, pediatric
anesthesia has a six-month subspecialty
experience for CA-3 residents and a
one year postgraduate fellowship in
Pediatric Anesthesia that includes experience
in pediatric general, cardiac and
critical care medicine. We have also
established an inter-departmental conference
program dedicated to pediatric
anesthesia and perioperative care of
children. Fellow education, research
and participation in national organizations
remain important goals for the
Pediatric Anesthesia group.
68 CLINICAL ACTIVITIES
PEDIATRIC CRITICAL
CARE MEDICINE
John N. Meliones, M.D., FCCM
Chief, Pediatric Critical Care
Medicine
Medical Director, Pediatric
Intensive Care Unit
Professor of Pediatrics
Associate Professor of
Anesthesiology
Members:
Ira M. Cheifetz, M.D.
Eva N. Grayck, M.D.
Frank H. Kern, M.D., FCCM
Scott R. Schulman, M.D.
The Pediatric Intensive Care Unit is a
multi-disciplinary intensive care unit
which includes two pediatric anesthesiologists
and three pediatric trained critical
care physicians who jointly share
responsibility for the care of medical
and surgical postoperative patients in
the PICU and transitional care unit. The
faculty are responsible for all medical
and surgical admissions into Intensive
Care. Medical patients are admitted
directly to the critical care service. All
surgical patients are admitted to the primary
surgical service with a mandatory
consultation from the pediatric critical
care service. An ongoing fellowship
program is maintained at two fellows
per year.
Research
Research in the Pediatric Intensive Care
Unit has been robust. Areas of investigation
include: Partial liquid ventilation
in ARDS, effects of Nitric Oxide and
varying modes of ventilation on right
ventilation function, cerebral blood
flow, metabolism and near infrared
spectroscopic measurements of cerebral
oxygenation in critically ill newborns
undergoing extracorporeal membrane
oxygenation, pharmacokinetic
research on long term infusions of sedatives
such as midazolam and propofol
for continuous sedation of critically ill
children in the pediatric intensive care
unit. Exciting new areas of research
include the use of liquid ventilation during
CPB to decrease systemic and pulmonary
inflammatory responses. This
investigation is occurring in swine and
clinical arms are under investigation.
The effect of nitric oxide as a putative
mediator of lung injury is under investigation
in a rabbit model in our basic
science laboratory.
Teaching
Training of physicians at the resident
and fellowship level is a very important
part of the pediatric division. We currently
train two fellows per year in
critical care medicine. Three medical
residents receive clinical and didactic
teaching in pediatric intensive care per
month, and fellows and residents in
medicine, anesthesia, surgery frequently
rotate through the PICU. The PICU
rotation remains a favorite rotation for
Duke medical students.