Anesthesiology, Critical Care and Pain Medicine

Many medical procedures may provoke significant anxiety or require that the patient not move for a prolonged period. This is difficult for adults, but it is often impossible for young children. In such cases, the anesthesia team chooses the best of several possible sedatives or other drugs for your child's particular needs, so they will be drowsy (or completely asleep) during the procedure, but will awaken as quickly as possible afterward, with minimal side effects. Most infants and younger children are likely to require a fairly deep level of sedation or general anesthesia for most types of procedures.

General anesthesia refers to making a patient completely insensitive and unresponsive to pain, while maintaining vital bodily functions and providing conditions appropriate for a planned procedure. There are a number of different drugs and techniques that can be used to start and maintain anesthesia. With better drugs and advanced monitoring techniques, general anesthesia is much safer than it used to be, but it still carries some risks.

The anesthesiologist's job is to match the kind of anesthesia to the patient's physical status, medical condition, and surgical procedure, in order to provide the safest possible experience — and then to closely monitor and adjust the function of their heart, lungs, and other vital organs throughout the procedure. Extensive knowledge and expertise is particularly necessary in patients with heart disease.

Anesthesiologists also are responsible for analgesia, or pain control. Just as there are many different kinds of pain, with different causes, there are many medications and techniques available to reduce and eliminate pain. A local anesthetic can numb the area around a wound while it is stitched. Epidural or spinal anesthetics can prevent the nerves from transmitting signals of pain from large areas of the body. Opiates, such as morphine and fentanyl, can reduce the experience of pain throughout the body.

Making the most effective use of these and many other medications requires in-depth knowledge of the biology of pain and the ways it interacts with a child's medical status, physical and emotional development, and medical condition.

Even with the growth of minimally invasive surgical techniques, many cardiac surgeries still require that a machine take over the functions of the heart and lungs while the heart is repaired. The supervision of this "bypass" (or heart-lung) machine is the responsibility of the anesthesiologist, in conjunction with the cardiac surgeon and perfusionist (a medical professional with special training in this task).

Boston Children's Hospital has dedicated and highly experienced pediatric perfusionists. In carrying out each of these duties, the anesthesiologist's primary concern is to shield each patient from pain and anxiety, support critical bodily functions, and minimize the risks associated with surgery. Physicians at Boston Children's Hospital continually re-examine the standard methods of anesthesiology, and work to develop better, more reliable practices for protecting heart, lung and brain function, and blood circulation during anesthesia. Their record of innovation and publication has made them leaders in the field.