A Day in the Life of a Duke Anesthesiology Resident

Andrew Peery, MD, CA-3 Resident

Pediatric Anesthesia Rotation

Each day of your pediatric rotation is an opportunity to relearn everything you thought you knew about anesthesia. Previously simple procedures like intubations and IV’s are challenging again. All your instincts of drug dosing are useless, replaced with strict weight-based calculations. Subtle changes in vital signs now demand immediate attention. The cases are shorter, the familiar tones of your monitors are faster, and even your own heart rate may be faster than normal.

As always, you start off your day by setting up your room. Duke has two operating rooms and a smaller procedure room that are dedicated to our pediatric patients. “Peds 1” and “Peds 2” are among the largest operating rooms in the hospital. They are decorated with marine murals and contain multiple flat screen televisions, which are useful for distracting your patients with cartoons as you get them off to sleep. While these rooms are designed for pediatric surgery, they do not begin to contain the daily volume of pediatric cases. Pediatric patients are also cared for in the main operating rooms, in the cardiac operating rooms, at the Ambulatory Surgery Center, in the pediatric catheterization lab, and in the radiology suites of the first floor. Wherever you are working, all but the healthiest children will be supervised by an attending from our division of pediatric anesthesia.

Once your room is set up, you will head to the pediatric perioperative care unit to meet your patient and their family. Your patients may be calm or nervous and it is your job to convince them that they can relax with you. The trust you build in those first few minutes can be the difference between a smooth induction in front of an appreciative parent or an awkward wrestling match with a screaming child.

You will have the chance to participate in a wide variety of cases. “Simple” line cases allow you to work with premature children less than 1 kg in size or syndromic infants with complicated medical conditions. General surgery cases range from hernia closures to classic board emergencies. Neurosurgery cases may be as simple as a shunt revision or as complex as a craniotomy for clipping of a vascular malformation. Our plastics department performs cleft palate revisions and craniosynostosis repairs. There are also active services in pediatric orthopedics, urology, and ENT. In the past few months, residents have even taken part in our growing pediatric liver transplant program.

Any of these cases can be emotionally challenging. By the end of the day, you may feel sadness or frustration that your patients and their families are forced to go through the discomfort of surgery or the challenges of severe illness. Whatever your feelings, the care you provide these children is invaluable. The art of pediatric anesthesia is putting a calm child off to sleep, keeping them safe whatever the risks, and then delivering them back to their parents, calm and well. You will not always succeed—it is not always possible to succeed—but you will always be doing something important.

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