The members of the Division of Pediatric Anesthesia include a variety of faculty with dedication to perioperative care and a host of achievements in research, education, and clinical care. The faculty has actively participated in national and international societies for the betterment of perioperative care for children and continues to support that mission with advances in care that are driven by evidence-based medicine. All members are specialty trained in pediatric anesthesia and the majority is also trained in either pediatric intensive care or pediatric cardiac anesthesia. Teamwork is the cornerstone of the Division and this results in extensive and successful collaboration with surgical and pediatric colleagues.

Clinical Program

The Division of Pediatric Anesthesia is charged with providing comprehensive care for the pediatric patient throughout the Duke system. Members of the Division provide a wide range of pediatric anesthesia services both in the operating rooms and at multiple remote anesthetizing sites including a minor procedure suite for bone marrow biopsies, endoscopies, and bronchoscopies, diagnostic and interventional radiology arenas, radiation oncology, the eye center, and a cardiac catheterization suite. Annually, nearly 7,000 anesthetics are delivered to children in the Duke system. The pediatric division has continued to grow to support children’s services at Duke and is an integral part of the perioperative experience for children and their families. For the convenience of the families, pediatric patients are able to have their surgical and preoperative screening appointments in the same location in the Children’s Health Center. On the day of surgery, these same children who are having procedures in the main pediatric operating rooms will have the advantage of a specific pediatric waiting area, preoperative holding area, and postanesthesia care unit (PACU). Children who will have their procedures in other location such as the eye center, ambulatory surgery center or cath lab will receive the same child-centered care with the goal of providing an overall pleasant experience for the entire family.

The following services are covered by the Division of Pediatric Anesthesia: Pediatric general surgery, neurosurgery, otolaryngology, cardiothoracic surgery, plastic surgery, dental surgery, urology, and orthopedics. In addition, pediatric specialty groups that take advantage of anesthetic services for their patients include radiology, gastroenterology, pulmonology, rheumatology, hematology/oncology, bone marrow transplant, neurology, cardiology, encephalography and audiology. In fact, the off-site pediatric services have witnessed a 10-20% growth in volume of anesthetized patients each year.

Training Program

The Division of Pediatric Anesthesia at Duke provides a 1-year ACGME-accredited fellowship for residents who choose to pursue a fellowship in pediatric anesthesia following their CA-3 year. The fellow benefits from being the focus of advanced pediatric anesthesia training in specialty areas such as cardiac and regional anesthesia in addition to the core fellow curriculum. After a vast experience as a provider of clinical anesthesia, the fellow moves to a position of having a supervisory role in the Division and has the opportunity to work closely with residents and medical students on their pediatric anesthesia rotations. An academic day each week allows the fellow to participate in areas of interest including cath teaching conferences and/or clinical research.

Resident education continues to be an important aspect of teaching in the department, and certainly in the Division of Pediatric Anesthesia. In addition to hands-on training and didactic lectures, the residents participate and present pediatric topics at the weekly specialty conferences. Members of the CA-2 year have mandatory pediatric anesthesia time in their curriculum where they learn the basics of taking care of both healthy and critically ill children for a variety of procedures. Residents in their CA-3 year have the opportunity to spend additional time on a pediatric anesthesia elective rotation where they are offered even more challenging cases, procedures, and rapid turnover options.

Research Program

Dr. Scott Schulman is the Director of Pediatric Anesthesia Research and manages the ongoing opportunities for clinical trials in the Division. There is a wide range of options for research with a sound departmental research infrastructure that has been emulated nationally. Two of the members of the Division have participated in the Duke Clinical Research Institute in order to achieve a Masters of Clinical Research.

Pharmacology Research. Our group has had a long-standing interest in pediatric drug development in sedative, analgesic, neuromuscular blocking, and cardiovascular agents. Under the leadership of Dr. Schulman, there has been developed a comprehensive program in pharmacologic investigation that spans the operating rooms, recovery and ICU. Dr. Schulman has been a site principal investigator for several industry-sponsored trials in the perioperative setting and has also published articles on the ethical challenges of recruiting pediatric patients into clinical trials. More recently, Dr. Schulman has been active as a principal investigator in the large project on NIH Pediatric Off-Patent Drug study (PODS) for varying agents. Other projects include a study for the Duke Pediatric Cardiology Clinical Center’s Pediatric Heart Disease Clinical Research Network, and an NIH trial for the North Carolina Collaborative Pediatric Pharmacology Research Unit Network. All members of the Division participate in pharmacologic trials as they relate to the varying types of surgical procedures.

Physiologic Research. The physiologic effects of CPB on cerebral blood flow, cerebral metabolism, systemic inflammation, calcium regulation and cardio-respiratory interactions have been major focus areas for the members of the Division who manage children for cardiothoracic procedures. The faculty in pediatric cardiac anesthesia at Duke 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 dissolved oxygen on cerebral oxygen utilization during profound hypothermia. Members of the group have also described the effects of carbon dioxide on cerebral blood flow during deep hypothermia in children, and have pioneered the use of jugular venous saturation and near infrared spectroscopy as monitors for effective cooling of the brain prior to the institution of circulatory arrest. Presently, members of the faculty are actively involved with the use of NIRS and its value as a monitor for noncerebral blood flow.

Regional Anesthesia. Regional anesthesia has proven to lessen overall perioperative pain, facilitate early discharge from the PACU, and minimize the deleterious effects of general anesthesia and opioids in high-risk patients. Regional anesthesia continues to be a fertile area of research and publication for our group with emphasis on peripheral nerve blocks.

Other Clinical Research. Other members of the division are actively working on virtual airway trials and labs, the clinical effects of different agents for premedication, and the use of laryngeal masks for GI procedures. This is only a sample of the ongoing smaller trials that are continually managed throughout the Division.

Basic Science Research. Dr. Mayumi Homi has been an active researcher that has resulted in the development of models of neonatal brain ischemia. With continued work in this area, Dr. Homi hopes to describe the effects of anesthetics on the developing and injured brain.

Other Areas of Interest

Members of the Division of Pediatric Anesthesia at Duke have been officers and members of the Board of Directors in the Society for Pediatric Anesthesia as well as being active in the American Society of Anesthesiology and many of its branch committees. In addition, the faculty is represented on editorial boards for such journals as Anesthesia and Analgesia and Pediatric Anesthesia.

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Allison K. Ross, MD

Chief, Division of Pediatric Anesthesia
Associate Clinical Professor of Anesthesiology

Faculty

Warwick Ames, MBBS, FRCA
Guy deLisle Dear, MB, FRCA
John B. Eck, MD
Heather Frederick, MD
H. Mayumi Homi, MD
Richard J. Ing, MBBCh, FCA (SA)
Scott R. Schulman, MD, Chief, Section of Pediatric Cardiac Anesthesia
B. Craig Weldon, MD

CRNA Staff

Carleen Bagnall, CRNA
Donalie Guin, CRNA
Daniel Geniton, CRNA
Janet Goral, CRNA
Shelley Hilliard, CRNA
Carrie Kaylos, CRNA Lisa Lipscomb, CRNA

Support Staff

Myra Stein
Shelia Johnson