Pediatric Anesthesiology Division

Best Medical Schools for Anesthesiology #4 in the nation.The Pediatric Anesthesiology Division provides expert care to all children in a family-centered environment. These pediatric specialized faculty are experts in managing a variety of surgeries, including general, transplant, open heart, orthopaedic, urological, and ear, nose, throat. The division’s comprehensive approach integrates specialized pain and regional anesthesia techniques to minimize postoperative discomfort. It has achieved national and international prominence through cutting-edge research in pain management and bleeding management during open heart surgeries.

Edmund H. Jooste, MB ChB - Chief, Pediatric Anesthesiology Division

Since pediatric anesthesiology first became a specialty nearly 20 years ago, remarkable progress has been made. The faculty numbers have tripled and the space and support to care for children of all ages continues to grow each year. Housed in a beautiful family-centered building, equipped with the necessary facilities and an exceptional team of faculty and staff, the future of pediatric anesthesiology is as bright as the environment in which these team members work.

Duke Children’s Hospital, known as Duke Children’s, and the Pediatric Anesthesiology Division are the premiere children’s hospital and pediatric anesthesiology division in the state. The 13 pediatric anesthesiology faculty and two fellows provide care to approximately 8,000 patients each year throughout the Duke University Health System and support Duke Children’s and Duke’s Department of Pediatrics for their sedation and airway needs in many different locations, including the intensive care units, Duke Radiology, Duke Ambulatory Surgery Center, and Duke Eye Center.

Duke Children’s is a Level-one trauma center with 8.6 dedicated pediatric operating rooms, 1.25 pediatric cardiac operating rooms, two cardiac catheterization labs, and two procedure rooms. The dedicated pediatric hospital entrance, preoperative, PACU areas, and operating rooms are both pediatric patient and family focused. Duke was one of the first pediatric centers verified by the American College of Surgeons as a Level 1 center for optimization of care for children and was recently re-verified in 2019. Additionally, it is a hemostasis and transfusion center of excellence.

The Pediatric Anesthesiology Division at Duke is a model for children’s care, and education and research excellence in a children’s hospital within a hospital. Unlike freestanding children’s hospitals, Duke Children’s has the ability to use the wealth of knowledge from adult colleagues to provide advanced care for pediatric patients. The access to medications and technology, not traditionally seen in children’s hospitals, shapes both clinical experience and research endeavors of the pediatric anesthesiology faculty.

In addition to exemplary clinical care and nationally-recognized training programs, the division promotes the development of faculty educators and innovative research to improve outcomes by enhancing quality and safety. Specifically, the division’s areas of research interests include pharmacodynamics and pharmacokinetics of anesthetic and pain agents in children, hemostasis strategies in pediatric cardiac patients, large database studies, and participation in many multicenter studies.

Under the directorship of Dr. John Eck, our Pediatric Anesthesiology Fellowship Program benefits from a customized schedule that provides extra training in our fellows’ area of interest. And, a second-year cardiac preceptorship is now offered to our pediatric anesthesiology fellows to provide advanced training in cardiothoracic anesthesiology, including ECHO. A testament to the commitment to resident teaching in our division is demonstrated through teaching scores where pediatric anesthesiology faculty consistently score higher than departmental averages.

The current fellowship schedule includes a 10-month pediatric anesthesiology rotation where fellows are exposed to complex surgical procedures in both general pediatric and pediatric cardiac surgery. The operating room rotation is the main opportunity for fellows to learn advanced pediatric airway, invasive monitoring and regional anesthesia skills (our fellows also acquire these procedures in numbers above the 50th percentile of the ACGME database). Training in pediatric cardiac anesthesia is not obtained in a block rotation, but is assigned one day per week throughout the year, allowing a progressive education throughout the year. One to two days per month are spent at the Duke Ambulatory Surgery Center learning regional anesthesia techniques and one to two days per month are spent in the Pediatric Cardiac Catheterization Lab. Occasional assignments occur outside the operating room, preparing fellows to provide anesthesia for a variety of radiologic imaging/interventional studies, minor invasive/diagnostic procedures and radiation therapy for infants and young children. One-month rotations in pediatric critical care (multidisciplinary and/or cardiac PICU) and pediatric acute pain provide fellows with extensive experience in the postoperative care of these complex patients.

A unique feature of the Duke Pediatric Anesthesiology Fellowship is that fellows have direct input into their daily case assignment. This allows fellows to help select “fellow-level” cases and to maintain an optional balance in the mix of cases throughout the year. Based on case log data from the ACGME, compiled for all 50 plus approved fellowship programs in the country, our fellows have consistently acquired numbers of cases at greater than the 50th percentile in the following case categories:

  1. Cardiac (>80%)
  2. Newborn (90%)
  3. Infants (1-11 months) (>90%)
  4. Craniofacial Reconstruction (>70%)
  5. Solid Organ Transplant (90%)
  6. Airway Surgery (75%)
  7. Fiberoptic Intubation, arterial cannulation, and central venous cannulation (>90)

Pediatric Congenital Cardiac Fellowship: Dr. Edmund Jooste was involved with the Congenital Cardiac Anesthesia Societies’ task force to apply for an ACGME-approved pediatric cardiac fellowship. This was recently approved and we look forward to creating the position at Duke.

Medical Students

In 2019, Dr. Elizabeth Malinzak was appointed the director of medical student education for Duke Anesthesiology. Under her leadership, the program welcomes students interested in shadowing or pursuing  research opportunities within anesthesiology. Students rotating throughout the division receive both clinical experience and didactic components through problem-based learning, simulation and didactic learning. The positive experience by the medical students on anesthesia rotation is evidenced by the roughly 10 percent of medical students who pursue anesthesiology as their specialty.

Additionally, Malinzak is a forerunner for diversity and inclusion in education evidenced by her grant from the American Society of Anesthesiologists (ASA) for education research on the subject.

Medical Student WebpageAnesthesia Group Interest

Residency

In 2021, US News & World Report ranked our department within Duke University #4 among the “Best Medical Schools for Anesthesiology.” As part of their training, the Duke Anesthesiology Residency Program includes a pediatric rotation. In order to maximize both learning and the overall experience, Malinzak developed simulations specific to pediatric scenarios and for crisis resource management. Additionally, she, alongside Drs. Kelly Machovec and Lisa Einhorn, are heavily involved in the resident leadership development series.

Continuing Medical Education

As part of Duke’s commitment to continuing medical education to provide exemplary patient care, Einhorn coordinates the division’s weekly pediatric conference. Each week, the pediatric anesthesiology faculty, fellows and residents on their monthly rotations engage in a collaborative discussion on a wide range of topics. Conferences include case presentations, journal clubs on recent research publications, morbidity and mortality reviews, and problem-based learning discussions. These meetings allow the group to continue to learn from each other on a regular basis and introduce our trainees to a variety of anesthetic considerations for pediatric patients.

The Pediatric Anesthesiology Division is very active with primary investigator initiated, societal and industry funded research. Much of the specific research has centered around pharmacokinetics and pharmacodynamics of anesthesia agents, pain research, hemostasis strategies in the congenital cardiac patients, and participation in large databases and multicenter studies. Drs. Edmund Jooste and Kelly Machovec have created and lead the Hemostasis Interest Group, a group associated with the Congenital Cardiac Anesthesia Society that facilitates research and collaboration among the top congenital heart centers in the country around hemostasis management following cardiopulmonary bypass in children. The entire division is involved in many anesthesia medication and pain studies that are either industry funded or part of NIH multi-center studies. Drs. Allison Ross, Lisa Einhorn and Andrea Udani are experts in pain management and regional pain blocks and have pioneered the use of and research into the use of regional techniques to decrease the use of opioids during surgery. Drs. Warwick Ames and H. Mayumi Homi continue to collaborate with members of the Department of Pediatrics in imaging studies for chronic disease, such as autism and cerebral palsy. Dr Brad Taicher is another very active researcher and in addition, is the department’s quality and safety officer with many innovative quality assurance projects that are changing the care in the pediatric perioperative arena. Drs. John Eck and Elizabeth Malinzak are our master educators for fellows, residents and medical students; they continue to study and innovate around teaching tools and educational options, which include flipped class rooms and simulations.

View the department’s competitive and non-competitive research grant awards by calendar year.

Please contact the Pediatric Anesthesiology Division’s interim staff assistant, Sarah McClaren, at 919-681-4877 or sarah.mcclaren@duke.edu with inquiries.

Divisional News

Chris KeithPediatric Anesthesiology Division