Pediatric Anesthesiology Rotation
Curricular Milestones
Preparation:
1. Facilitates smooth and timely start of case by coordination with anesthesia techs,
pre-op RN, OR RN, and surgical attending
2. Sets up OR with appropriate equipment and medications for case
3. Attends morning lectures and Grand Rounds
4. Prepares for cases ensuring s/he has the knowledge relating to patient conditions
and procedure
5. Sees and consents inpatients in a timely manner prior to procedure.
6. Discusses cases (via formal patient presentation) and plan with attending in a timely
manner (includes contacting the attending the day before for complex or unfamiliar
cases)
Basic Pre-op assessment and planning:
1. Identifies patients that require pre-anesthesia medication, prescribes appropriate
medication/ dose/route, and ensures it is given in a timely fashion
2. Pre-op assessment on chart is timely, accurate, and complete
3. Interacts professionally and communicates well with guardian/family and patients
on an age appropriate level
4. Describes anesthetic plan and risks to family/ guardian/ patient including what to
expect during induction and recovery.
5. Selects and reviews appropriate anesthetic technique for intra op management
Advanced Pre-op assessment and Planning:
1. Selects and reviews applicable regional analgesia techniques
2. Correctly identifies patient indications and contraindications for neuraxial/regional
blocks
3. Identifies patients that may require advanced airway management techniques
4. Accurately examines and describes patients with acute illness and other abnormal
physical exam findings
5. Identifies pertinent abnormal lab and imaging results and modifies anesthetic plan
accordingly
6. Identifies and develops a plan to navigate potential ethical issues (i.e. blood
transfusion refusal by guardian)
Pre-op assessment and planning for neonates and infants
1. Identifies and accurately describes age-specific challenges for anesthesia and
comorbidities
2. Identifies patients that will require post op admission due to age
3. Correctly modifies anesthetic plan to account for pre-term birth and other common
neonatal issues (e.g. lung disease, apnea, immature organ systems)
Pre-op assessment and planning for >1 yr olds
1. Identifies age-appropriate techniques to facilitate a smooth induction
2. Identifies and accurately describes age specific comorbidities and modifies plan
accordingly
Pre-op assessment and planning for patients with comorbidities
1. Identifies patients with contraindications for succinylcholine and volatile
anesthetics
2. Modifies anesthetic plan for comorbidities
3. Identifies patients with acute issues (e.g. respiratory infections, NPO violations) and
knows when rescheduling would be appropriate
4. Recognizes metabolic disorders and develops a plan to manage safely
5. Understands the comorbidities of commonly seen diagnoses in pediatric (e.g.
Trisomy 21, OSA, CP, CF, cancers) and correctly modifies plan.
6. Identifies prior anesthetic issues and plans accordingly
Procedures:
1. Placement of a PIV in an infant
2. Placement of a PIV in a child or young adult
3. Placement of a arterial line in an infant
4. Placement of a arterial line in a child or young adult
5. Understands and uses appropriate sterile technique for all procedures
6. Makes age appropriate modifications for procedures, including techniques and
equipment.
7. Placement of caudal blocks and pediatric lumbar epidurals
8. Placement of peripheral nerve blocks
Airway management:
1. Makes an appropriate plan and gets equipment ready based on pre-procedure
airway assessment
2. Demonstrates skill in mask ventilation and mask induction for infants and neonates
3. Demonstrates skill at managing airway by mask ventilation for children and young
adults
4. Demonstrates skill at securing the pediatric airway atraumatically
5. Uses the correctly sized equipment in the appropriate manner, including ETT, blade,
LMA, etc.
6. Continually assesses the patient’s airway and ventilation and makes adjustments as
necessary
7. Manages peri-procedure airway problems properly including upper airway
obstruction, laryngospasm, stridor, and bronchospasm.
Teamwork and Communication
1. Communicates effectively with all care team members with respect in a way that
fosters teamwork and mutual respect
2. Communicates with attending effectively and asks for help appropriately
3. Follows procedures for post-op handoff communication with ICU and PACU staff
4. Provides accurate and concise handoffs to subsequent providers when relieved of
care.
5. Appropriately contributes to the care of patients during out of OR emergencies
6. Effectively and professionally carries out call coverage for the Acute Pain Service
including communication and documentation.
7. Documents reportable QI events and trauma/code events
8. Communicates and coordinates post op analgesic plan with APS
Delivery of anesthetic
1. Follows time-in, debrief, handoff, and other peri procedure policies
2. Maintains appropriate vigilance at all times during patient care
3. Avoids inappropriate distractions during patient care
4. Takes all appropriate measures to avoid infections (e.g. excellent hand hygiene,
cleaning of injection ports, capping lines, isolating dirty equipment, changing dirty
gloves, returning used drugs before subsequent patients enter the room, using
probe covers)
5. Secures necessary vascular access to facilitate administration of medications, fluids,
blood.
6. Uses additional monitoring as needed for age, comorbidities, and case
7. Delivers correct age and size based drug dosing for induction and intra-op
management
8. Maintains normal vital signs including temp, for age
9. Estimates and manages fluid loss and replacement correctly for age and size
10. Estimates and manages blood loss and replacement correctly for age and size
11. Does not give medications that would be contra-indicated due to patient age, size,
condition, or case.
Management of intra operative problems
1. Identifies problems as early as possible and takes appropriate action
2. Demonstrates knowledge of the basic elements of pediatric resuscitation
3. Correctly manages common OR problems
Emergence and post-op
1. Reversal of anesthesia and airway in a smooth and appropriate manner for case,
patient’s age, comorbidities
2. Follows through on analgesic plan that is effective, safe, and appropriate for age and
case
3. Delivers anesthesia care to ensure the most efficient PACU discharge and avoids
prolonged stays
4. Writes appropriate post op orders and post-op notes
5. Documents follow-up visits on inpatients,
6. Foresees likely post op problems and proactively takes measures to avoid them
7. Manages post op problems effectively
8. Determines the appropriate post procedure disposition and escalates care as
needed.