Stanford Anesthesia Residents Pediatric Anesthesia Rotation Guide
PEDIATRIC PAIN MANAGEMENT
Rotation Contacts
Program Faculty:
Pain Management Program Chief
Rotation Director
Inpatient Attendings
Additional Pain Program Contacts:
Advanced Practice Nurse On Call
Administrative Assistant:
Pain Clinic APN & Coordinator
Elliot Krane, M.D. ekrane@stanford.edu pager: 13831
Julie Good, M.D. julieg@stanford.edu pager: 23194
Brenda Golianu, M.D. bgolianu@stanford.edu pager: 13344
Genevieve D’Souza, M.D. gdsouza@stanford.edu pager: 23376
Meredith Brooks, M.D. mrbrooks@stanford.edu pager:13849
Jeannie Seybold, M.D. jlo@stanford.edu pager: 13202
Pager 18779 (Sandy’s pager), office voicemail 650-497-8057
Sandy Sentivany-Collins, RN M.S. ssentivanycollins@lpch.org
Christina Almgren, PNP calmgren@lpch.org
Susan Lim susan.lim@stanford.edu 650-725-5848
Anh-Thu Nguyen, PNP atnguyen@lpch.org 650-724-5338
_____________________________________________________________________________________________
Length of Rotation: The 8-week pediatric anesthesia rotation is a required rotation in the Anesthesia residency.
Pediatric pain management education is a portion of this rotation.
Preferred Level of Training: All training levels are welcome, though most participate in the rotation in the CA1
and/or CA2 year, after having participated in the Adult Acute Pain Service.
A Pediatric Pain Management Elective may be pursued subsequently if the resident has specific interests and goals.
These can include participation in the management of in and outpatients with complex, chronic pain conditions,
those enrolled in our intensive outpatient day treatment program called PPPRC (Packard Pediatric Pain
Rehabilitation Center), and those followed for palliative care. Please contact Dr. Good at the above email for
information.
INTRODUCTION
The Pediatric Pain Management Inpatient Service provides care for children with acute and chronic pain, and other
symptoms arising in the course of straightforward and complex disease states. The Anesthesia Resident on his/her
Pediatric Anesthesia rotation will gain confidence to understand the role the anesthesiologist plays in initiating,
recommending and/or managing postoperative pain and related symptoms, and be given opportunities to engage in
supervised management of these conditions.
Through clinical care, didactic and case based sessions, emphasis will be placed on the peri-operative management
of straightforward acute pain conditions that are likely to be valuable in future practice. The resident will round on
postoperative patients in conjunction with the inpatient pain team and assume a shared responsibility with the pain
attending (and fellow if applicable) for the night time management of pain issues for this group of patients on our
service. Residents will learn when and how various treatment modalities are applied including oral analgesics,
opioids, adjuvant drugs, neuraxial and peripheral regional infusion techniques, acupuncture, biofeedback,
rehabilitation therapies, cognitive-behavioral therapy, hypnosis, family therapy, and massage.
ORIENTATION
An informal orientation to our service will take place on your first day of call for the rotation. This is a supplement
to the information provided during the formal orientation by the Pediatric Anesthesia Rotation Director. The
purpose of this meeting is to welcome you to our service, define your specific goals, and answer any questions. The
attending and advanced practice nurse for the day will be available, please page 18779 or the pain attending on
service after determining with your OR attending a good time to break for rounds to locate the pain team for this
meeting.
EVALUATION AND FEEDBACK
Residents can expect to receive direct feedback, and evaluation of performance on the pain aspects of the Pediatric
Anesthesia Rotation through evaluations in the Medhub evaluation system. Residents will be asked to evaluate the
rotation and the faculty via Medhub.
COURSE OBJECTIVES
(adapted from Society of Pediatric Anesthesia “Curriculum on Pediatric Anesthesia for Residents in Anesthesia” Litman et al,
accessed online 1/31/12 at http://pedsanesthesia.org/corecurriculum.iphtml AND American Board of Anesthesiology Content
Outline accessed 1/31/12 at http://www.theaba.org/pdf/ITEContentOutline.pdf )
Knowledge (K) and Skills (S)
I. Acute pain assessment
A. Understand methods for recognition and assessment of pain in all pediatric age groups (K)
B. Demonstrate appropriate use of each of the pain tools to assess pain in a pediatric patient (S)
II. Treatment of acute postoperative pain in children
A. Systemic medications
1. Understand the age related differences in use of opioid analgesics in children (K)
2. Demonstrate the ability to develop and carry out a plan to manage and treat postoperative pain
in children across all age groups (S)
3. Be able to evaluate a child for the use of patient-controlled analgesia (PCA), and demonstrate
appropriate ordering of PCA for all age groups. (S)
4. Be able to prevent, evaluate and treat common complications of analgesic therapy in children
(e.g., nausea, vomiting, pruritus, and ventilatory depression). (S)
5. Understand methods for converting patients to oral analgesics for postoperative pain (K)
B. Regional Analgesia
1. Know different regimens for peri-operative regional analgesia in children (K)
2. Be able to initiate and manage regional nerve block techniques, including caudal, epidural and
peripheral nerve blocks, including management of break through pain. (S)
REFERENCES
Overview (Access chapters online at www.expertconsult.com, using own login or contact Dr Good to obtain, hard
copy also available in Anesthesia Library)
1. Smith’s Anesthesia for Infants and Children, 8th Edition. Davis, Cladis and Motoyama, Eds. (2011). Chapter 15,
Pain Management, 419-451.
2. A Practice of Anesthesia for Infants and Children. Cote, Lerman and Todres, Eds. (2008). Chapter 44, Acute
Pain, 939-978.
3. Introduction to Pediatric Pain Management, PowerPoint presentation by Dr. Good, see Medhub.
Pain Assessment
1. Cote et al above (2008), p 939-946
2. https://intranet.lpch.org/formsPoliciesReferences/policies/hospitalWide/patientCare/painManagement.html
3. Pocket guide: Packard Assessment Tools: http://pedsanesthesia.stanford.edu/education/teaching_materials.html
Treatment of Acute Pediatric Pain
1. Kraemer FW, Rose JB. (2009). “Pharmacologic Management of Acute Pediatric Pain.” Anesth Clin 27:241-268.
2.Yaster M. (2010). “Multimodal analgesia in children” Eur J Anaesthesiol 27:851–857.
3. Krane EJ. (2008). “Patient-Controlled Analgesia: Proxy-Controlled Analgesia?” Anes Analg 107:15-17.
4. Voepel-Lewis T et al. (2008). “The prevalence of and risk factors for adverse events in children receiving patientcontrolled analgesia by proxy or patient controlled analgesia after surgery.” Anesth Analg 107:70–5
5. Nelson KL et al. (2010). “A National Survey of American Pediatric Anesthesiologists: Patient-Controlled
Analgesia and Other Intravenous Opioid Therapies in Pediatric Acute Pain Management” Anesth Analg 110(3): 754760.
6. Williams et al. (2002). “Pharmacogenetics of codeine metabolism in an urban population of children and its
implications for analgesic reliability” British Journal of Anaesthesia 89 (6): 839-45.
7. Geary et al. (2012). “Perioperative management of the child on long-term opioids” Pediatric Anesthesia 22(3):
189-202.
Regional Techniques/Management in Pediatrics
see also chapters under general, and Kraemer, Yaster articles under acute pediatric pain
1. Lo¨nnqvist PA (2011) “Blocks for pain management in children undergoing ambulatory surgery” Curr Opin
Anesthesiol 24:627–632.
2. Bosenberg AT, Johr M, Wolf AR. (2011). “Pro con debate: the use of regional vs systemic analgesia for neonatal
surgery” Pediatric Anesthesia 21(12):1247-58.
3. Ivani G and Mossetti V. (2010). “Continuous central and perineural infusions for postoperative pain control in
children” Current Opinion in Anaesthesiology 23:637–642
WEEKLY SCHEDULE
The Faculty on this rotation recognize the importance of structured education in a residency program; residents are
expected to attend morning teaching sessions, grand rounds, and their weekly conference. Service obligations that
arise during these times should be signed out to a member of the pain team . Please let Dr. Good know of any other
conflicts you’ll have with the rotation so that we can plan your time with us to meet or exceed your educational
goals.
MONDAY
6:45-8 Anesthesia
Grand Rounds
7:30 – 12
Pain
Rounds/Resident
(round then) to OR
8:30-12
Pain Clinic (Krane)
TUESDAY
6:30-7 3rd Tues
Case based teaching
session
8-9 Palliative Care
Meeting (biweekly
clinical, open to
residents)
7:30-12 Pain
Rounds/Resident
(round then) to OR
8:30-12 Pain Clinic
(Brooks)
WEDNESDAY
7:30 – 12
Pain
Rounds/Resident
(round then) to OR
THURSDAY
7:30-12
Pain
Rounds/Resident
(round then) to OR
8:30 – 12:00
Pain Clinic
(D’Souza)
8:30-12 Pain Clinic
(Golianu)
12:30-1:30 Pediatric
Pain Bi-Weekly
Meeting, QI process,
Journal Club
FRIDAY
7:30 – 12:00
Pain
Rounds/Resident
(round then) to OR
8-9 Pediatrics Grand
Rounds
1:30-3:30 PPPRC
Team
Meeting/Patient
Conferences
1-5 Pain Clinic or
Procedures (Krane),
Inpatient
consults/follow-up
1 – 5 Pain Clinic
(Brooks), Inpatient
consults/follow-up
1 – 5 Pain Clinic
(D’souza), Inpatient
consults/follow-up
1 – 5 Pain Clinic
(Golianu), Inpatient
consults/follow-up
1 – 5 Pain Clinic
(Golianu, Seybold,
Brooks), Inpatient
consults/follow-up
~4 Resident/Pain
Attending PM
Rounds
~4 Resident/Pain
Attending PM
Rounds
~4 Resident/Pain
Attending PM
Rounds
~4 Resident/Pain
Attending PM
Rounds
~4 Resident/Pain
Attending PM
Rounds
4:45-5:30 CA1
Lecture
4:45-5:30 CA2
Lecture
4:45-5:30 CA3
Lecture