The Cardiac Anesthesiologist at The Children’s Hospital
from Practice Update, Winter 2004
By Robert H. Friesen, MD, Director of Cardiac Anesthesia
The field of pediatric cardiac anesthesiology has evolved along with that of cardiac surgery. The cardiac anesthesia group functions as a member of a team of cardiologists, surgeons, intensivists, nurses and perfusionists. As both patients and procedures become more complex, the role of the anesthesiologist has become increasingly specialized. It is essential to have a solid understanding of the pathophysiology of complex congenital heart disease, to appreciate the cardiovascular effects of anesthetic drugs, to be facile with invasive hemodynamic monitoring techniques, and to be familiar with the intricacies of cardiopulmonary bypass and surgical techniques. In such a highly technical setting, we strive to remain focused on the child—to allay fear, to ease pain, to ensure safety and to use our knowledge and skills to achieve a healthy outcome.
The Children’s Hospital has a special team of pediatric cardiac anesthesiologists who provide anesthetic care for the many infants and children who undergo surgical repair of congenital heart defects. The team consists of five anesthesiologists with extra experience and interest in congenital heart disease. Team members are Robert Friesen, MD, Rafael Campanini, MD, Peter Fritz, MD, Glenn Merritt, MD, and Kim Weigers, MD. The goals of the cardiac anesthesia team are to provide expertise in clinical care, excellence in teaching, achievement in research, and quality in program development.
The cardiac anesthesiologists provide perioperative clinical care to all cardiothoracic surgical patients for both open and closed cardiothoracic operations—nearly 500 procedures at Children’s in 2003. In addition, we care for children undergoing the more complex interventional cardiac catheterization procedures. Perioperative anesthetic care includes participation in the weekly cardiac surgery case conference, preoperative evaluation of the patient and discussion with the family, intraoperative anesthetic care, postoperative transition to the cardiac intensive care unit and postoperative evaluation of the patient.
In addition to clinical roles, the team is dedicated to teaching, research and program development. The department of Anesthesiology of the University of Colorado has a pediatric anesthesia fellowship program at The Children’s Hospital and we teach the anesthetic implications of congenital heart disease to our fellows, to residents in anesthesiology and pediatrics, and to medical students.
Research activities in pediatric cardiac anesthesia have resulted in national presentations of scientific abstracts and articles in leading journals. Recent work includes hemodynamic effects of anesthetic drugs, respiratory effects of sedative drugs in cardiac patients, development of fast-track anesthetics for pediatric cardiac patients, modified ultrafiltration, coagulopathy associated with cardiopulmonary bypass and quality of sedation in the ICU.
As The Children’s Hospital Heart Institute continues to evolve and grow, the cardiac anesthesia team also expands its participation. Future plans include the development of neonatal cardiac anesthesia protocols, critical pathways for clinical case management, the protocol for fast-track cardiac anesthesia, and design of the cardiac areas in the new Children’s Hospital on the Fitzsimons campus.
