Pediatric Anesthesiology Research

The preoperative area can be a stressful time for patients and parents, however better understanding each patient and prescribing better appropriate care can make the transition to the operating room go much smoother.

• Reducing anxiety without medications: We demonstrated that, for many children, watching a movie or playing a video game on an iPad while going back to surgery works just as well giving a giving a medication. We have since taken these results and made it standard practice.
• Determining differences to individual care: We believe every parent and child is unique, and their care plan should reflect this. With dozens of families a year have two or more siblings undergoing the same procedure, on the same day, with the same surgeon and anesthesiologist, we seek to pinpoint psychosocial differences between families and children.

Postoperative pain is a source of distress to patients and families. From the tip of a needle to multi-departmental collaboration, our goal is to manage pain while identifying strategies to minimize opioid consumption and its side-effects.

• Nerve Blocks & Regional Anesthesia: Injection of small volumes of local anesthetic near a nerve can block transmission of pain signals to the brain while the tissue heals, which promotes faster recovery and fewer opioids. An early adopter and leader in the field, we have evaluated new techniques, re-evaluated old ones, and searched for safer methods of delivering regional anesthesia with techniques such as ultrasound-guidance.
• Tonsillectomy Adjuncts and Best Practices: With almost ½ million tonsillectomies performed annually, our investigators have focused on reducing pain and speeding up recovery by prospectively identifying novel non-opioid strategies to manage pain, such as Magnesium and Lidocaine, through randomized-controlled-trials and retrospectively looking at every teenager who has had a tonsillectomy to gain insights on controlling pain.
• Enhanced Recovery After Surgery Pathways (ERAS): Collaborating with other departments, our anesthesiologists have played an important role in identifying and evaluating best perioperative medications and anesthetic management techniques as part of multi-team efforts to establish best practices in major surgeries such as spine correction, pectus excavatum, and urological procedures.

Airway management in children with difficult airways is associated with significant morbidity under anesthesia and in the critical care units. There are several studies, including multi-center that members of the department are involved in and include:

• Best practices for airway management in children- devices, effective approaches
• Clinical guidelines and algorithms
• Patient safety during emergency and difficult airway management

Practice makes perfect and preparing for what’s ahead is an important element of every anesthetic delivered. Through internal initiatives and the Northwestern Center for Clinical Simulation, we aim to prepare our physicians for every situation. 

• Utilizing Ultrasound for Difficult IV Access: Led by Heather Ballard, MD, through a FAED Seed Grant, we aim to train and re-train all anesthesia providers in difficult IV insertion to reduce the number of attempts needed. On custom designed manikin models created by the Northwestern Fab Lab.
• Communication: Fellowship trainees attend simulations held at the Northwestern Center for Clinical Simulation to learn how to best communicate with their peers and parents, especially in difficult situations. We are evaluating how to make this training as efficient and impactful as possible in this rapidly emerging area of simulation training.

Some big questions require data analysis from thousands, tens or hundreds of thousands of patients.

• Unplanned Re-Intubation: Needing a breathing tube soon after removing a previous breathing tube is an undesirable event occurring only 0.2 percent of the time. We developed a novel model with data from 87,000+ patients to identify risk factors which may predict this rare event.
• Low sodium and patient outcomes: In an analysis of 150,000+ patients, Eric Cheon, MD, described a novel association in pediatric patients of low sodium levels and poor outcomes.