Unsung Heroes: Pediatric Cardiac Anesthesia at Boston Children’s

They are behind the scenes keeping patients alive during open heart surgeries, catheterizations, and electrophysiology procedures.  They are on-hand for echocardiograms, MRIs, CT scans and minor surgical procedures in the cath lab recovery room. They provide consultative input when cardiac patients undergo any kind of procedure at Boston Children’s Hospital.  They are the dedicated physicians and nurses of pediatric cardiac anesthesiology.The Heart Center at Boston Children’s has the largest dedicated pediatric cardiac anesthesiology department in the world. Every day, 15 anesthesiologists and five CRNAs (nurse anesthetists) staff four operating rooms, three catheterization labs, an electrophysiology (EP) lab and a cardiac MRI scanner.  “We also have specially trained nurse practitioners who work with us in the Cardiology Clinic,” says James DiNardo, MD, Chief of Cardiac Anesthesiology. “They can perform 90 percent of the patient intake. Without them, our group could never handle the volume of patients.”DiNardo says he was drawn to the field because of its inherent challenges.  “You can’t have a one-size-fits-all approach to anesthesiology when it comes to kids” he explains.  “You have to be more creative, more flexible and more cognizant of the child’s and parents’ needs. Every day is a new experience.”Kristen Odegard, MD, Clinical Director of the Cardiac Anesthesia Division and Director of the Pediatric Cardiac Anesthesia Fellowship, feels the same. She enjoys the variability of her work and the opportunity to encounter new challenges every day.  “Compared with the adult cardiac patient population, the patients we see are sicker, more fragile,” Odegard says.  She originally worked with adults, but prefers working in pediatrics because she feels “less like a technician, and more like a doctor on a team.” As the Fellowship Program Director, she also oversees the year-long training curriculum and teaches morning lecture sessions (start time: 6:30am!) on a rotating schedule with other attendings.

Members of department are also involved in research on top of their clinical work.  Current projects are investigating the long-term neurodevelopmental impact of anesthesia for open heart surgery in infants, the immunomodulation effects of anesthetic agents, and anticoagulation monitoring.

Odegard says that in her 17 years with the Heart Center, she has witnessed her department expand significantly and treat a growing number of patients.

“We are seeing more cases, and longer cases,” she explains.  “There are more international referrals, and international staff as well.”  Odegard herself is native to Norway, and can rattle off at least seven other countries her colleagues call home: Canada, Columbia, Germany, South Africa, Norway, England, and Japan.

Even though they come from different backgrounds, the group is very cohesive.  Says Odegard, “We work well together and help each other out. Communication is critical as a group gets bigger and bigger, and we have always emphasized that.”

Working well as part of a team among surgeons, cardiologists, nurses, administrators, and patient families is a huge part of the job for a cardiac anesthesiologist.

“We have to balance the daily schedules with family situations, and sometimes a child can be nervous or refuse to cooperate.  We have to be flexible and adapt to the unique circumstances that arise at a moment’s notice,” says DiNardo.

“It’s always intense, but it’s never boring,” Odegard adds with a smile.

Unlike many adult patients, pediatric patients often return for repeat surgeries or interventions. “Parents might remember you from their child’s first surgery, and they’re happy to see you again because they remember how you helped their child,” says Odegard.  “Seeing someone who had severe cardiomyopathy go through a successful transplant and return as a happy, healthy kid- that’s a wonderful feeling.”