Peds is good. The babies are cute. Actually, this is a problem on rounds, because I would rather play with the babies than pay attention to the details of calculating their feedings or TPN orders.
The anesthesia part is amazing. Anesthesia for these tiny babies is incredibly delicate. The ET tubes for the smallest babies are about the size of an adult venous introducer. . . And for the older children, the finesse with which the anesthesiologists talk them into staying calm during the trip back to the OR (admittedly, with the help of versed) is impressive. For adults, induction of anesthesia is usually performed with an iv agent – quick. For kids, though, they avoid putting in an iv until they already have them asleep with an inhalational agent – which means they have to be bagged the whole time an iv is being found on their tiny hands or arms.
Not to mention the matter of waking up: In adults, you like to get some definite responses to commands before actually pulling the tube out. For kids, there’s no way they’re going to do anything coherent while still coming out of anesthesia, so the anesthesiologists have to just pick a moment when they think the child is awake enough, and doing some spontaneous respiration, to pull the tube out, and wait to see what happens. After all, they’re small, and easy to ventilate by hand if they need a few more minutes to wake up. (Some anesthesiologist will no doubt come by and explain that there’s a lot more detailed calculation involved. Either way, I’m impressed.)
Cut On The Dotted Line 
December 6, 2008 at 3:05 pm
It’s been a long time since I visited your blog. A bit ironic too, since this is the first post I see and I’m doing my last pediatric anesthesiology rotation now.
A lot of anesthesiology residents find pediatric anesthesia rather intimidating, but I don’t think there are secret criteria for extubation. If the child is crying, clinching eyelids closed, or reaching for the breathing tube, these all suggest he’s ready to extubate. And you’re right, regular respiration is key.
I’m very impressed with the finesse of pediatric surgeons. They operate on babies whose bellies are the size of an orange, or hearts barely bigger than a pecan. The ones I’ve worked with all seem very professional, kind, and good with both parents and kids.