Pediatric Anesthesia

Surgical Services / Operating Room Activity 

We provide anesthesia services for General and Thoracic surgery, ENT, Neurosurgery, Orthopedics, Plastics, Ophthalmology, Spine, Urology, Gynecology, Dental & Oral Maxillofacial, GI Endoscopy, and Interventional Radiology. 

In 2023, a total of 9223 (8348 in 2022) operating room cases were completed at the ACH, not including interventional radiology and induction room sedation cases. Of these, 7255 (6510 in 2022) were elective and 1968 (1838 in 2022) were emergency cases. 

Clinical Alternative Reimbursement Programs (ARPs)

The Pediatric Anesthesia Pain Services clinical ARP provides pediatric complex pain management, acute pain service, radiation therapy for oncology at the Tom Baker Cancer Centre, Bridging Pain Services (BPS), Intensive Pain and Rehabilitation Program (IPRP), oncology sedation, and burn dressings and care.

Acute Pain Service 

The Acute Pain Service led by Dr. Meggie Livingstone, and run by Sarah Shantz NP and Jessica Gill NP provides evidence-based pain and symptom management to postoperative and medical patients including patients with pain secondary to hematological and oncological issues, medical patients such as those who suffer from complications related to sickle cell disease, and complex pain patients.  

APS offers general anesthesia and sedation to oncology, hematology, and burn patients requiring painful procedures. We continue to be engaged in research and education to help implement best practices related to pain management throughout our hospital.

We have seen an increased demand for our Acute Pain Service team over the last few years with 4150 patient consults in 2023. This is showing a significant increase compared to previous years (2019 = 2424 consults, 2020 = 2834 consults , 2021 = 3074 consults , 2022 = 3209 consults).  We are also seeing an increased demand to care for Hematology and Oncology patients. In 2023, we provided anesthesia services for 369 pediatric patients undergoing a painful oncology procedures such as lumbar punctures or bone marrow biopsies / aspirates. 

Despite the success with a number of perioperative guidelines we continue to strive to improve patient outcomes and experience using multimodal analgesia and regional anesthetic techniques. 

Examples include: 

• Idiopathic Scoliosis / Posterior Instrumentation
• Cleft Palate Repair Guidelines
• Alveolar Bone Graft surgery
• Cranial Vault Reconstruction 

A new initiative over the last year has been the addition of cryoablation into our Nuss bars (pectus excavatum repair) clinical guideline. Patients receive intrathecal opioids, bilateral erector spinae plane blocks, and cryoablation at 3-4 intercostals levels. This new program offers excellent pain control, decreased opioid requirements and patients and families are very satisfied with the program.  

Complex Pain 

Overall, we have also seen a significant increase in complex pain visits in 2023 (539 visits) mainly due to the Bridging Pain Clinic. 

Complex Pain Clinic (CPC)

The Vi Riddell Pain Program continues to provide care to children and youth suffering from pain.  The Pediatric Complex Pain Clinic (CPC) assesses and manages children and their families in a hybrid model with new assessments most often in person, with many follow-up appointments completed virtually, to facilitate patient and family centered care. Care in CPC is provided by Dr. Kerryn Carter, Dr. Meggie Livingstone and Dr. Nivez Rasic.  We are also joined by an outstanding multidisciplinary team, with one psychologist (Dr. Torie Carlson), two physiotherapists (Ms. Amanda De Chastelain, Ms. Kate Gerry), our clinic nurse (Ms. Kelsey Barrie), our nurse program coordinator (Ms. Laura Rayner), and clerk (Ms. Lisa Burger). We welcome Ms. Kate Gerry to our team from the adult pain clinic and Ms. Lisa Burger back to our pain team after a hiatus! Our AHS program administrators are Ms. Megan Mill and Ms. Louise Mills.  We have restarted the Comfortability program, a one-day educational workshop providing children and parents with tools to be able to self-manage pain. A team from Boston Children’s Hospital came to ACH in June, to train staff on how to administer this program. This last year has been marked by staffing changes and challenges with the allied health and clerical teams, which seems to be a fairly widespread challenge throughout the site since the pandemic. Furthermore, the burden of illness and disability amongst our patients continues to grow. Our core team has welcomed new staff and “showed them the ropes” in an effort to continue to provide excellent care to our patients and families. We have seen over 120 new patients this year and over 250 follow ups in CPC. 

Intensive Pain & Rehabilitation Program

The Intensive Pain & Rehabilitation Program is continuing to run three cohorts a year.  This 3-week outpatient day treatment program is designed to improve functional outcomes for youth living with severe pain and associated disability.  It was the first program in Canada, launched in 2014, which means we have now reached our 10 year milestone!  It is the gold standard of care for youth with this condition. It is closely aligned with the research program, run by Dr. Miller, that is embedded within the Vi Riddell Program. All youth receive an MRI prior to starting the program and at discharge, to study neurologic changes associated with functional improvement.  Furthermore, repetitive Transcranial Magnetic Stimulation has been added as a treatment modality, which is the first program in the world to do so. Our team has presented extensively at scientific meetings on the work that has been done in this innovative program.

Bridging Pain Service

The Bridging Pain Service (BPS) is a new program developed and run out of the department of Pediatric Anesthesia. The program’s leads are Ms. Sarah Shantz NP and Dr. Nivez Rasic. Physicians involved clinically include Drs. Kerryn Carter, Nivez Rasic, Meggie Livingstone and Debbie McAllister.

The BPS supports families and youth experiencing pain with the goal of bridging the gap between the acute and chronic pain services. The development of chronic post-surgical pain (CPSP) affects 10-30% of surgical patients (latest data suggests that 25% of youth develop CPSP after major surgery), and additionally, many patients develop persistent opioid use after surgery to manage lingering pain.  The implementation of this service fills the gap in care and is the widely accepted solution to this problem.

The goals of the BPS include:

• Reducing the risk of children developing chronic pain
• Ensuring the continuance of pain care and close follow up after hospital discharge to provide:
• Appropriate analgesia management including opioid stewardship
• Access to education and resources for self-management techniques, and support coordination where required with the multidisciplinary team

The program has proven itself to be very successful with referrals from a mix of medical and surgical specialties. Over the course of the past year, the clinic has seen 130 patients, each with multiple, separate encounters.

The Pediatric Anesthesia Care Outside Alberta Children’s Operating Room (Out of OR) clinical ARP provides operating room induction sedation services, MRI/CT, preoperative assessment clinic, and remote pediatric work at adult sites including RGH (Ophthalmology), PLC (ERCP), FMC (MRT, Angiography / IR, Cardiac Ablations, PDA ligations), and Tom Baker Cancer Center (Radiation Therapy, PET scans). We have significantly increased the number and types of procedures offered as part of our sedation service while we continue to provide support for more remote location work than ever before. 

In 2023, we provided 1487 anesthetics related to diagnostic imaging (MRI – cardiac and non-cardiac, CT, and interventional radiology procedures).  We completed 1155 hands-on procedures which include urgent surgical consults, anesthetics for wound and burn dressings, Botox injections for children with spasticity, difficult IV insertions, and supported various emergency airway activations, resuscitations, and surgeries. 

The Out of OR induction sedation service has grown exponentially over the last two years (255 cases in 2022 and 466 cases in 2023), with the ability for all pediatric specialties at ACH to access this service. The induction sedation service offers  a safe and effective setting for treating pediatric patients presenting for many different painful procedures. This care bypasses what has historically required operating room time; therefore, leading to improved patient access and significant cost savings for our system. 

The Out of OR Anesthesiologist provided anesthesia to 52 pediatric patients requiring specialty surgery at the above-listed remote locations in the past year. 

Finally, we completed 279 preoperative anesthesia consultations during our weekly scheduled POAC (Friday preoperative assessment clinic) days, in addition to the urgent consults we complete throughout the week. 

Education within the Section of Pediatric Anesthesia 

We continue to offer a range of activities aimed at educating clinical clerks, anesthesia residents, pain residents and non-anesthesia residents (pediatrics, emergency medicine), fellows (pediatric anesthesia, PICU, pediatrics), and other healthcare professionals about the principles, practices, and advancements in anesthesia care and pediatric pain medicine. Our section members are involved in Clinical Supervision and Mentorship, Didactic Teaching and Simulation-Based Education, as well Research and Scholarly Activities.  

Many colleagues are actively involved in research, including supervising research projects conducted by medical students, residents and graduate students, fostering an environment of inquiry and evidence-based practice within the specialty.

Simulation 

Drs. Mark Gale and Karthik Sabapathi lead our simulation team.

Following an absence of regular simulation since Covid-19, the Perioperative Crisis Management Course (POCM) was once again offered at the Alberta Children’s Hospital. Perioperative Crisis Management Course (POCM) is an all-day simulation course designed and developed at the ACH to improve crisis management in our operating rooms.  POCM is a multidisciplinary, inter-professional course involving OR RNs, PACU RNs, pediatric Anesthesiologists, Pediatric Surgeons, and RTs.  The course involves four simulated crises scenarios based on our last one-year experience in the perioperative environment.  Cases which have been reviewed at our Quality Improvement / Quality Assurance rounds are used as a foundation for scenario development. Leads: Drs. Karthik Sabapathi and Mark Gale. The course was a huge success with participation from Anesthesia, Surgery and Nursing colleagues. It is planned to be offered a few times every year. 

Managing Emergencies in Pediatric Anesthesia (MEPA) for residents.  This full day simulation course aims to give all anesthesia trainees the opportunity to develop management strategies for emergencies in pediatric anesthesia through the use of high-fidelity simulation. Lead: Dr. Karthik Sabapathi.

Continuing Medical Education 

Continuing Medical Education (CME) related to pediatric anesthesia plays a crucial role in ensuring that healthcare professionals stay updated with the latest advancements, guidelines, and best practices in this specialized field. 

We have an active CME program led by Dr. Elisabeth Dobereiner who is responsible for planning and organizing Friday morning rounds. In 2023, Dr. Dobereiner organized some fantastic rounds including a few multidisciplinary sessions involving PICU, NICU, surgical and nursing colleagues. 

Patient Safety and Quality Improvement 

ACH has been a strong supporter of patient safety and quality improvement initiatives. RLS rounds and Educational Case rounds based on significant events are held regularly, and attended by multidisciplinary teams in order to drive improvements. This year the ACH OR has been looking at the Safe Surgery Checklist and Surgical Time-out process to better fit the needs of our patients. Standardized perioperative protocols for Nuss Bar procedures, cleft palate and alveolar cleft procedures, posterior spinal instrumentation have improved patient care by improving pain management while decreasing narcotic use and length of stay. These initiatives are a testament to the collaborative efforts of our Pediatric Anesthesia Section, and surgical and nursing colleagues.