Anesthesia care under one roof
In October, Children's Hospital Boston and the Dana-Farber Cancer Institute (DFCI) turned another new corner in their more than 50-year partnership to treat young cancer patients when Children's began offering general anesthesia services onsite at the Jimmy Fund Clinic.
The service allows many patients to receive all their therapy and procedures in one place, rather than traveling between the Jimmy Fund clinic for treatment and lab tests, and to Children's for procedures requiring anesthesia. The service is provided on Tuesdays and Fridays by anesthesiologists from Children's, with brand-new equipment and specially trained support staff.
A new exam room at the Jimmy Fund Clinic features special outlets and wall connections for anesthesia delivery and monitoring equipment. In addition, Jimmy Fund Clinic nurses have trained at Children's to help patients recover from anesthesia, while Children's operating room staff have been credentialed at DFCI so they can be on hand if DFCI staff have questions or need help.
"Some of our patients undergo painful procedures, such as lumbar punctures [in which a needle is inserted into the spinal canal to extract fluid], bone marrow aspirates and biopsies [in which a needle is used to remove marrow from bones]," says Jimmy Fund Clinic Medical Director Lewis Silverman, MD, who helped organize the new service.
"To alleviate pain, we've used either local anesthetics [which numb the area around the needle entry site] or short-acting sedatives that block pain and cause drowsiness," he says. "But for some patients, especially younger children, anxiety and discomfort are still a significant problem."
That's where Children's anesthesiologist Rosalie Tassone, MD, director of the new service, and her team come in. "We aim to provide the same level of comfort and safety for those select patients by streamlining their procedures under general anesthesia at DFCI," she says. "In doing this, we're shortening a patient's 'downtime' by eliminating the need to move from institution to institution; we're coordinating multiple services more easily; and we're lessening the burden of a demanding OR schedule."
The service is generally available to Jimmy Fund Clinic patients who have had a high level of pain and anxiety during past procedures and are judged healthy enough to receive general anesthesia in an outpatient setting. Danielle Mocarski, RN, an anesthesiology nurse, screens candidates and talks with patients' families about the procedure. She then consults with Tassone.
During the procedure, Tassone, or a colleague from Children's, administers intravenously a powerful anesthetic agent called propofol. "Our ultimate goal is that kids will associate procedures like lumbar punctures or bone marrow biopsies with taking a nap," says Tassone. "It's bad enough to have cancer; trauma associated with treatment can make it even worse. With general anesthesia, we can erase that trauma, so children don't have to carry it into the future."
printer friendly version