Division of Perioperative Anesthesia

The Preoperative (or "Pre-Op") Clinic at Boston Children's Hospital will likely be your first stop if your child is scheduled for surgery or other procedures performed under anesthesia.

At the Pre-Op Clinic, you’ll receive information about your child’s surgical visit, including:

• When your child should stop eating
• What time to arrive at the hospital
• What will happen during surgery
• How long your child will have to stay in the hospital

Our anesthesiologists will also review your child’s medical history and create a plan of care for both during and after surgery. Our preoperative nurse practitioners and doctors will be available to answer any questions you have about anesthesia and the surgical process.

We understand that having surgery or simply being at the hospital can be a frightening time for your child and for you, so we’ll do everything possible to make sure you’re prepared.

Boston Children's Hospital provides special surgical care in a family centered environment. Our caring, compassionate, and kid-friendly surgical team includes expert pediatric surgeons, anesthesiologists, and nurses, all extensively trained and experienced in pediatric surgical care.

If your child is scheduled for day surgery, he will not need to stay in the hospital overnight and will be able to go home the same day.

• Information on the Day Surgery Program

Members of the Neuroanesthesia Program at Boston Children’s Hospital are experts in providing anesthesia for neurosurgical procedures varying from simple to complex. Each patient under going neurosurgery at Boston Children's receives care from a team of individuals who work collaboratively along with the patient and family to provide state-of-the-art care.

Patients under general anesthesia, regardless of size or age, commonly receive oxygen and anesthetic gases far in excess of their needs. This excess gas is scavenged and discarded, contributing to environmental waste, pollution, and expense. During low-flow anesthesia, oxygen delivery is titrated to oxygen consumption, resulting in much lower total fresh gas flow. The technique of low-flow anesthesia allows the clinician to deliver amounts of oxygen and anesthetic gases that match the patient’s metabolic and clinical needs, and reduces the waste of resources, pollution, and greenhouse effects.

In addition to the reduction of waste, low-flow anesthesia provides other, tangible benefits to all patients, especially in pediatrics. Fresh gas delivered to the circuit is cold and dry, and is then heated to body temperature upon entering the lungs and, subsequently, humidified via evaporation. This process removes heat from the patient’s body and causes the loss of moisture from lung tissue. With the administration of low-flow anesthesia gases, this loss of heat and moisture from the patient body is minimized.

This practice of administering anesthesia provides patients with the amount of oxygen and anesthetic gases that directly match their metabolic and clinical profile, allows for better maintenance of patient temperature and humidity, and reduces patient recovery time. In addition to these benefits, low-flow anesthesia also prevents the loss of moisture from the patient’s lung tissue.

Millions of patients receive general anesthesia each year, and thus the use of low-flow techniques could generate substantial savings in anesthetic drug expenditure without reducing the patient's comfort or increasing adverse events. It can also provide a more tailored, patient-centered approach to administering anesthesia. A small group of Boston Children’s Hospital attending anesthesiologists and certified registered nurse anesthetists (CRNAs) are currently using the technique of low-flow anesthesia gases for the purpose of practicing clinical care techniques that are both safe to the patient and provide an economic method of administering anesthesia, as compared to common practices.

For questions, please contact:

• Robert Holzman, MD, MA (Hon), FAAP: Perioperative Anesthesia/Main-OR - robert.holzman@childrens.harvard.edu
• Craig McClain, MD, MPH: Perioperative Anesthesia/Main-OR - craig.mcclain@childrens.harvard.edu
• Andres Navedo-River, MD: Perioperative Anesthesia/Main-OR - andres.navedo@childrens.harvard.edu

Providing safe blood for transfusion remains a challenge despite advances in preventing the transmission of hepatitis B, hepatitis C, AIDS/HIV, West Nile virus (WNV), and transfusion-transmitted bacterial infection. Human errors such as misidentifying patients and drawing blood samples from the wrong person present much more of a risk than transmissible diseases. The introduction of screening practices for the presence of transmissible diseases has greatly improved the safety of the blood supply, while simultaneously shrinking the donor pool, creating blood shortages in the United States and worldwide. In fact, in many industrialized countries, less than 5% of the eligible population is blood donors.

As a result of this shortage, the global medical community has increasingly moved from allogeneic blood transfusions (blood collected from another person) towards autologous ones, in which patients receive their own blood. Intraoperative cell salvage (CS) — the process of collecting blood which is shed during surgery and re-infusing it into patients — reduces the need for allogeneic blood transfusion, results in fewer transfusion-related adverse events, and consequently, leads to greater quality of life and life expectancy as compared to surgery without CS.

As an effective and safe blood conservation strategy, CS also results in fewer transfusion-related reactions and infections. As an effective and safe blood conservation strategy, use of cell salvage has been shown to result in fewer transfusion-related adverse events; with a longer life expectancy for patients as compared to surgical procedures without cell saver. In addition to the patient benefits, the use of cell saver along with autologous blood pre-donation indicates a cost-saving benefit in pediatric surgical procedures. For example, savings from the use of Intraoperative Cell Salvage at Boston Children’s exceeded $213,000 in FY 2010 alone.

Another impetus for autologous transfusion is the position of various religious groups, including Jehovah's Witnesses, on blood transfusions. For religious reasons, Jehovah's Witnesses will not accept any allogeneic transfusions from a volunteer's blood donation, but may accept the use of autologous blood salvaged during surgery to restore their blood volume during the course of an operation.

Additionally, the department would like to explore the use of cell saver in other surgical procedures with the goal of constructing models to predict whether a perioperative blood transfusion is necessary, and if cell saver could be ordered instead of other additional blood products. Furthermore, expansion of intraoperative cell salvage to other pediatric surgical procedures will result in fewer adverse events and increase transfusions of a whole blood product to patients, delivering high levels of clotting factors and other imperative constituents such as viable platelets.

For questions, please contact:

• Robert Brustowicz, MD: Perioperative Anesthesia/MOR - robert.brustowicz@childrens.harvard.edu