Anesthesiology Clinical Teaching Sites

The Department of Anesthesia at Le Bonheur Children’s Hospital (LCH) administers over 18,000 anesthetics annually. These cases are delivered in 17 operating rooms, two cardiac catherization labs, two MRI’s and a CT scanner. Two thousand (2,000) anesthetics occur at the pediatric surgery center (Le Bonheur East). Three hundred and twenty-five (325-350) open-heart procedures are performed in the hospital each year. The Society of Thoracic Surgeons has given the cardiac program at LCH three stars, its highest designation. Only 10 programs out of more than 140 receive such a rating. For the past several years, LCH has annually performed 14 heart transplants, five VAD’s, including Pedimag, Centrimag, and Heartmate/Heartware, and 500 cardiac catherization.

Anesthesiology at LCH supports the orthopedics program that performs spinal fusions, Vertical Expandable Prosthetic Titanium Rib (VEPTR) placement and growing rods from the MAGECTM (MAGnetic Expansion Control) System.  The orthopedic program is one of the highest rated in the nation and is in partnership with the Campbell Clinic. The neurosurgical program and tumor volume is one of the highest in the United States. LCH is one of only a few hospitals with an intraoperative MRI in a children’s hospital. In 2010, it was the first one to have a 3T IMRI in the USA.

Liver and Kidney transplants are performed as a part of Methodist University Hospital’s very highly rates solid organ transplant program. LCH has also performed surgery on a congenitally joined ischiophagus set of twins over the past two years and has done no less than three sets of patients over the past ten years — a very large and unique clinical experience. The hospital is a Level 1 Trauma Center and has one of the busiest pediatric emergency departments in the United States. The anesthesia department supports a very active regional anesthesia service and is engaged in collaborative research papers with several departments including orthopedics, ENT and cardiac surgery.

Operating within the department of Pediatric Medicine, the Division of Anesthesiology provided care for approximately 13,000 encounters in FY17 (including pain management) in all phases of pediatric anesthesiology throughout the hospital setting. This included diagnostic imaging, radiation oncology, surgery, the procedure room, the outpatient pain clinic and on the inpatient pain service.

Anesthetizing locations in diagnostic imaging include MRI, CT, nuclear medicine, PET, MIBG and interventional radiology. Three operating rooms host procedures such as intrathoracic and intraabdominal surgeries, as well as orthopedic oncologic procedures. Anesthesia is provided in a procedures area where typical oncology procedures such as lumbar punctures, bone marrow aspirates and biopsies and administration of intrathecal chemotherapy are performed. Anesthesiology is active in traditional radiation oncology (photon) for both treatments, MRI and CT simulations and in the world’s only dedicated pediatric proton treatment facility.

The Division of Anesthesiology assists the Division of Critical Care Medicine in providing anesthesia care for critically ill patients requiring bedside procedures and provides consultation for airway management in the ICU and for other emergencies as needed.

For pain management, the scope of clinical practice includes consultation for inpatients with complex medical conditions related to acute and chronic pain, and outpatient consultations in the pain clinic. Related to acute pain management, the spectrum of practice ranges from acute postoperative pain (with short duration of follow up) for invasive pain management (with continuous epidural catheters, continuous peripheral nerve catheters) to opioid patient controlled analgesia and continuous ketamine infusion or lidocaine infusion. The most prevalent consultations in a vast array of clinical circumstances are chronic neuropathic pain secondary to chemotherapeutic agents, tumor-related nerve compression, and bone marrow transplant related neuropathic chronic pain. Of a rarer nature, but requiring a high level of acuity of care, the service provides consultation and pain management for palliative care and at the end of life, in close collaboration with the Palliative Care service. 

There are ongoing research projects in pain management and peri-operative anesthesiology, as well as collaborations with Psychology, Neuro-Oncology, Radiology, Radiation Oncology, and Orthopedics among others. Recently, the Division focused on long-term effects of anesthesia and on influence of anesthetic management on cancer outcomes. Over the past 18 years, clinical research from the pain service has generated more than 50 manuscripts addressing multiple areas of pain management in pediatric oncology. 

Patient safety is a key focus of the Division of Anesthesiology. St. Jude is member institution of Wake Up Safe, the patient safety organization sponsored by the Society for Pediatric Anesthesia.