Pediatric Anesthesia Policy Statement on Provision of Pediatric Anesthesia Care

Þed|atr|c Anesthes|a Þo||cy Statement on Þrov|s|on of Þed|atr|c Anesthes|a Care

1he SocleLy for ÞedlaLrlc AnesLhesla (SÞA) has developed Lhe followlng sLaLemenL due Lo
lncreaslngly frequenL requesLs for advlce and supporL regardlng Lhe naLure of personnel and
faclllLles requlred Lo provlde varlous levels of pedlaLrlc anesLhesla servlcesŦ 1hese requesLs have
been dlrecLed Lo pedlaLrlc anesLheslologlsLs aL LerLlary care and pedlaLrlc hosplLalsţ as well as
Lhe SÞA and oLher organlzaLlonsŦ 1he quesLlons come from mulLlple sourcesţ lncludlng pracLlclng
anesLheslologlsLsţ pedlaLrlclansţ surgeonsţ and oLher physlclansţ hosplLals and oLher healLh care
faclllLlesţ and parenLs and oLher members of Lhe lay publlcŦ ln parLlcularţ lL ls apparenL LhaL
many anesLheslologlsLs and pedlaLrlclans ln Lhe communlLy feel under some slgnlflcanL amounL
of pressure Lo underLake Lhe perloperaLlve care of pedlaLrlc paLlenLs whoţ based upon facLors
lncludlng ageţ planned surgeryţ and/or coŴexlsLlng medlcal condlLlonsţ seem lnapproprlaLe ln
Lhelr pracLlce seLLlngŦ 1hls pressure has come from hosplLal admlnlsLraLorsţ PMCs and LhlrdŴ
parLy payersţ surgeonsţ and aL Llmes oLher members of Lhe anesLheslologlsLƌs pracLlce groupŦ

lL ls Lhe poslLlon of lLs communlLy and academlc anesLheslologlsL members of Lhe SÞA LhaL lL ls
lncumbenL upon lnsLlLuLlons and deparLmenLs provldlng care for pedlaLrlc paLlenLs Lo
prospecLlvely esLabllsh whaL pedlaLrlc surglcal and perloperaLlve servlces Lhe lnsLlLuLlon ls
capable of provldlng and deflne crlLerla for anesLheslologlsLsƌ and surgeonsƌ prlvllegesŦ
lurLhermoreţ Lhe members of Lhe SÞA malnLaln LhaL Lhere are cerLaln aspecLs and Lypes of
pedlaLrlc anesLhesla careţ lncludlng perloperaLlve care for lnfanLs and chlldren wlLh complex
medlcal dlseases and/or who are Lo undergo complex surglcal proceduresţ LhaL requlre unlque
skllls and ongolng experlence wlLh such cases on Lhe parL of Lhe anesLheslologlsLţ as well as
needlng speclal resources wlLhln Lhe lnsLlLuLlonŦ

1he followlng sLaLemenL ls based upon dellberaLlons of Lhe 8oard of ulrecLors and LxecuLlve
CommlLLee of Lhe SÞAţ buL also upon slmllar acLlvlLles conducLed by Lhe Callfornla SocleLy of
AnesLheslologlsLs (1)ţ Lhe AnesLhesla and Þaln ManagemenL SecLlon of Lhe Amerlcan Academy
of ÞedlaLrlcs (2)ţ a Lask force of Lhe CommlLLee on ÞedlaLrlc AnesLhesla of Lhe Amerlcan SocleLy
of AnesLheslologlsLs (3)ţ and a [olnL efforL of Lhe AnesLhesla ÞaLlenL SafeLy loundaLlon and Lhe
SÞAţ wlLh Lhe supporL of Lhe ASA (4)Ŧ

lL ls Lhe poslLlon of Lhe SÞA LhaL lL ls Lhe duLy and responslblllLy of local medlcal sLaffs Lo creaLe
and malnLaln approprlaLe pollcles and credenLlallng sLandards perLalnlng Lo Lhe perloperaLlve
care of lnfanLs and chlldrenŦ 1he elemenLs of Lhls pollcy should lncludeť


1Ŧ ÞerloperaLlve LnvlronmenL
A wrlLLen pollcyţ LhaL deflnes perloperaLlve care for pedlaLrlc paLlenLs ln Lhe lnsLlLuLlon should
be esLabllshed by Lhe medlcal sLaffŦ 1hls pollcy should deflne Lhe naLure of perloperaLlve care of
pedlaLrlc paLlenLs LhaL can be approprlaLely provlded wlLhln Lhe lnsLlLuLlonŦ Cverallţ Lhe
lnsLlLuLlonal resources and envlronmenL need Lo be able Lo fully supporL Lhe care of Lhe
pedlaLrlc paLlenL LhroughouL Lhe perloperaLlve perlodŦ 1hls pollcy should be based upon paLlenL
and cllnlcal facLors such as ageţ surglcal procedureţ and rlsk assessmenL (lncludlng boLh Lhe
planned surgery and coŴexlsLlng medlcal condlLlons)Ŧ necessary personnel lnclude
anesLheslologlsLsţ surgeonsţ pedlaLrlclansţ and nurses who have approprlaLe experlence ln Lhe
perloperaLlve care of pedlaLrlc surglcal paLlenLsţ as well as oLher healLh professlonals wlLh
sufflclenL pedlaLrlc experlence and experLlse such as radlologlsLsţ resplraLory LheraplsLsţ
pharmaclsLsţ and chlld llfe speclallsLsŦ 1he lnsLlLuLlon musL have Lhe medlcal equlpmenLţ and
oLher servlces such as blood bank and laboraLory servlcesţ approprlaLe Lo Lhe care belng
underLakenŦ An esLabllshed relaLlonshlp for consulLaLlonţ referralţ and LransporL Lo a speclallzed
pedlaLrlc cenLer should also exlsLŦ

2Ŧ Þrlvlleges
AnesLhesla for pedlaLrlc paLlenLs can be provlded dlrecLly or by dlrecL and lmmedlaLe
supervlslonŦ 1he local medlcal sLaffţ ln con[uncLlon wlLh Lhe faclllLyƌs deparLmenL of
anesLheslologyţ should esLabllsh crlLerla for Lhe anesLheLlc care of pedlaLrlc paLlenLsŦ 1he faclllLy
and lLs deparLmenL of anesLheslology should malnLaln a quallLy assessmenL and lmprovemenL
process for pedlaLrlc casesŦ 1he faclllLy and lLs deparLmenL of anesLheslology should deflne
paLlenL and rlsk caLegorles LhaL are aL lncreased rlsk for anesLheLlc and perloperaLlve
compllcaLlonsŦ Such paLlenLs requlre care by anesLheslologlsLs wlLh speclal cllnlcal prlvllegesţ
experlenceţ and LralnlngŦ 1he faclllLy and lLs anesLhesla deparLmenL should deflne Lhe level of
experlenceţ Lralnlngţ and conLlnulng educaLlon requlred Lo care for pedlaLrlc paLlenLs ln ƍ8egular
Cllnlcal Þrlvllegesƍ and ƍSpeclal Cllnlcal Þrlvllegesƍ caLegorlesŦ 8equlremenLs regardlng mlnlmal
volumes and Lypes of pedlaLrlc cases ln each of Lhese caLegorles should be deLermlned by Lhe
faclllLyƌs deparLmenL of anesLheslologyţ and approved by Lhe faclllLyƌs medlcal sLaff and
governlng boardŦ


8egular Cllnlcal Þrlvlleges
LxLenslon of regular cllnlcal prlvlleges for pedlaLrlc anesLhesla would be approprlaLe for
anesLheslologlsLs who are graduaLes of anesLheslology resldence Lralnlng programs LhaL are
accredlLed by Lhe AccredlLaLlon Councll for CraduaLe Medlcal LducaLlon or lLs equlvalenLŦ 1hey
should be boardŴellglble or boardŴcerLlfled ln AnesLheslologyŦ 1hey should have documenLed
currenL compeLence ln Lhe care of paLlenLs ln Lhls caLegory ln order Lo malnLaln Lhese prlvllegesŦ

Speclal Cllnlcal Þrlvlleges
1he faclllLyƌs deparLmenL of anesLheslology ls expecLed Lo deslgnaLe caLegorles of pedlaLrlc
paLlenLs as belng aL lncreased rlsk for compllcaLlonsŦ AnesLheslologlsLs carlng for Lhese paLlenLs
should meeL Lhe requlremenLs seL forLh aboveţ and ln addlLlon should be credenLlaled by Lhe
deparLmenL of anesLheslology for care ln Lhese lncreased rlsk caLegorlesŦ CraduaLlon from an
ACCMLŴaccredlLed fellowshlp program ln pedlaLrlc anesLheslaţ or lLs equlvalenLţ ls one crlLerlon
Lo be consldered ln Lhe credenLlallng of anesLheslologlsLs for ƍspeclal cllnlcal prlvlleges for
pedlaLrlc anesLheslologyƍŦ WlLh or wlLhouL prlor fellowshlp Lralnlngţ granLlng of ƍspeclal cllnlcal
prlvlleges for pedlaLrlc anesLheslologyƍ should lnclude demonsLraLlon of currenL cllnlcal
compeLence and experLlse ln Lhe care of such paLlenLsţ as deLermlned by Lhe faclllLyƌs
deparLmenL of anesLheslologyŦ

8eferences
1Ŧ CSA Þollcy on ÞedlaLrlc AnesLheslaŦ 8ulleLln of Lhe Callfornla SocleLy of ÞedlaLrlc
AnesLheslologlsLs 2003Ť !ulyŴSepLemberţ 33Ŵ33Ŧ
2Ŧ Culdellnes for Lhe ÞedlaLrlc ÞerloperaLlve LnvlronmenLŦ ÞedlaLrlcs 1999Ť103ť312Ŵ13Ŧ
3Ŧ ÞedlaLrlc AnesLhesla ÞracLlce 8ecommendaLlonsŦ
hLLpť//wwwŦasahqŦorg/cllnlcal/ÞedlaLrlcAnesLheslaŦpdf
4Ŧ SafeLy ln ÞedlaLrlc AnesLheslaŦ (AÞSl vldeoLape)