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Pediatric anesthesiologists give children the medications needed to
sedate them or put them completely to sleep during surgery and other
procedures. They also monitor children’s heart rate and other health
measures while surgery is going on.
Small children needing more serious medical care should be treated
by pediatric anesthesiologists, who have a special certification to
work with children, rather than doctors without this training,
according to new guidelines from the American College of Surgeons.
However, many young children with medical needs, particularly in
rural areas, live more than 50 miles away from a pediatric
anesthesiologist, the researchers write in the journal Anesthesia
and Analgesia.
“Families are faced with the choice of traveling long distances to
centers where experts practice, or to utilize the services of
anesthesiologists in their locality who may care for children on an
occasional basis only,” lead author Dr. Matthew Muffly told Reuters
Health by email.
In addition to surgery, very young children may need anesthesia to
stay still during procedures like body scans, and their risks of
complications from sedative medications are much higher than those
of older children, said Muffly of Stanford University Medical Center
in California.
Using four medical registries and databases, Muffly and colleagues
identified just over 4,000 pediatric anesthesiologists practicing in
the U.S. in 2015. They compared this information with 2010 census
data on children under the age of 18 and created a map of driving
distances of families to the nearest pediatric anesthesiologist.
The results showed that 90 percent of child anesthesiologists work
in urban areas, which the researchers defined as counties with more
than 50,000 young children.
The majority of children, 71 percent, live within a 25-mile drive of
a pediatric anesthesiologist.
But more than 10 million children, or nearly 15 percent, live more
than 50 miles from the nearest pediatric anesthesiologist,
particularly in the western region of the country.
This includes more than 2.7 million children under age 5 – the group
that needs these specialists the most, according to the American
College of Surgeons.
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Muffly told Reuters Health that six states had ten or fewer
pediatric anesthesiologists: Alaska, Idaho, Montana, North Dakota,
South Dakota, and Wyoming.
“Younger children have physical and emotional needs that obviously
differ from adults. Their anatomy and physiology, particularly under
anesthesia, change in ways that are unlike anesthetized adult
patients,” Dr. Alison Ross, chief of the pediatric anesthesia
division at Duke University Medical Center, said by email.
Ross stressed the importance of specialized training but noted that
in areas without trained pediatric anesthesiologists, medical
facilities are likely to have staff with a lot of experience
treating children.
“It is important to realize that it is often more important in an
emergency to be taken to the nearest facility for care rather than
to delay care due to a desire to be in a pediatric facility,
depending on the nature of the event or the medical condition of the
child,” said Ross, who was not involved in the study.
Muffly said that for families living far from pediatric
anesthesiologists, older children may fare perfectly well. “But for
young children,” he added, “particularly younger than 2 years old,
and for older children with complex medical conditions, they may
need to travel to an institution that routinely cares for these
vulnerable patients.”
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