Pediatric anesthesia: "I would object to a specialty medical training"

Interview with Dr. Karin Becke, Spokesperson of the Scientific Working Group of Pediatric Anesthesia of the DGAI, Chief Physician of the Department for Anesthesiology and Intensive Medicine at the Hallerwiese Clinic/Cnopf'sche Pediatric Clinic

When very young children already need to be in the operating room, it’s not just the parents that are concerned. This type of situation is a special challenge for the entire operating team, because children are always very special patients - especially since they are not just simply small grown-ups!


Photo: Female physician with glasses and long red hair - Dr. Karin Becke; Copyright: private

Dr. Karin Becke; © private spoke with Dr. Karin Becke, Spokesperson of the Scientific Working Group of Pediatric Anesthesia of the DGAI and Chief Physician of the Department for Anesthesiology and Intensive Medicine at the Hallerwiese Clinic/Cnopf'sche Pediatric Clinic.

Dr. Becke, anesthesia always carries risks. What is the difference between anesthesia for an adult and a child?

Dr. Karin Becke
: The biggest difference is between very small children, the one and two-year-olds and adults. The child's body still needs to adjust during this stage of development to develop the function of mature organs like adults have. During this time, children are very susceptible to complications, because there is a discrepancy between oxygen consumption and oxygen demand. Children at this age need a lot more oxygen compared to grown-ups and if there is a lack of oxygen due to a complication, it manifests itself much quicker. Another difference is the child’s body height of course. Small children are very rarely in an operating room, which is great and preferable of course. However, this often results in a lack of routine for the anesthesiologist, who gained his/her experience more by treating adults.

Photo: A child's arm is pierced with a hollow needle; Copyright: Boston

How to deal with children in an operation room? Doctors have to cope and to learn, because children are not little adults; © Franck Boston

Concerned parents worry that anesthesia could have a harmful effect to their child’s development. Recent animal studies have provided fodder to these fears: they suggest apoptosis and a disruption of synaptogenesis during the neural development due to anesthetics. Is this a cause for concern?

: We have findings from new animal studies that anesthetics influence neural development. I don’t want to talk about damage at this junction, because apoptosis in and of itself is an entirely natural process. A human being loses approximately 50 percent of his/her congenital neurons during the course of his/her life even without anesthesia. Apoptosis is thus a very important component in the development of the central nervous system. However, we now know from these animal models that there are signs of increased apoptosis. Nevertheless, transferring these results to human beings is difficult. Animals exhibit differences in terms of brain development; particularly when the studied animals include different types of animals such as rats and monkeys. The main point however is that humans exhibit an entirely different neural development because "they are human". Before anesthesia, parents should make sure that their child is in competent hands, with a team that is experienced and skilled in dealing with children. This way, complications can be prevented most effectively.

How can anesthesiologists currently continue their education specifically in the field of pediatric anesthesiology?

: There are many conventions and continuing education seminars. Added to this is the day-to-day work in special centers where many children are cared for. It is a mix of clinical training under the supervision of an experienced anesthesiologist and the continuing education in the theoretical field. Yet there are also countries that offer a specialist training to become a pediatric anesthesiologist after specialty medical training, with the U.S. leading the way. The Scandinavian countries also offer a so-called pediatric anesthesiology fellowship program. It is currently not available in Germany.

Do you think a pediatric anesthesiologist makes sense?

: No. Training in anesthesiology should be done in its entirety. If you would like to specialize in pediatric anesthesiology, it makes sense to broaden your knowledge in this area after becoming a medical specialist, for instance through a training program. But I would object to a specialty medical training.
Photo: Simone Ernst; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Simone Ernst and translated from German by Elena O'Meara.