Melanie Cole (Host): Surgery can be so scary and daunting for patients and their families. Welcome to the podcast series from the Experts at the Shriners Hospitals for Children in Portland. I'm Melanie Cole and today we're discussing behind the red line the surgical process. Joining me is Dr. Josie Davidson. She's the Chief of Anesthesia at Shriners Hospitals for Children in Portland. Dr. Davidson, it's a pleasure to have you join us today. You're the Chief of Anesthesia at the Portland Shriner's. Certified in anesthesiology. You've received a subspecialty Board Certification in Pediatric Anesthesiology. What does that subspecialty mean for your patients? What is that?

Dr. Josie Davidson (Guest): Well, to answer that question, I think it helps to have an understanding of the training that we go through in order to become a pediatric anesthesiologist. Physician anesthesiologists complete four years of medical school and then we complete a four year anesthesiology residency. And it's during that time that we gain experience providing anesthesia and pain management for patients of all ages. And while this anesthesiology residency includes the care of pediatric patients, those anesthesiologists that wish to specialize in pediatric anesthesia or care for patients in pediatric hospital follow this residency training with a pediatric fellowship. And during this pediatric fellowship, the training is focused on the care of pediatric patients. So during this time, pediatric fellows learn the care of patients ranging from neonates to young adults. They take care of patients undergoing a whole variety of operations, including simple operations to more complex operations and care for patients with a whole spectrum of health issues.

So this additional training is important because children aren't simply small adults. They have unique physical, functional emotional needs. And as a result require special anesthetic considerations and technical skills. So if you get your board certification in pediatric anesthesia, it's really acknowledgement that you've completed this training. It's acknowledgement that the anesthesiologist has proven experience caring for the entire spectrum of pediatric ages. There's an intense knowledge exam that is completed, and it's acknowledgement that the anesthesiologist has committed to lifelong learning through ongoing board certification. And so all that being said to our patients and families, really it means that we have the specialized training, the specialized experience, and the commitment to caring for pediatric patients. That's really important for caring for this special population with distinct needs.

Host: Well, it certainly is. And thank you for that. And as you say, they're not little adults. And so their whole chemistry makeup is different for anesthesiology. What drew to work at Shriner's Hospital for Children in Portland?

Dr. Davidson: Well, I did my training, my pediatric fellowship training next door. And so I knew about Shriners and I knew about the mission. I knew I wanted to care for children, obviously. I love Portland and this whole community. So I was excited to join a specialty hospital that was really providing top quality care, which is what Portland Shriners is. And from the moment I arrived here, I really knew that it was a great opportunity. I've now been here for about 10 years and I can honestly say that I truly love my job. We have a really, you know, extremely talented and dedicated staff throughout the entire hospital. We operate at the forefront of medical care and technology. And really the greatest reward is every day we interact and care for really incredible patients and families who inspire us to do the work that we do.

Host: Isn't that wonderful? What a great job that you have and I can hear the passion in your voice, doctor. So tell us, surgery can be really scary. As I said in my intro, what does the Portland Shriner's Hospital team do prior to surgery to help comfort patients and their parents who sometimes are more concerned than the little guy themselves?

Dr. Davidson: Well, I think that one of the biggest reasons that patients and families have anxiety anticipating surgery is really that it's unfamiliar and they don't know what to expect. So that being said, not every patient necessarily wants to know the details to the same degree as someone else. So what's important is understanding where each child is at developmentally and emotionally to help determine what they might need in order to make their surgery experience as positive as possible. So listening to the concerns of the patient family is obviously key and likewise the ability and willingness of us as a care team to be flexible is critical to achieving a positive outcome. So making a plan that's individualized to each child's needs and one that can flex as their needs change. So at Shriner's, most of our patients and families are seen in our preoperative clinic and there are, they have the opportunity to meet with several members of their care team. So, they will meet with their anesthesiologist, the surgeon, clinicians providing their inpatient care. They might meet with their physical therapist, the pharmacist, social worker, child life specialist. And the goal of this appointment really is to familiarize the patient and their family with the whole surgical process. We answer any questions that they have and we create the plan for surgery, one that's safe, one that's medically appropriate, and one that meets the needs and goals of that child and their family.

Host: Well thank you for that. It's such a multidisciplinary comprehensive approach, especially for children. So important. Walk us through the process. So you talked about that appointment and now it's the day of surgery. What is that like for the patients and their families? How long can the parents be with the child? We're calling this behind the red line. At what point do the parents have to step back and let you take their child into the operating room? What is that whole process like? And even when the child gets in to the operating room, what does that look like for them?

Dr. Davidson: Well, when a patient arrives here for their surgery at Shriner's Portland, they check in at our front desk and then they confirm just some basic information with our registration team. They're then directed upstairs to our operating rooms suite, and there they're met by our pre-surgery clinical team. Each patient that comes in is given their own room in our preoperative area where they wait with their families as our nurses and the physicians help them to prepare for the next steps in surgery. So the patients will change into a gown. They're encouraged to engage in an activity that can help to distract them or make them comfortable. So oftentimes for our patients that means watching a show or movie on a device, sometimes listening to music. Some patients just like to communicate with their family members. During this time, the surgeon and anesthesiologist will stop by and answer any final questions.

Very often a relaxing medication is given about 30 minutes or so before surgery, and in some of our older patients we will start an IV. The patients stay with their families right up until it's time to go into the operating room. At that point then anesthesiologists and nurse wheel the patient into the operating room on their bed and oftentimes during this time the patient will continue to watch their movie, listen to music or perhaps just have a conversation with the anesthesiologist and nurses that are going back. Once we get into the operating room, it's really just a couple of minutes, sometimes even less than that and the patient is off to sleep. And this is either by breathing through a mask or with medicine through their IV. As anesthesiologists, we stay with the patient through the entire surgery.

When the surgeon is done with the operation, we wake them up and take them to the recovery room. And in the recovery room the patient is cared for by nurses who are specially trained in postoperative care. During this time, the goal is to carefully monitor the patient during their immediate recovery and obviously to make sure that the patient is comfortable. It's during this time that family members are invited into the recovery room and they're invited in as soon as it is safe and reasonable for them to do so. Patients usually very much appreciate having their parents or family members and with them, and so it's our feeling that as soon as we can get them in, that is to the benefit of the patient. If the patient's going home that day, we make sure that they've had something to eat, make sure that they're comfortable before discharging them. And if the patient's staying overnight they're then wheeled down to our inpatient unit where they would meet with their inpatient nurse and care team.

Host: Wow. That is quite an explanation really. You really walked us through so very well. Parents worry about afterwards in the recovery room there with their kids. There's a lot of clinicians and providers around. They worry about pain after surgery. They worry about pain management, taking their child home, keeping all of that clean. What do you tell parents about that part of it? Taking their child home and caring for them and also give us one piece of advice you'd give parents who are apprehensive about their child's surgery?

Dr. Davidson: Sure. Well here at Portland Shriners we have a huge focus on what we call multimodal pain control. And what that means is we aim to attack pain in multiple ways, with the ultimate goal of creating an overall experience where a patient wakes up and is comfortable and prepared for discharge with a plan to manage the pain postoperatively. And what this means to patients and families is usually a combination of medications, such as Tylenol and anti-inflammatories. We are very often able to do something that we call nerve blocks where we can use local anesthetic or numbing medicine to numb up some of the nerves that supply the areas where the surgery is going to cover and in that way we can minimize the use of some of the opioid medications that can sometimes have some negative or unwanted effects.

We always make sure that when a patient is looking toward discharge that we have a plan in place for their home care, which means a plan for medication management and a plan to make sure that the patient is comfortable in the upcoming days. As far as a piece of advice I would give to parents who are apprehensive, I would say really just to ask questions and share concerns. All of us as members of the team want parents and families to be comfortable with and be active participants in the child's care plan. And really the key to successful surgical experience and recovery is clear understanding and communication between the care team and the families. So we want to hear parents input, we want to hear the patient's input. Parents, and obviously the child, know them best and that's what's most helpful to us.

Host: Well that certainly should relieve parents what you've said about making the plan and that they have this care plan and that you encourage questions. As we wrap up, what makes the Portland Shriner's hospital the destination for pediatric orthopedic care?

Dr. Davidson: The care at Portland Shriners is really excellent. We have really dedicated, knowledgeable, skilled pediatric orthopedic surgeons, pediatric anesthesiologists, specialty clinicians, therapists. We have a really cutting edge facility. We have the latest in diagnostics and imaging. We have a nationally recognized and award winning nursing team, and we really have proven excellent outcomes. As anesthesiologists who are specialized in the care of children and with extensive experience caring for children with orthopedic needs. We really aim to provide the absolute safest and most comfortable surgical experience possible. We're really a team committed to patient and family focused care and really committed to excellence.

Host: Thank you so much Dr. Davidson for coming on and sharing your incredible expertise as a pediatric anesthesiologist. Thank you again, and that concludes this episode with Shriner's Hospital for Children in Portland. Please visit our website at PortlandShriner'sHospital.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the Shriner's Hospitals for Children in Portland podcasts. For more health tips and updates, please follow us on your social channels. I'm Melanie Cole.