CRNAs drive innovation, ensure high-quality care in pediatric anesthesia

Pediatric anesthesia care is a complex field that requires specialized knowledge, skill, and sensitivity to the needs of young patients. At Ann & Robert H. Lurie Children’s Hospital of Chicago, Certified Registered Nurse Anesthetists (CRNAs) play an essential role in ensuring that children receive safe and effective anesthesia care.

Under the guidance of Audrey Rosenblatt, PhD, CRNA, FAANA, Director of Advanced Practice Provider Anesthesia Services, Lurie Children’s leverages the expertise of CRNAs to provide top-tier anesthesia services for its patients. Rosenblatt, who has been with the hospital for 12 years, oversees a team of 23 CRNAs, ensuring high-quality care for children undergoing surgery and medical procedures.

“Surgery is a big day for anyone. When you’re in the formative years of your life, the way you’re treated and the care you receive really makes a difference for how you interact with the medical system for your whole life,” Rosenblatt said. “I like having the opportunity to create a positive environment for children and to make sure they’re safe.”

Part of creating a positive environment is involving parents in their child’s care. Rosenblatt said she finds parents to be excellent collaborators prior to surgery, and she values their input. This partnership helps reduce anxiety for both the child and the parents, fostering a sense of comfort and trust throughout the surgical experience.

“Parents know if their child is going to tolerate separating from them and going back to the operating room, or if their child is going to find that to be anxiety-provoking,” she said.

She added, “The outcomes children have after surgery are deeply important to me because those outcomes are a result of the care I provide. There are things I think about when I’m not at work that I take home with me, and it really makes a difference in how smoothly the anesthesia care goes.”

Factors contributing to the child’s anesthesia care include the child’s age, medical condition, and the type of procedure. Rosenblatt noted that even if two children are undergoing the same surgery, the approach to anesthesia may differ drastically if one child is an infant and the other a teenager. This variability makes pediatric anesthesia particularly challenging and rewarding for CRNAs, who must adjust their approach to suit the individual needs of each patient.

“For pediatric pain, anytime I have a non-verbal patient, I have to proactively think about the ways that I can manage their pain without them having the ability to say, ‘This hurts a lot,’ or ‘This hurts a little.’ I have to think ahead about how painful the procedure is going to be and try to be as proactive as possible with making sure they get either proactive pain medication or regional anesthesia,” Rosenblatt said.

Ultrasound has greatly enhanced the safety of regional anesthesia for children, she said. Using ultrasound allows CRNAs to target specific nerves with precision and reduce the risk of complications, such as local anesthetic systemic toxicity. Ultrasound-guided techniques are especially critical in pediatrics, where the small size and anatomical differences in children require precise, careful management. For the smallest patients, that approach to their anesthesia care makes all the difference.

“One of my favorite things is when I have an infant I’m taking to the operating room, and we administer general anesthesia and we perform a regional anesthetic, like a caudal block,” Rosenblatt said. “At the end of the case, you wake the child up, you take out the breathing device and they’re calm, comfortable, and looking around. They get a bottle and a snuggle. The beauty of that perfect wake-up, and a patient that is incredibly comfortable at the end of the procedure — there’s something so rewarding about that. I was able to take this patient through something that could potentially be dangerous.”

The hospital’s CRNAs also work closely with other departments, such as audiology, to improve anesthesia care based on the latest research. CRNAs recently implemented a practice change based on a study showing that a specific type of anesthesia is superior for certain hearing tests in children. This CRNA-led change helped improve the accuracy of the test and was well received by the audiologists performing these tests.

Rosenblatt’s team is committed not only to providing excellent patient care but also to mentoring the next generation of CRNAs. Lurie Children’s offers a CRNA fellowship program, one of only three such programs in the country, designed to provide advanced training for CRNAs transitioning into pediatric anesthesia. The fellowship program offers a combination of clinical training and research opportunities, ensuring that new CRNAs are well-prepared to handle the challenges of pediatric anesthesia.

Over the course of the program, CRNA fellows gain experience across a variety of pediatric subspecialties, including cardiac anesthesia. This broad exposure is vital for ensuring CRNAs have the skills and knowledge necessary to provide care in a wide range of pediatric cases, from routine procedures to highly specialized surgeries.

Patients come from all over the world to Lurie Children’s for targeted care.

“There are things we offer that aren’t offered at other hospitals. We’re a specialty center for certain diseases as well,” Rosenblatt said, such as spinal muscle atrophy, a genetic condition. The hospital provides gene therapy for the condition.

Across the country, CRNAs are a vital part of providing anesthesia care for pediatric patients, she said. They’re driving innovation, improving patient care, and enhancing safety protocols.

“A big portion of the people who take care of children are CRNAs, whether that’s in the rural setting where 80% of care is provided by CRNAs, or in an urban setting,” she said. “I believe it’s important that we lift up CRNA pediatric expertise and showcase it as a profession.”

Whether it’s through pioneering new anesthesia techniques, improving pain management strategies, or mentoring the next generation of anesthesia providers, one thing is clear: CRNAs are essential to the future of pediatric healthcare.