Male: The biggest concern parents have is sometimes not even the doctor operate anesthesia. You operated in some of the finest hospitals in the city and I am sure you have very good anesthesia people. Have you heard a real major risk when you have a good anesthesiologist there beside the table with you today?
Dr. Dolitsky: Anytime a child has a general anesthesia there is always a potential risk for catastrophe. Fortunately, that happens very few and far between. The American Academy of Anesthesiology quotes that one in 250,000 people will die of anesthesia unexpectedly. When you extrapolate that to an otherwise healthy child for relatively short procedure it is probably even less than that but the truth is when it is your child, even that seems like too much. Fortunately, I have personally never seen any such catastrophe because in the hands of skilled anesthesiologists this usually does not happen. But once in a while, unfortunately you hear about it when it happens it is so infrequent that it is usually in the newspaper or on the news. So it is a cause of concern and for that reason we should never take anesthesia cavalierly but if you operate in a place where they have good skilled anesthesiologist, anesthesiologists who have lot of experience either with particular training in children or at least have a lot of experience with putting children to sleep, chances are, that child is going to do very, very well.
Male: My impression, pediatric sub specialist in the surgical field are very selective with what to use on the side of table because they don’t want to have any problems, is that true?
Dr. Dolitsky: Absolutely, nobody wants to hear “The surgery went well but the anesthesia did not and there is subsequently a big problem”. So no surgeon can be successful without a good anesthesiologist. I tend to work with only few people. I’ve worked in New York Eye and Ear probably for 15 years and I have developed a rapport with several anesthesiologists who I feel very comfortable with. Two of them have had actual pediatric training like myself but two of them have not but over the years they have done this operation, where the anesthesia for this operation so many times that I feel very comfortable with them. In any hospital, a surgeon has to feel comfortable with the anesthesiologist and the recommendation I would make is that if you don’t know the anesthesiologist in your hospital and you are operating on small children, you should have someone who has had a pediatric anesthesia fellowship. Once you have develop a rapport with certain anesthesiologist, certain anesthesiologists who may not have had that fellowship can still be very good and very qualified but you should never be using an anesthesiologist for the first time that you don’t know that you feel uncomfortable with, because if you don’t feel comfortable then the parent is not going to feel comfortable and if something goes wrong, you will feel that it was your problem. And it is your problem. So it is your job to make sure that you are working with an anesthesiologist whom you feel comfortable with.
Male: All it takes is one bad situation. So I think most pediatric sub specialists in the surgical field are very, very careful with it to get this out of the table.
Dr. Dolitsky: Absolutely. Aide from catastrophes, just in the general flow of a surgical case, people who were not comfortable with children might be a little bit more traumatic with the way they handle the child in terms of their teeth, in terms of inserting a breathing tube. They have to know just the right size and have to know how to insert it gently so that there is not trauma to the voice box. Also, just the handling of the child, I think it is a big difference, the handling of the child as to putting a child to sleep. We have parents in the room with the child as the child is going to sleep. And you can tell the difference between an anesthesiologist who has skill and has concern and has compassion for that child and understand that that is a very traumatic episode and putting that parent to ease. There are some anesthesiologists who would rather not have a parent in the room because they don’t feel that comfortable with the situation and they are really not able to empathize with the parent and the child.
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