Pediatric anesthesiology certification requires completion of a one-year
fellowship
in pediatric anesthesiology, fulfilling the
case log minimums, and passing the
pediatric anesthesiology exam
The Pediatric Anesthesiology Examination assesses knowledge of disease states,
management considerations, and clinical issues that are relatively unique to
pediatric patients. Browse or search the content outline below.
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I.
BASIC SCIENCE
A.
Anatomy
1.
General Development
c.
Water, volume, and blood composition
2.
Anatomy for Procedures
b.
Central neuraxial blockade
c.
Peripheral nerve blockade
B.
Physics and Anesthesia Equipment
1.
Respiration
b.
Ventilation devices and techniques
2.
Methods for Monitoring
a.
Brain, spinal cord, and neuromuscular function
b.
Cardiac rhythm and vascular pressures
c.
Oxygenation, gas concentration, and ventilation
3.
Ultrasound: Physics and Clinical applications
C.
Anesthetic Pharmacology: Physiologic States, Pathophysiologic States and Adverse Effects, Development Pharmacology
1.
Pharmacokinetics and Pharmacodynamics
e.
Biotransformation and excretion
4.
Sedative and Anxiolytic Agents
6.
Inhalation Anesthetics
8.
Neuromuscular Blocking and Reversal Agents
9.
Sympathetic and Parasympathetic Agents
10.
Agents Affecting Coagulation
II.
ORGAN-BASED BASIC AND CLINICAL SCIENCES
A.
Respiratory System
1.
Anatomy and Physiology
a.
Prenatal and postnatal development
b.
Respiratory mechanics, ventilation, and lung volumes
d.
Surfactant, surface activity, and lung mechanics
1)
surfactant and surface tension
3)
ventilation / perfusion matching
2.
Clinical Sciences
c.
Anesthesia for thoracic procedures
2)
video-assisted thoracoscopy
4)
chest wall surgery / reconstruction
B.
Cardiovascular System
1.
Anatomy and Physiology
a.
Prenatal and postnatal development
b.
Fetal, transitional, and adult circulation
2.
Clinical Science
a.
General considerations
1)
cardiovascular effects on anesthetic uptake and delivery
2)
anesthetic effects on the cardiovascular system
3)
vasoactive medications
4)
pulmonary hypertension
10)
heart transplantation
c.
Anesthesia for cardiac procedures
1)
complete anatomic and physiological repairs
2)
single ventricle procedures
4)
management and consequences of cardiopulmonary bypass
5)
deep hypothermic circulatory arrest
6)
anesthesia for pacemaker / implantable cardiac defibrillator insertion and replacement
7)
anesthesia for diagnostic, interventional and electrophysical procedures
d.
Anesthesia for the adult with congenital heart disease
e.
Cardiopulmonary resuscitation
f.
Anesthesia for non-cardiac procedures in child with congenital heart disease
C.
Central and Peripheral Nervous Systems
1.
Anatomy and Physiology
a.
Prenatal and postnatal development
1)
brain, fontanelles, cranial sutures, and spinal cord
2)
myelinization, autonomic nervous systems, and pain pathways
3)
neurodegenerative changes after anesthesia
2.
Clinical Science
a.
General considerations
1)
intracranial pressure and blood flow
2)
pharmacology of diuretics, steroids, and anticonvulsant medications,
1)
autism, developmental delay, and attention-deficit hyperactivity disorder
5)
cerebrovascular disorders
6)
open and closed head injuries
8)
neurodegenerative disorders
c.
Anesthesia for neurosurgical procedures
2)
intracranial tumors and vascular lesions
3)
craniofacial reconstruction / cranioplasty
4)
meningomyelocele / spinal surgery
D.
Gastrointestinal System
1.
Anatomy and Physiology
a.
Prenatal and postnatal development
2.
Clinical Science
a.
Esophageal, stomach and intestine disorders
1)
abdominal wall defects
2)
intestinal rotation defects
3)
atresias, stenoses and webs
5)
duplications and cysts
7)
necrotizing enterocolitis
b.
Liver, biliary tract and spleen disorders
d.
Morbid obesity / bariatric surgery
e.
Gastrointestinal endoscopy
f.
Esophageal / gastrointestinal foreign bodies
g.
Liver, intestinal, and multivisceral transplantation
E.
Renal/Urinary
1.
Anatomy and Physiology
a.
Prenatal and postnatal development
2.
Clinical Science
b.
Phimosis and hypospadias
c.
Ureteropelvic junction obstruction
F.
Endocrine/Metabolic
1.
Anatomy and Physiology
a.
Prenatal and postnatal development
2.
Clinical Science
d.
Disorders of sodium regulation
g.
22q.11 deletion syndrome (DiGeorge)
G.
Hematology/Oncology
1.
Anatomy and Physiology
a.
Prenatal and postnatal development
2.
Clinical Science
4)
sarcomas / osteosarcomas
c.
Chemotherapeutic agents and side effects
e.
Bone marrow and stem cell transplants
1)
graft versus host disease
f.
Immunologic disorders (congenital and acquired)
H.
Genetics
1.
Anatomy and Physiology
2.
Clinical Sciences
a.
Chromosomal abnormalities
b.
Craniofacial syndromes
c.
Effects of environmental agents
f.
Inborn errors of metabolism
g.
Malignant hyperthermia
h.
Mitochondrial myopathies
n.
Osteochondrodysplastic syndromes
o.
Skin and connective tissue disorders
III.
CLINICAL SUBSPECIALTIES
A.
Fetal
1.
General Considerations
2.
Clinical Science
b.
Ex utero intrapartum treatment (EXIT) procedure
B.
Neonatal
1.
General Considerations
b.
Post conceptional age and organ system maturity
c.
Effects of anesthesia and surgery on cognitive development
f.
Neonatal resuscitation
2.
Clinical Science
a.
Surgical disease states
2)
congenital cystic adenomatoid malformation
3)
congenital diaphragmatic hernia
6)
hypertrophic pyloric stenosis
8)
necrotizing enterocolitis
9)
neonatal lobar emphysema
10)
omphalocele and gastroschisis
11)
sacrococcygeal teratoma
12)
tracheo-esophageal fistula
13)
vein of Galen malformation
b.
Medical disease states
3)
bronchopulmonary dysplasia
5)
intraventricular hemorrhage
7)
persistent pulmonary hypertension
8)
persistent fetal circulation
9)
retinopathy of prematurity
10)
neonatal abstinence syndrome
C.
Painful Disease States
1.
Pathophysiology
a.
Procedural, postoperative, and posttraumatic pain
2.
Treatment
b.
Pharmacologic and non-pharmacologic techniques of pain management
c.
Complementary and alternative pain management
D.
Otolaryngology
1.
Airway Procedures
a.
Bronchoscopic procedures
b.
Tonsillectomy, adenoidectomy, and abscess drainage
d.
Choanal atresia repair
e.
Laryngotracheal reconstruction
2.
Otologic Procedures
b.
Cochlear implant, tympanoplasty, and mastoidectomy
E.
Plastic and Oral-Maxillary Facial Surgery
1.
Coexisting Diseases
a.
Craniofacial syndromes
b.
Congenital heart disease
c.
Increased intracranial pressure
d.
Obstructive sleep apnea
2.
Clinical Science
a.
Craniosynostosis repairs
e.
Tissue flaps and tissue expanders
f.
Vascular malformations
F.
Ophthalmology
1.
General Considerations
b.
Pharmacology of ophthalmologic medications
2.
Clinical Science
b.
Retinopathy of prematurity
G.
Orthopedic Surgery
1.
Coexisting Diseases
a.
Cardiopulmonary disease
b.
Congenital malformations
2.
Clinical Science
a.
Anterior, posterior, and combined spine fusion
b.
Chest wall reconstruction
H.
Trauma and Burns
1.
Trauma
a.
Age-related mechanisms and associated injuries
b.
Incidence, patterns, implications of abuse
c.
Management of the polytrauma victim
d.
Hypothermia and submersion injury
2.
Burns
a.
Types, mechanisms, locations and implications of injuries
b.
Inhalation injuries/airway management
c.
Fluid resuscitation and calculating burn surface area
d.
Anesthetic and pain management of the burn patient
IV.
CLINICAL SCIENCE OF ANESTHESIA
A.
Evaluation and Preoperative Preparation of the Pediatric Patient (See Specific Disease States)
1.
Normal developmental milestones
2.
Evaluation of Coexisting Disease
d.
Gastro-esophageal reflux
g.
Reactive airway disease
h.
Upper respiratory tract infections
i.
Congenital heart disease
j.
Autism spectrum disorders
5.
Psychosocial Preparation of the Patient and Family
6.
Parental Presence and Pharmacologic Preparation for Anesthetic Induction
8.
Age-Related Differences in Anesthetic Risk
B.
General Considerations of the Perioperative Period
1.
Fluid, Electrolyte, and Glycemic Management
4.
Transfusion Therapy and Blood Conservation Techniques
C.
Regional Anesthesia and Analgesia
1.
Pharmacology and Toxicity of Local Anesthetics
2.
Central Neuraxial Blockade: Indications, Contraindications, Techniques, Adjuvants, and Controversies
3.
Peripheral Nerve Blockade: Indications, Contraindications, Techniques, Adjuvants, and Controversies
D.
General Anesthesia
1.
Stages and Signs of Anesthesia
3.
Airway Management
a.
Indications, techniques, limitations, and devices for mask ventilation
b.
Indications, techniques, limitations, and devices for endotracheal intubation
c.
Management of the difficult airway
d.
Methods for single lung ventilation and lung separation
E.
Complications of Anesthesia
2.
Inadequate Vascular Access
3.
Iatrogenic trauma / positioning injury
8.
Anaphylactic and Anaphylactoid Reactions
9.
Awareness and Recall Under Anesthesia
10.
Psychosocial Complications
F.
Special Techniques and Situations
1.
Controlled Hypotension
2.
Controlled Hypothermia
4.
Management of Laparoscopic Surgery
5.
Anesthesia for Satellite and Remote Locations
6.
Perioperative Management of the Intensive Care Unit Patient
G.
Postoperative Period
1.
Management and Diagnosis of Pain, Anxiety and Emergence Agitation
2.
Respiratory, Cardiovascular, and Neurologic Consequences of Anesthesia
3.
Post Operative Nausea and Vomiting
4.
Management of the Post Anesthetic Care Unit
H.
Monitored Anesthesia Care and Sedation
I.
Acute and Chronic Pain Management
V.
SPECIAL PROBLEMS OR ISSUES
A.
Special Surgical Procedures
B.
Professional Issues
1.
Ethical and Legal Obligations of Pediatric Anesthesia Care and Research
2.
Teaching, Supervision, and the Anesthesia Care Team
3.
Practice-based Learning and Improvement
4.
Continuous Quality Improvement
C.
Principles of Biostatistics and Pediatric Study Design
E.
Ethics and Medico-Legal Issues
1.
Professionalism: definitions and teaching
a.
Disclosure of errors or adverse events
b.
Professional behavior: honesty, integrity, compassion, respect, altruism, conflicts of interest, response to marketing
c.
Recognizing limitations in expertise and need to seek guidance
d.
Personal role in reporting unsafe conditions and fitness for work
e.
Recognizing and responding to unprofessional behavior
f.
Evidence-based practice
2.
Patient autonomy and decision making
a.
Principles of informed consent and shared decision making
b.
Advance Directives, Do Not Resuscitate (DNR) Orders, medical orders for life-sustaining treatment
c.
Health care proxy laws and limitations
d.
Patients Refusing Transfusion or Other Treatments
3.
Legal and regulatory issues
a.
Elements of medical malpractice: duty, breath of duty, causation, damages
b.
Legal actions and consequences, National Practitioner Data Bank, Closed Claims findings, professional liability insurance
c.
Understanding laws related to controlled substances, including opioids and cannabinoids
d.
Patient privacy issues: principles of confidentiality, access to records, protected health information
e.
The Health Insurance Portability and Accountability Act (HIPAA)
4.
Primary Certification, Recertification, Maintenance of Certification and Related Issues (Professional Standing, Lifelong Learning, Cognitive Knowledge, Clinical Practice Assessment, Systems-Based Practice)
5.
Research ethics
a.
Principles of justice, autonomy, beneficence, nonmalfeasance
b.
Ethical standards in research design: scientific validity, fair subject selection, favorable risk-benefit profile
c.
Review and implementation of trials, the institutional review board
d.
Informed consent in research
e.
Conflicts of interest and financial disclosure
6.
Clinician wellness and self-care
a.
Diagnosis and treatment of burnout
c.
Adaptations for clinical disability
F.
Practice Management
1.
Costs of medical/anesthesia care
a.
Understanding principles of healthcare funding and payment
b.
Cost-conscious practice
2.
Efficient OR staffing and scheduling
a.
Subspecialization issues: pediatrics, cardiac, regional, obstetric coverage
b.
Anesthesia care team and scope of practice
3.
Population health: perioperative surgical home and enhanced recovery
a.
Population based health determinants, resources to improve access
b.
Health care disparities between populations
4.
Clinical informatics
a.
Electronic medical record systems: costs and benefits
b.
Artificial intelligence and machine learning
5.
Documentation, coding, and billing
a.
Compliance with documentation requirements
b.
Accuracy, clarity, specificity of medical records
c.
Coding integrity, audits, and insurance denials
G.
Quality Improvement and Patient Safety
1.
Definitions
a.
Medical error, adverse events, sentinel events, misuse of medications and technology
b.
Human factors and mindfulness
c.
Systems thinking and technology design
2.
Medication errors: assessment and prevention
a.
Medication reconciliation
b.
Information technology to reduce medication errors
3.
Crisis Management and Teamwork
b.
Crisis manuals and other cognitive aids
e.
Preoperative and procedural checklists
4.
Quality Improvement (QI) Basics
a.
Design, Analysis, and implementation of QI projects
d.
Patient satisfaction measurement
e.
Value-based care incentives, pay-for-performance
5.
Performance Assessment
a.
Individual benchmarking
b.
Group and facility scorecards
1)
Federal Quality Payment Program
6.
Change Management Methods
a.
Peer review and morbidity and mortality Conferences
e.
Failure mode and effects analysis
H.
Diversity, Equity, and Inclusion (DEI) in Health Care
1.
Barriers
a.
Systematic racism, colorism/shadeism, sexism, discrimination against sexual orientation, gender identity, language, national origin, ethnicity, religion, immigration/citizenship status, age, familial status, and disability
b.
Bias; Implicit bias, microaggression, stereotype threat
2.
Approaches to improvement; interventions at individual, inter-personal, community, organizational and policy levels; cultural and gender competency, upstander vs. bystander, allyship vs. performative action, tokenism vs. representation, assortativity vs. homophily
4.
DEI in academia
b.
Scholarship; Representation of diversity and race related topics in research, Importance of language in reports discussing racial inequities
I.
Healthcare Disparities
1.
Social determinants of health considerations in assessment and management of patients – race, language, education status, religion, housing, nutrition, geographic location, rural vs. urban, access to and quality of care, health coverage
2.
Infant, child, and adolescent healthcare disparities
3.
ICU disparities and outcomes
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