The pace has changed, along with the technology and other aspects of anesthesiology practice. But Gregory Gardner, DO, anesthesiologist, sees all the ways that care has improved for patients who are having surgery, from those who present airway challenges to patients who benefit from highly effective nerve blocks. Dr. Gardner, who is fellowship-trained in pediatric anesthesia, is happy to report that his son, daughter and wife have all come to Emerson for surgery.
How did you become interested in pediatric anesthesia?
In medical school, I found the study of anesthetics fascinating. I wound up doing an internship in pediatrics and, because there weren’t enough residents in the hospital, I often covered the NICU and pediatric ICU, as well as the Emergency Department. I considered becoming a neonatologist, but then the light went on; I realized how much I liked doing pediatric anesthesia. I had the required dexterity and the personality to handle children and their parents in the operating room (OR). At Emerson, about 15 percent of our surgical patients are kids.
You must need to spend time with a child’s parents prior to surgery.
I do. They don’t know me from Adam; as their child is heading into the OR, I believe parents worry most about the anesthesiologist. I need to win their trust and confidence, so I explain to them how we operate and what the risks are, which are very minimal unless there are airway-related issues, such as asthma. Given that they are young and healthy, and have strong hearts and lungs, children are our best customers; they do better under anesthesia compared with adults. And we have the Pediatric Intervention Team, which is a godsend. Thanks to them, we can often give a child minimal sedation because they adjust so well to being in the hospital.
How has anesthesiology changed since you began practicing?
The OR in general used to be slower-paced. Now, patients move through the system more quickly, often without an overnight stay. This has resulted in the use of much more regional anesthesia — specifically ultrasound-guided nerve blocks. We have three ultrasound machines in the OR, and the level of detail they provide is amazing. We use blocks for orthopedic, podiatric and vascular surgery. For example, today we do adductor canal blocks, which isolate the nerve at the front of the knee while leaving motor function intact. We can inject continuous pain medication through a small catheter so that patients can receive an infusion while they are in the hospital. Some patients go home with it.
What is a typical day like for you?
I’m usually here by 6:30 a.m. to begin putting blocks in for the first surgeries. I might be involved with ten cases in a day; some days I cover the endoscopy suite. We definitely use a team approach, and everyone knows their role. If I’m putting a nerve block in or doing something in the pre-op holding area, one of the nurse-anesthetists is there to help. The nurses are fantastic. Patients often tell us they’d rather be at Emerson than downtown.
Do certain patients require special attention?
In the past, bariatric patients sometimes posed a challenge, but we’ve improved our ability to intubate them by bringing in fiber-optic equipment that includes a high-resolution camera. I’ve always been interested in the difficult airway; this technology has made our job easier. We are seeing older orthopedic patients; they are more challenging because they have more medical problems. When you operate on someone who is in their 90s or even 100, which we do, you have to be meticulous in managing them. We use medicines that are rapidly metabolized, so they are quicker in onset, and the body eliminates them more quickly.
What do you enjoy in your time off?
My favorite thing is to go sailing; we have a sailboat in Pocasett. I like to bike and often jump on my bike for a ride at the end of a long day at the hospital. And I also like to travel. I guess my favorite place is France, but I love the Caribbean because of the water, the sailing and the people, who are so nice. But I also like Cape Cod.