How did you first become interested in anesthesiology?
James DiNardo: I actually started off my medical career thinking I wanted to be a surgeon. I was training at Beth Israel Deaconess Medical Center when, during my surgery residency, I realized I was more interested in the doctors keeping patients alive than the ones performing the actual surgery. That’s the beauty of medicine—you can always reinvent yourself!
I further specialized in pediatrics because I liked the challenge. When you’re working with kids, you can’t have a “one-size-fits-all” approach to anesthesiology. You have to be more creative, more flexible and more cognizant of the individual’s needs. Every day is a new experience.
What does a typical work week look like for you?
Every day, members of our team staff four operating rooms, three catheterization labs, an electrophysiology (EP) lab and a cardiac MRI scanner. We also provide anesthesia for echocardiograms, CT scans and minor surgical procedures in the cath lab recovery room. We’re everywhere! If you are a child having a cardiac procedure—whether it’s a catheterization, an EP study, an echocardiogram, MRI or open-heart surgery—someone from our team is going to be taking care of you. Doug Atkinson, MD, and I also attend in the Cardiac Intensive Care Unit (CICU).
We are all involved in some sort of research as well. For example, I spend three days a week doing clinical work and two days a week doing research.
How many clinicians are in Cardiac Anesthesiology at Boston Children’s?
There are 15 pediatric cardiac anesthesiologists and five CRNAs (nurse anesthetists) in our group. It’s such a specialized field that although this may not seem like a huge number, Boston Children’s has the largest pediatric cardiac anesthesiology division in the United States. We also have five specially trained nurse practitioners who work with us in the Cardiology Clinic. They can perform 90 percent of the patient intake. Without them, our group could never handle the volume of patients.
You’ve said that your group is very “process-oriented.” What do you mean by that?
Anesthesiologists are the ones working behind the scenes to make sure everything runs smoothly. We need to coordinate around the daily schedules of each procedure unit while catering to each patient’s specific needs and preparing for potentially difficult circumstances.
Are you involved with patient care outside of cardiology?
Yes. Whenever a patient with cardiac disease comes here for any procedure, our consult attending for the day provides consultative input to the anesthesiologist from our main OR. It is not uncommon for cardiac patients to need other kinds of interventions, ranging from g-tube placement to scoliosis surgery. In these instances, we collaborate closely with the anesthesiology team, so they understand each patient’s unique cardiac physiology.
Can you talk about your division’s ongoing research?
Koichi Yuki, MD, is working on an NIH-funded grant to investigate the immunomodulation effects of anesthetic agents.
Barry Kussman, MD, is working with Jane Newburger, MD, on neurodevelopmental outcomes of children who undergo heart surgery, and is very involved in the use of NIRS technology to assess brain oxygenation.
We’re also doing some really cutting-edge research on coagulation monitoring in a free- standing, dedicated coagulation lab on 8S. Juan Ibla, MD, Kirsten Odegard, MD, and Ram Emani, MD, from Cardiac Surgery, and I are very involved in these projects. In addition, we have one of the world’s leading experts in the field, David Faraoni, MD, from Belgium, here for a two-year research fellowship to work in our lab.