The soul-searching among anesthesiologists at Kaiser Permanente's Woodland Hills hospital began in 1999, after 2-month-old Grant Wray nearly died as he was being sedated for hernia surgery.
Doubts grew the following year when 19-month-old Jose Fajardo III suffered throat spasms during anesthesia, then died.
General anesthesiologists at Woodland Hills questioned whether they could safely care for children so young; they implored hospital leaders to send these patients elsewhere or hire pediatric specialists.
Hospital administrators said the two cases were aberrations and strongly defended using general anesthesiologists for pediatric surgeries. They did, however, make some changes, such as enlisting neonatologists, who specialize in caring for newborns, to help sedate the youngest infants.
Today, hospital officials and many of the anesthesiologists remain at odds. But the dispute has wider significance: It dramatizes a national debate about how much training and experience anesthesiologists need to safely care for young children.
Most experts agree that pediatric anesthesia is a specialty markedly different from its adult counterpart, involving different equipment, doses and techniques.
Children are not miniature adults. Their bodies and reactions to anesthesia are different, sometimes making surgery more difficult and risky, especially for infants.
Experts say that children fare better when their doctors handle a steady pediatric caseload.
But many hospitals don't have such a stream of patients, and pediatric expertise is in short supply. As a result, some community hospitals rely on general anesthesiologists for pediatric cases -- sometimes with the help of neonatologists.
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Task Force Formed
Several states, including California, have formed task forces to study the issue. California Children's Services, a state program that pays for specialized pediatric care, is considering a proposal to require participating anesthesiologists to treat at least 25 infants and children annually.
"There's a general consensus among people ... that anesthesiologists who take care of kids all the time are more comfortable with what they're doing and do a better job," said Dr. Mark Singleton, a San Jose anesthesiologist who is on the state's task force.
At Woodland Hills, doctors trace the turmoil to what should have been a routine hernia operation on a 2-month-old boy in November 1999.
