Pediatrics Division

The UVA Pediatric Anesthesiology Division Faculty at the Battle Building Children's Hospital
Dr. Barb Castro, MD, Section Chief of Pediatric Cardiac Anesthesiology reviews scans with resident physicians.
Dr. Samantha Vizzini, MD teaches Dr. Evan DaBreo, MD on a Pediatric Anesthesia case.

About

The Division of Pediatric Anesthesiology at UVA Children’s is committed to providing comprehensive, compassionate, family focused care to children of all ages.

Our fellowship-trained and board certified pediatric anesthesiologists provide over 5,300 individualized anesthetics to children in settings throughout UVA Health. These settings include the main ORs of UVA Health Tertiary Hospital, the Ambulatory Surgery Center in UVA Children’s Battle Building, and various non-OR settings located in our radiology, oncology and GI departments.

We recognize the unique challenges and stresses each family experiences in the perioperative period. Our pediatric anesthesiologists collaborate with our team of surgeons, intensivists, radiologists, and child life specialists. The team develops an anesthetic plan that ensures all needs are met in a safe, supportive and child friendly environment.

A Message from the Division Chief

University of Virginia Samantha Vizzini, M.D., Anesthesiology

Samantha Vizzini, MD
Chief of Pediatric Anesthesiology

The Division of Pediatric Anesthesiology has four distinct missions: provide quality and comprehensive pediatric anesthesia care to children of all ages in the operative and non-operative setting, educate and inform the next generation of physicians, commit to continual improvement and innovation, and advocate for children’s health at the local and national levels.

Our division comprises 10 pediatric anesthesiologists with diverse training and interests. This promotes collaboration and innovation. We introduce residents to pediatric anesthesia early in their career and allow access to advanced level cases as they progress.

We are dedicated to quality care and participate in the Multicenter Perioperative Outcomes Group (MPOG) as a member institution. Through our membership in professional societies we routinely advocate for resources to ensure the health and safety of our patients at the local and national levels. We consider it an honor and a privilege to serve our pediatric patients at the number one Children’s Hospital in Virginia.

Our Division

Faculty Clinical Programs Research

Books and Chapters:

McNaull PP. “The Opioid Epidemic and Children.” In: Smiths Anesthesia for Infants and Children, Tenth Edition. Elsevier, Philadelphia, PA; 2022, Video content.

McNaull PP, Suchar A. “Fluids, Electrolytes, and Nutrition.” In: Gregory’s Pediatric Anesthesia.
John Wiley & Sons, Inc, Oxford, UK; 2020: 54 pages.

McNaull PP, Waller E. “Don’t let the surgeon discharge every pediatric patient.” In: Avoiding
Common Anesthesia Errors, 2 nd edition. Lippincott Williams & Wilkins, Baltimore, Maryland;
2020: 7 pages.

Refereed Papers/Articles:

Marulanda K, Purcell LN, Strassle PD, McCauley CJ, Mangat SA, Chaumont N, Sadiq TS,
McNaull PP, Lupa MC, Hayes AA, Phillips MR. “A Comparison of Adult and Pediatric Enhanced Recovery after Surgery Pathways: A Move for Standardization.” Journal of Surgical
Research 2022; 269: 241-248.

Herb J, Williams B, Chen K, Chidgey BC, McNaull PP, Stitzenberg K. “The Impact of Standard Post-operative Opioid Prescribing Guidelines on Racial Differences in Opioid Prescribing: A Single Institution Experience.” Surgery 2021; 170(1): 180-185.

Isaak RS, Kolarczyk L, Blacker S, McNaull PP, Arora H, Zvara DA. “Time Will Tell: Going Beyond Relative Value Units and American Society of Anesthesiologists Units to Objectively Quantify Nonclinical Contributions in Academic Medical Practice.” Anesth Analg 2021; 132(3):
910-915.

Dorismond C, Hunter SE, McNaull PP, Zimmerman KO, Benjamin DK, Greenberg RG, Corey KM, Laughon MM, Jackson WM. “Wide range of perioperative drugs and doses used in inguinal hernia repairs for premature infants.” J Perinatol 2021;41(3):577-58.

Gessner KH, Jung J, Cook HE, Graves JL, McNaull P, Chidgey B, Mann J, Woody N, Deal AM, Coward RM, Figler B, Borawski K, Bjurlin MA, Raynor M, Tan HJ, Viprakasit D, Wallen EM, Nielsen ME, Smith AB. “Implementation of Postoperative Standard Opioid Prescribing Schedules Reduces Opioid Prescriptions without Change in Patient-reported Pain Outcomes.”
Urology 2021: 148: 126-133.

Purcell LN, Marulanda K, Egberg M, Mangat S, McCauley C, Chaumont N, Sadiq TS, Lupa C, McNaull P, McLean SE, Hayes-Jordan A, Phillips MR. “An enhanced recovery after surgery pathway in pediatric colorectal surgery improves patient outcomes.” J Pediatric Surg 2021;
56(1): 115-120.

Yaster M, McNaull PP, Davis PJ. “The opioid epidemic in pediatrics: a 2020 update.” Curr Opin Anaesthesiol 2020; 33(3): 327-334.

Hart WM, Doerr P, Qian Y, McNaull PP. “What constitutes effective team communication after an error?” AMA J Ethics 2020; 22(4): E298-304.

Phillips MR, Adamson WT, McLean SE, Hance L, Lupa MC, Pittenger SL, Dave P, McNaull PP. “Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and
shortens time to full feeding.” Journal of Pediatric Surgery 2020; 55(1): 101-105.

Refereed Unpublished Oral Presentations:

McNaull PP: “Hospital Leadership – Ask the Experts.” (Invited/Oral Presentation). Given at Society for Pediatric Anesthesia Annual Meeting, Nassau, Bahamas 02/2020.

McNaull PP: “Practical Opioid Stewardship: What is a Pediatric Anesthesiologist’s Role in the
Opioid Crisis?” (Invited/Oral Presentation). Given at Society for Pediatric Anesthesia Annual
Meeting, Houston, TX 03/2019.

McNaull PP: “Review Game: Historical Figures and Images from Anesthesiology.” Given at
Society for Pediatric Anesthesia Annual Meeting, Houston, TX 03/2019.

Refereed unpublished abstracts:
McNaull PP, Castro B, Sharma R, Vizzini S, Frank D, Vergales J, Dean P, Gangemi J, Roeser M, Edelson M, Raphael J. “A pilot and feasibility study comparing fibrinogen concentrate and cryoprecipitate in children undergoing cardiac surgery.” Accepted to Society for Pediatric Anesthesia Spring Meeting, Tampa, FL 03/2022.

Yildirim MI, Castro B, McNaull P, Raphael J, Sharma R, Spaeder M, Vizzini S, Frank D. “The effect of oral versus nasal intubation on feeding outcomes in neonates requiring cardiac surgery.” (Solicited/Poster) Given at the Society of Critical Care Medicine Congress, Virtual, 02/2022.

Purcell LN, Marulanda K, Mangat S, McCauley C, Chaumont N, Sadiq T, McLean SE, Lupa C, McNaull P, Phillips MR. “Enhanced Recovery After Surgery Pathways Improve Outcomes in Pediatric Colorectal Surgery.” (Solicited/Poster) Given at the American Pediatric Surgical
Association, Virtual, 05/2020.

Marulanda K, Purcell LN, Strassle PD, Koonce R, Mangat S, McCauley C, Sadiq T, Chaumont N,
McNaull P, Lupa C, Phillips MR. “Enhanced Recovery After Surgery Pathways Improve Outcomes in Pediatric Colorectal Surgery.” (Solicited/Poster) Given at the 15 th Annual Academic Surgical Congress, Orlando, FL, 02/2020.

Bryant MK, Purcell LN, Marzinsky A, Charles AG, McLean SE, Farber L, McNaull P, Phillips MR. “Patient-reported Outcomes after Implementing Standard Opioid Prescribing for Pediatric Appendectomy.” Given at the 15 th Annual Academic Surgical Congress, Orlando, FL, 02/2020.

Ricketts K, Phillips M, Marzinsky A, Woody N, Higginbotham C, Bradford K, Farber L, Hildebrand K, Chidgey B, McNaull P. “Utilizing a length of stay algorithm to guide opioid prescribing for pediatric surgery patients: A quality improvement project.” (Solicited/Poster) given at Society for Pediatric Anesthesia Spring Meeting, Nassau, Bahamas 02/2020.

Ricketts K, Phillips M, Marzinsky A, Woody N, Higginbotham C, Bradford K, Farber L, Hildebrand K, Chidgey B, McNaull P. “Utilizing a length of stay algorithm to guide opioid prescribing for pediatric surgery patients: A quality improvement project.” (Solicited/Poster)
Given at Society for Society for Pediatric Pain Medicine Meeting, Nassau, Bahamas 02/2020.

Research Projects

Dr. Ronak Patel. 2018-Present Ongoing research: “Oral vs. Intravenous Acetaminophen for Post-Tonsillectomy Pain.”

Dr. Ronak Patel. 2017-Present Ongoing research: “Intravenous Lidocaine Infusions for Analgesia in Scoliosis Surgery.” (Affiliation with Harms Anesthesiology Study Group).

Patel, Ronak. “2 Year Old with A Large Mediastinal Mass Presenting For Biopsy and Excision.” ‘Medically Challenging Cases.’ American Society of Anesthesiologist Annual Meeting, Virtual Conference, October 3, 2020.

Politis GD, Gregory G, Yudkowitz F, Fisher Q, Bhettay A, Wexler A: “Guidelines for Conducting Plastic Reconstructive Short-Term Surgical Projects in Low-Middle Income Countries.” Pediatric Anesthesia 30:1308-1321, 2020, (Featured Cover Article). Dr. George Gregory is a largely considered one of the pioneers in pediatric anesthesiology

Electronic Forum

Politis, G. “Anesthesiology and Critical Care Forum: Implications of COVID-19 for Low-middle
Income Countries,” Electronic Forum by Operation Smile International, April 23, 2020 (Electronic Publication). The Forum was led by Doctor George Politis who served as Host/Panel Moderator, and Speaker. Dr. Politis organized experts, developed topics, led group meetings, wrote and edited most of the manuscript, obtained guideline endorsements from national and international pediatric anesthesia societies and NGOs.

Politis GD. “Anesthesia for Surgical Missions.” in Davis P, Cladis F, and Motoyama E, eds. Smith’s
Anesthesia for Infants and Children, 10 th ed., 2022 (Invited chapter in the pediatric anesthesiology textbook largely considered to be the most prestigious multi-authored text
in the field.)

Poster Presentations

Lindsay Brown, Ziyad Knio, William Kim, Marcel Durieux, Bhiken Naik, Barbara Castro, Ruchik Sharma. “Comparative incidence of adverse events during gastrostomies in infants with and without congenital heart disease (selected in the top five posters).” Congenital Cardiac Anesthesia Society Meeting, March 2021.

USA Accepted Abstracts: Adams J, Vizzini S, Romeo D. “Urgent Non-Obstetrical Surgery in a Noncompliant Parturient with Fontan Circulation Physiology” Congenital Cardiac Anesthesia Society Annual Meeting, Medically Challenging Case Presentation, Nassau Bahamas: February 2020.

Adams J, Vizzini S, Romeo D. “Urgent Non-Obstetrical Surgery in a Noncompliant Parturient with Fontan Circulation Physiology.” Society for Pediatric Anesthesia, Annual Meeting, Medically Challenging Case Presentation, Nassau Bahamas: February 2020.

Specialty Impact

EDUCATION

Residents at the University of Virginia complete their required pediatric anesthesia rotations on campus at UVA Children’s Hospital. Residents are first introduced to pediatric anesthesia in their CA-1 year. Prior to their first rotation they spend two days with a dedicated pre-peds team. Residents shadow and learn the logistics of providing care from their pre-peds team in the pediatric operating rooms, and outside of the OR locations.

Residents complete a total of 4 weeks of pediatric anesthesia in their CA-1 year, all at the main UVA Children’s Hospital. During the CA-2 year, residents are assigned higher level pediatric cases and do a rotation at the outpatient surgical center (OPSC). In the CA-3 year, residents function at the level of a fellow and are often assigned index cases in the main OR, as well as high turnover rooms at OPSC where efficiency is critical.

PEDIATRIC CARDIAC ELECTIVE

Our residents have a unique opportunity to do a three-week pediatric cardiac anesthesia rotation in their CA-3 year. During this rotation, they spend 3 days a week in the cardiac OR and one day a week in the pediatric catheterization lab. One day per week is devoted to education, highlighted by the opportunity to attend a weekly Cath Conference and participate in discussions of case selection and management by the cardiology and surgery teams.

There are no pediatric fellows at our institution. This enables our residents to participate in the care of a wide range of cases, from neonates, to adult congenital cardiac patients. The majority of cases are performed one-on-one with a pediatric cardiac anesthesiologist. This allows for close supervision and guidance while completing procedures with ample opportunity for teaching/learning.

GLOBAL HEALTH OPPORTUNITIES

Residents who would like to participate in global health initiatives easily find mentors within the Pediatric Anesthesia Division. Many attendings travel with various organizations to provide anesthetic care for pediatric patients in developing/underserved countries.

The department encourages and supports resident participation when possible and safe to do so. Residents at UVA also have the opportunity to help organize and give monthly web-based, case oriented presentations to students and residents at the University of Rwanda/Ethiopa.