Michigan Medicine’s Department of Anesthesiology has reached a significant milestone when it comes to the care of some of our youngest patients. A team led by Ashlee Holman, MD, recently completed its 1000th procedure under awake pediatric spinal anesthesia at C.S. Mott Children’s Hospital.

The department’s pediatric spinal anesthesia program offers a needle-based technique that provides sensory and motor block without the use of intubation or general anesthesia for pediatric surgery. The program — which Holman launched in 2018 in partnership with urologist John Park, MD — is growing in popularity for “below the belly button” procedures like circumcisions and inguinal hernia repairs. 

“Spinal anesthesia benefits our youngest of patients by making the perioperative period safer for them. The riskiest part of an anesthetic for children under the age of 1 is management of their airways. Spinal anesthesia takes this completely out of the picture,” Holman said. 

“Their vital signs stay remarkably stable throughout the surgery with spinal anesthesia, and they aren’t exposed to general anesthesia medications or opioids. Babies have smoother operative and postoperative courses and are reunited quicker with their caregivers in the recovery room. Our surgeons and parents just love it.”

By chance, Holman and Park were in the operating room together for the 1000th procedure.

“1000 spinals is wonderful, but what means the most to me is that the stars aligned for John and I to perform the 1000th one together. It’s just extraordinary,” Holman said. “He was the one who initially came up with this idea. He has supported me as we have celebrated our successes and worked through the issues together, and he continues to be an inspiration for myself and everyone who knows him. John is a beautiful soul.”

Holman now leads a team of approximately 25 pediatric anesthesiologists who perform awake pediatric spinal anesthesia at University of Michigan in Ann Arbor and University of Michigan-Sparrow Health Center in Lansing.

She also has trained six classes of pediatric anesthesia fellows — about 50 fellows — several of whom have started their own pediatric spinal anesthesia programs at hospitals throughout the country. Holman and a Michigan Medicine team received an Innovation Research Grant last year from U-M’s Graduate Medical Education office to continue this work, developing a simulation-based spinal anesthesia skills training program in order to support faculty, fellows and residents as they further develop their skills.

As the program continues to grow, Holman reflects back on the colleagues who helped get to this milestone. 

“None of this would have been possible without the hard work of all of my pediatric anesthesia colleagues, who have so gracefully and expertly changed their practice over the last five years. I am thankful for my talented Spinal Superstars — Dr. Kathleen Gibbons, Dr. Margo Stewart, and Dr. Lisa Vitale — who are the most amazing and innovative anesthesiologists I know,” she said. “The anesthesiologists who form the Pediatric Acute Pain Service were integral to the program’s success. I can’t thank them enough for all they’ve done. I am grateful for the nurses and techs who promoted this program, the surgeons who gave it a chance, and my own department for supporting me in this endeavor.”

Now, the team turns toward the next chapter with an eye on continuing to advance spinal and regional anesthesia both locally and across the country — and bolstered by a friendly competitive spirit. 

“A friend of mine, who is an expert in pediatric spinal anesthesia, told me that our program here is the third program in the country to hit the 1000th spinal mark. This is a huge accomplishment, but for those who know me well, I don’t like to settle for anything less than first,” Holman said. 

“So, here’s to the next 1000 and continuing to push the boundaries to make surgeries safer for children!”