How much training and experience do anesthesiologists need to safely care for young children? That's a good question without a good answer, other than these two, both of which appear to be bobbing on the same sea of uncertainty:

• The comfort zone. General anesthesiologists can handle children's surgeries - as long as they are comfortable doing so.
• The magic number. California Children's Services, a state program that pays for specialized pediatric care, is considering a proposal that would require participating anesthesiologists to treat at least 25 infants and children annually.

"Pediatric anesthesiologists cannot do all children, not even half of all of them," says Ronald Litman, DO, an attending anesthesiologist at the Exton Ambulatory Surgery Center of The Children's Hospital of Philadelphia. "There's not enough of us to go around. Not nearly enough."

And therein lies the problem: While the supply of pediatric anesthesiologists is in full wane, the number of outpatient pediatric cases is on the rise. It's little coincidence that reports of things that can go wrong when you administer anesthesia to pediatric patients - laryngospasm, bronchospasm, hypoxia, gastric aspiration, arrhythmias, pulmonary edema and delayed recovery - is also on the rise in outpatient settings.

As our cover story ("Handle with Care" on page 28) points out, everything's different when you care for kids, from the equipment and anatomy to the pharmacology and psychology. While research hasn't determined exactly how much experience is required to produce better outcomes, studies have made two things clear:

• Infants and young children have a higher incidence of complications from anesthesia, including cardiac arrest and death, compared with adult patients.
• Infants cared for by general anesthesiologists have a higher incidence of cardiac arrest and oxygen loss during surgery than those cared for by pediatric anesthesiologists.

While no one is saying that you shouldn't use general anesthesiologists for your pediatric cases, few would argue that anesthesiologists who take care of kids all the time are more comfortable with what they're doing and do a better job.

As Dr. Litman says, "when you pay exquisite attention to detail and do every single case exactly the same way, when the drugs, wires and equipment are in the exact same place, that's when you minimize mistakes."