New Heart Institute Facility Concentrates Pediatric Cardiac Anesthesia Resources and Reduces Anesthetic Events for Patients

Children with congenital heart disease do not receive one anesthetic. They receive a lifetime of them, beginning in some cases within days of birth and continuing across cardiac surgery, catheterization, cardiac MRI, sedated echocardiography, dental care, and diagnostic studies unrelated to the heart. Guidance from the U.S. Food and Drug Administration on anesthetic exposure in the developing brain recommends deferring elective procedures in patients younger than three years of age. For much of the UPMC Children’s Heart Institute population, that option does not exist.

The pediatric cardiac anesthesia program at the UPMC Children’s Heart Institute works from that principle. When deferral is not possible or advisable, the remaining options are the number of separate anesthetic events a patient undergoes and the duration of each one. The new Heart Institute facility, which opened June 4, 2026, changes what is achievable on both counts. The new Heart Institute facility allows for cardiac MRI, catheterization, and a dedicated sedation area within one procedural environment, and it allows the clinical teams to redirect anesthesia staffing away from general operating room coverage and toward the Heart Institute.

"Most of the agents we use have been in practice since I began my career, and we are confident in them. What we can control is how many times a child is brought under and how long we keep them there. Combining procedures into a single anesthetic and shortening the time we need is where the meaningful risk reduction happens," says Patrick M. Callahan, MD, chief of pediatric cardiac anesthesia at UPMC Children’s.

New Facility Redirects Anesthesia Capacity to the Heart Institute

The program is currently staffed by six pediatric cardiac anesthesiologists. Under the model in place before the new facility opened, those six also covered general operating room cases, including otolaryngology and orthopedic procedures on otherwise healthy children, whenever cardiac volume did not require them. The addition of the new hybrid cardiac catheterization and cardiac MRI suite, and the other new catheterization rooms changed that allocation. The program now runs three cardiac assignments on a typical day: one anesthesiologist covering surgical cases, one covering the catheterization laboratory, and a third dedicated to cardiac imaging and sedated procedures. Anesthesia coverage for sedated cardiac imaging has expanded to two full days per week.

The physical arrangement of the new facility matters. In the previous configuration, the MRI scanners sat on a different floor from the catheterization laboratories, and an anesthesiologist assigned to either one worked alone for the day.

"Those assignments used to be islands. An anesthesiologist in MRI was on a different floor from the one in the catheterization laboratory, and neither could do anything for the other. Putting those rooms together means two pediatric cardiac anesthesiologists in the same space every day, with immediate backup if a case turns difficult or otherwise," Dr. Callahan says.

The third assignment also gives the program scheduling latitude it did not previously have. Most cardiac CT and MRI studies at the UPMC Children’s Heart Institute proceed without anesthesia support, but the studies that require it can now be clustered onto designated days. A single day might open with a cardiac CT in the adjacent hospital building, move to the Heart Institute for two or three cardiac MRIs, and close with sedated echocardiography in the procedure area beside the MRI suite.

Fewer Anesthetic Events per Patient

Pediatric heart patients routinely accumulate procedural needs that have nothing to do with one another. A single child may require a dental cleaning, EEG lead placement, and a cardiac MRI within the same period. Each of those requires sedation and scheduling them separately means three inductions. The program’s standing practice is to combine whatever can be combined into one sedation.

"The question I ask is not whether a given anesthetic is safe. It is what this child’s total exposure looks like by the time they are 10, and whether anything on the schedule can be folded into something already planned," Dr. Callahan says.

The new Heart Institute facility extends this practice into the procedural workflow. The co-located MRI and catheterization suite allows a diagnostic cardiac MRI and a catheterization to proceed under a single anesthetic rather than two. For the anesthesia team, the exchange is a longer individual case conducted across two procedural environments in place of two shorter cases on separate days. In exposure terms the trade is favorable. Induction and emergence occur once rather than twice, and the patient avoids a second period of preoperative fasting, a second recovery, and a second day away from school.

Sedated Echocardiography Moves Under Anesthesiology

Transesophageal echocardiography requires sedation in every case. Transthoracic studies require it selectively, depending on the patient’s age, size, and capacity to remain still. Previously, sedation for these studies came from a hospital sedation service rather than an anesthesiologist, working primarily with intranasal dexmedetomidine. The approach succeeded frequently but not reliably, and a failed sedation meant a family left without a completed study and had to return for a second attempt.

The new facility includes a dedicated sedation procedure area adjacent to the cardiac MRI suite, and responsibility for these studies now sits with the pediatric cardiac anesthesia program.

"A sedation service working with one agent has limited options when a child does not settle. An anesthesiologist in that room has the full range of what we use everywhere else in the hospital. The point is not that the previous approach was unsafe. The point is that a failed study becomes a second appointment, a second trip, and a second exposure," Dr. Callahan says.

Uniform Practice as a Method for Managing Patient Complexity

All six anesthesiologists in the program trained within the same institution and, for most of them, under the same mentor. The group has since made a deliberate choice to standardize how anesthesia is delivered rather than preserve individual preference.

"These patients carry enough clinical variability on their own. When something changes in the middle of a case, I want to be able to attribute it to the patient rather than wonder whether it has to do with who is running the anesthetic that day," Dr. Callahan says.

Patients anticipated to require intubation beyond approximately one week receive nasal rather than oral endotracheal tubes, a practice adopted to preserve mouth care and the suck reflex and to support postoperative feeding once the tube comes out. Vasopressin is used consistently in Fontan and single-ventricle patients to limit intraoperative fluid administration.

"When you work with individuals, you learn who does what well and you adjust to each of them in turn. When you work with a team, the team does things well, and when something needs to change, it changes for everyone at once. That is a different kind of reliability, and it is what the surgeons and cardiologists are actually relying on," Dr. Callahan says.

Anesthetic Management of Adult Congenital Heart Disease

Volume in the adult congenital heart disease population continues to grow, and most cardiac surgical procedures and catheterizations for these patients take place at UPMC Children’s Heart Institute, with some care delivered at adult UPMC facilities, including UPMC Presbyterian. The anesthetic challenge is the arrival of adult comorbidity in a pediatric procedural environment. Diabetes, hypertension, hyperlipidemia, renal disease, and coronary artery disease are not conditions a pediatric cardiac anesthesiologist has to deal with on a regular basis, and each carries intraoperative consequences, including tighter glucose control and closer attention to ischemia in susceptible patients.

"We have gotten good at this because we do a lot of it, and the volume keeps climbing. The harder problem is not the operating room. It is everything that surfaces afterward in the intensive care unit, where adult disease tends to declare itself," Dr. Callahan says.

Patient Experience in the Procedural Environment

The procedural spaces in the new UPMC Children’s Heart Institute include selectable ambient lighting, projected imagery, and video content in both the MRI suite and the catheterization laboratory, with patients choosing what they see. The program pairs those features with premedication for anxiety where appropriate.

"Children object to being out of control more than they object to any specific thing we do to them. Letting a child choose what is on the wall returns a small amount of control in a situation where they have almost none. That matters before we have to deliver and manage an anesthetic more than most people assume," Dr. Callahan says.

More Information

To refer a patient to UPMC Children’s Heart Institute, or for general questions or inquiries, please call 412-692-5540 or email CHPHeartReferral@chp.edu. You can also visit our Health Care Providers page for detailed referral information for cardiology specialists, emergency needs, cardiothoracic surgery, fetal and prenatal cardiology, and adult congenital heart disease.