Clinical Divisions

General

Ambulatory Care

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Ambulatory care is provided in 10 operating rooms within Yale-New Haven Hospital. The facility includes a preoperative area, 10 operating room suites, 4 block areas, and 13 PACU bays. The patient population generally excludes patients less than 13 years of age and/or with an ASA classification of IV. Anesthesiologists, along with Certified Registered Nurse Anesthesiologists (CRNAs) and anesthesiology residents, care here for out-patients who are discharged immediately after their surgery

This care, which spares patients the disruption of an overnight hospitalization, is designed to make the surgical experience as convenient and as safe as possible for patients while maximizing efficiency for surgeons. Our practice has a high-volume of routine cases as well as a significant number of sicker patients. Our emphasis on the doctor-patient relationship has resulted in very high patient satisfaction ratings. We also support our busy regional anesthesia practice by working with a dedicated anesthesia team trained in regional anesthesiology.

NORA Division

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The NORA (Non-Operating Room Anesthesia) team provides the administration of anesthesia outside the traditional operating room setting. This is routinely necessary for patients undergoing procedures or tests in the electrophysiology and catheterization labs, the interventional radiology, neuroradiology, and gastroenterology departments, and in the MRI and CT scan suites, among others.

With the increasing demand for anesthesia outside the operating room, the Department of Anesthesiology has assembled one of the nation's first non-operating room anesthesia divisions to specifically address the need to administer anesthesia safely and efficiently under these circumstances. Our goal is to become a model for the administration of non-operating room anesthesia by becoming the nationwide leader in constructing detailed guidelines and protocols for the safe and proficient administration of anesthesia outside the traditional operative setting. To this aim, we have made a comprehensive analysis to ensure adequate accommodation of necessary anesthesia equipment including emergency backup systems. Strict patient selection criteria, including thorough preoperative evaluation and screening are followed, and adequate staffing and recovery care protocols have been established that consider the type of anesthesia, the type of procedure, and special needs of each patient.

Post Anesthesia Care Unit

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The Post Anesthesia Care Unit (PACU) is a short-term Critical Care Unit of Yale- New Haven Hospital, Smilow Cancer Hospital at Yale-New Haven Hospital and Yale-New Haven Children's Hospital. There are separate PACU's for each operating suite: North Pavilion (Smilow), South Pavilion, East Pavilion (Ambulatory Operating Rom), and West Pavilion (Children's Hospital) as well as at the Yale New Haven St Raphael’s site. In the PACU patients are monitored for their acute recovery from intraoperative anesthesia and surgery before transfer to their inpatient bed or discharge from hospital. All the PACU patients are under close supervision of highly specialized Post-Anesthesia nursing and Anesthesiology staff.

Perioperative & Adult

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The Division of Perioperative and Adult Anesthesia is responsible for the medical care of patients with general surgical problems, as well as patients undergoing certain subspecialty surgical procedures:

The Otolaryngologic Section within the Department of Anesthesiology is committed to teaching and research opportunities for residents and visiting clinicians as well as state-of-the-art-care for our patients. Multiple modern techniques are available for the approach to a secured airway in patients with head and neck disease, including preoperative endoscopic examination by the Anesthesiology team.

Current research in the section involves evaluation of new and advanced models of the Laryngeal Mask Airway, use of the Laryngeal Mask Airway in otolaryngologic surgery, and airway

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A nationally recognized neuroanesthesia team is responsible for the anesthetic care of patients undergoing neurosurgical procedures, including craniotomies for brain tumors, aneurysms and arteriovenous malformations, carotid endarterectomies, posterior fossa surgeries, epilepsy surgeries, complex spinal surgery, and stereotactic and interventional neurovascular techniques. Neuroanesthesia locations include multiple MRI-equipped operating rooms plus advanced neurovascular interventional suites.

Clinical and basic science research opportunities exist in the areas of epilepsy control, cerebrovascular disease, intraoperative monitoring and the effects of anesthetics on cerebral vasculature and brain receptors.

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There is perhaps no other sub-specialty of anesthesia requiring a greater variety of anesthetic techniques than orthopedic anesthesia. As an alternative to a general anesthetic, many procedures in orthopedic patients may be better managed with regional anesthesia or with combined regional/general anesthetic techniques.

The orthopedic anesthesia team routinely care for patients undergoing orthopedic surgery as well as an elderly population suffering from severe co-existing cardiovascular or pulmonary diseases. In addition to requiring familiarity with regional anesthetic procedures, such as spinal, epidural, and major nerve blocks, the orthopedic anesthesiologists are also familiar with other anesthetic techniques, such as fiberoptic intubation for complex airway problems and special patient positioning to avoid intraoperative nerve injury.

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Cost-effective preoperative testing has become a major objective in this era of managed medical care. At the Pre-Admission Testing (PAT) Facility, the anesthesiologist reviews what testing is necessary for the patient. The Department has guidelines for testing and collaborates with Diagnostic Imaging and Laboratory Medicine to reduce the costs of unnecessary tests.

Patients requiring anesthesia prior to surgery are evaluated in the PAT facility. Nurse practitioners work under the supervision of Anesthesiology faculty and staff. The PAT facility is currently being expanded because of the rapid growth in Yale-New Haven Hospital's clinical activities.

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Regional anesthesia has experienced significant growth in a variety of surgical areas including: orthopedics, vascular and gynecology. The incrased use of peripheral nerve blockade is partly due to the development of ultrasound-guded plaement techniques, the utilization of indwelling catheters for continuous local anesthetic infiltration, and improved clinical efficacy. The Department of Anesthesiology has a group of dedicated faculty known as the "Regional Anethesia/Acute Pain Medicine Team" that supervises and educates anesthesiology residents during a formal clinical rotation in regional anesthesia. This rapidly growing service now offers a fellowship program along with multiple opportunities for clinical research.

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The section of Thoracic and Peripheral Vascular Anesthesia is comprised of a group of faculty anesthesiologists with special interests in these subspecialty areas. Most of our team members have sub-specialty fellowship training and many are double or triple board-certified.

The mission of the section is to provide outstanding clinical care to this population of high-risk patients. We anesthetize patients for a wide variety of surgical procedures including video-assisted and robotic-assisted lung resections, minimally invasive esophagectomies, tracheal resections, and open or endovascular repairs of aortic aneurysms.

Members of our team are actively engaged in research projects involving thoracic oncology patients. Other research interests of the section include goal-directed fluid therapy for lung resection patients and use of transesophageal echocardiography during endovascular aortic repair.

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The surgical organ transplantation group at Yale-New Haven Hospital is one of the busiest groups in New England, with a liver program that has among the best-in-the-nation survival rates for patients after surgery. A specialized group of faculty in the Department of Anesthesiology works closely with the multi-specialty transplant team to provide perioperative care to pediatric and adult cardiac, liver and renal transplant recipients

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Quality Management Program

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The Quality Management Program within the Department of Anesthesiology is integrated with the institution’s quality management programs, and is responsible for improving performance and demonstrating full compliance with all state and federal regulatory requirements, and hospital accreditation standards.

Components:

  • Performance measurement and improvement
  • Structured analysis of adverse events
  • Fatigue risk management study
  • Compliance with accreditation standards
  • Compliance with regulatory requirements
  • Credentialing, privileging and remediation
  • Standards and policies
  • Utilization review

VA Medical Center

The VA Connecticut Healthcare System's West Haven hospital has a long and treasured relationship as a clinical and research campus of Yale University. As such, it serves as a major teaching facility for Yale medical students and resident house staff. The hospital supports 7 operating locations that are staffed by Yale University faculty. Clinical services encompass a broad range of surgical and other invasive procedures and we serve as a regional referral center for complex cardiac, thoracic, vascular and neurosurgeries. To address the combination of complex surgeries and the high co- morbidity of the patient group the anesthesiology preoperative clinic provides consultative services to optimize the care plan.

Regional anesthetics are frequently employed both for intraprocedural and postprocedural analgesia. In addition we provide specialty acute pain services for the management of preoperative pain. A wide variety of advanced monitoring modalities are used perioperatively. Anesthesia staff also provides perioperative state-of-the-art echocardiography services

Anesthesia Department members are widely invested in research activities. Their work has been internationally recognized in the fields of health systems research, invasive and non-invasive cardia monitoring, fluid therapy and pain.

The VA’s interventional and diagnostic pain service provides comprehensive care and expertise to a challenging population. For those patients requiring the services of a tertiary care facility with advanced diagnostic, rehabilitation and interventional procedures, the Pain Center at VA Connecticut is the only center in New England which has the capability of providing a full range of interventional pain medicine services. We offer modern multidisciplinary pain medicine consultative services, as well as, provide education and tertiary referral capacity to the entire Northeast Region.

We enjoy expanded resource such as a "state of the art" procedure suite with fluoroscopy and ultrasound imaging capability and an infusion suite for complex intravenous treatments. The Pain Medicine Service at VA Connecticut is the only facility in the Northeast region which has the capability of performing complex interventional therapies including the implantation of spinal cord and peripheral neuromodulation stimulators. This accounts for approximately 900 procedures per year.

The VA Connecticut Healthcare System remains a vital tertiary care center offering specialty care services to US veterans. It serves as a key component to the clinical, research and educational goals it shares with Yale University.