The Department of Anesthesiology has a long tradition of excellence in the clinical care of cardiac surgical patients dating back to the development of the clinical application of pulmonary artery catheterization and transesophageal echocardiography. Today, Yale-New Haven Hospital is a busy pediatric and adult cardiac surgery center, delivering cardiac anesthesiology services for over 1,250 patients annually. With all cardiac anesthesia faculty members trained in transesophageal echocardiogapy (TEE), we are well equipped to provide intraoperative echocardiographic examination for all cardiac surgical procedures. Weekly echo conferences are designed to review interesting and challenging cases. There are active collaborations in the area of TEE associated research between the Department of Anesthesiology and Cardiology.
Significant clinical emphasis is placed on the management of patients with complex cardiac and cardio-thoracic disease as well as management of patients in the cardio-thoracic ICU. The expansion of clinical programs in the area of cardiac assist devices as well as cardiac transplantation have significantly expanded the scope and breadth of service provided by the cardiac anesthesia division. Recent clinical expansion into cares of port-access valve procedures as well as robotic surgical procedures have further embellished the division's clinical profile.
We have expanded the role of the cardiothoracic anesthesiologist to include management of patients in the Cardiothoracic Intensive Care Unit. This 18 bed unit is staffed exclusively by members of the Department of Anesthesiology.
Future activities will include the management of patients undergoing electrophysiology procedures and ablations. A program for lung transplantation is also planned for the near future.
Core Research Areas Include:
- Evaluation of the impact of cardiopulmonary bypass on the inflammatory response
- Invasive and non-invasive cardiovascular monitoring
- Impact of CPB on hepatic/renal function
- Development of TEE-quality-assurance mechanisms and education materials
- Tissue engineering/regeneration medicine
- Identifying outcome indicators in patients receiving cardiac assist devices
- Impact of LVAD on metabolic function
Critical Care Anesthesia
The Department participates in a variety of critical care units that are devoted to the care of patients throughout the various intensive care units at Yale-New Haven Hospital. The critical care faculty are all board certified in both anesthesiology and critical care medicine, and many have added qualifications in transesophageal echocardiography (TEE).
Faculty participating in critical care anesthesiology include: Dr. Stanley Rosenbaum, Dr. Shams Akhtar (Director of 7-1 SICU), Dr. Hossam Tantawy (Director ofCTICU), as well as Drs. Roberta Hines, Manuel Fontes, Jean Charchafleih, Ranjit Deshpande, Nikhil Chawla, Jing Tao, Amit Bardia, Christopher Czabo, Ashley Eltorai, Victor Lan, Oswaldo Razo-Vazquez .
This dedicated group of physicians provides care for patients in the:
- Surgical Intensive Care Unit (23 beds),
- 7-1 SICU (8 beds),
- Cardio-Thoracic Intensive Care Unit (18 beds), and
- Medical Intensive Care Unit (42 beds).
Together these units admit over 5,000 patients each year and provide care for patients with complex surgical procedures, trauma, transplantations (heart, liver, kidney and pancreas), ventricular assistance device implantations, CABG, and major vascular and thoracic surgery as well as thoraco-abdominal aneurysm repair. In the Medical Intensive Care Unit, care is delivered to a wide spectrum of medicine patients including those with sepsis, pneumonia and stroke.
There is a strong emphasis on the use of multi-disciplinary teams in the care of these critically ill patients. The Critical Care Anesthesiology team works closely with their colleagues from the Section of Trauma and Surgical Critical within the Department of Surgery, as well as with colleagues from the CardioThoracic Surgery and Internal Medicine services.
We are committed to providing round-the-clock anesthesia care for the labor and delivery suite. Our physicians provide different types of neuraxial analgesia as well as multi-modal regional blockade for vaginal deliveries and different types of neuraxial and general anesthesia for cesarean deliveries, tubal ligations, fetal surgeries and EXIT procedures. We also offer ante partum consultative services and management for high-risk obstetric patients.
In collaboration with our colleagues in Maternal-Fetal Medicine, we provide antenatal anesthesia consultation for parturients with complex medical issues, such as congenital and acquired heart diseases, neurological conditions, and coagulopathies. We are a tertiary care center with facilities to care for parturients with significant risk of peripartum hemorrhage, such as those with placenta accreta. Regional blockade for post-operative analgesia and the use of ultrasound for regional analgesia and epidural placement are some of the other special clinical interests/pursuits of our faculty.
In collaboration with our colleagues from Maternal Fetal Medicine and Internal Medicine, we are studying the management of peripartum hemorrhage using thromboelastometry and fibrinogen concentrate, working to understand the impact of bleeding and massive blood transfusion in patients with abnormal placentation. We also have staff studying the specifics of human brain metabolism during pregnancy. Other research efforts include the non-invasive assessment of blood volume status and uterine blood flow, and the management of modern labor analgesia and post-cesarean analgesia.
The Inpatient Acute Pain Service consists of a team of dedicated physicians with subspecialty training and board certifications in pain medicine, specialized nurse practitioners, and rotating anesthesiology residents that focus on the treatment of both adult and pediatric inpatients at both Yale New Haven Hospital York Street and Chapel Street Campuses with postsurgical pain, pain from chronic medical conditions, cancer pain, and various chronic pain syndromes.
We aim to utilize a variety of analgesic pharmacological approaches and delivery pathways (oral, topical, transdermal, intravenous, patient-controlled analgesia (PCA)) as well as interventional therapies such as regional and neuraxial anesthetic blocks to maximally optimize pain control in these patients. We also attempt to incorporate alternative modalities in treating pain whenever applicable such as the use of Transcutaneous Electrical Nerve Stimulation (TENS).
The Inpatient Acute Pain Service acknowledges the Biopsychosocial approach to treating chronic pain and strongly advocates for the integration of Primary Care, Psychiatry, Psychology, Neurology, Neurosurgery, and Physical and Occupational Therapy services in treating any patient with chronic pain.
The outpatient Center for the Assessment and Management of Pain (CAMP) sites currently consists of the Yale Long Wharf Spine Center with the anticipation of new sites at both the Yale Smilow Cancer Center as well as another self-standing facility that will be the home base of CAMP and focus on the assessment and management of the wide variety of painful conditions not related to spine or cancer.
At the Yale Long Wharf Spine Center site, a team of dedicated physicians with subspecialty training and board certifications in pain medicine, a specialized nurse practitioner, and rotating anesthesiology residents work together and specialize on the management of pain related to spinal and paraspinal disorders including spinal stenosis, disc disease, radiculopathy, facet arthropathy, spondylosis, spondylolysis, spondylolisthesis, post-laminectomy syndrome, cervicogenic headaches, as well as sacroiliac joint dysfunction, piriformis syndrome, hip dysfunction, and neuropathic and myofascial pain syndromes. We utilize a comprehensive and multidisciplinary approach in treating spine related pain that includes a wide variety of oral, topical, and transdermal medications, Transcutaneous Electrical Nerve Stimulation (TENS) units, as well as advanced interventions carried out in our procedure suite equipped with fluoroscopy and ultrasound that includes epidural steroid injections, sacroiliac and other joint injections, bursa injections, piriformis injections, trigger point injections, facet medial branch blocks, radiofrequency ablation procedures, peripheral nerve injections, sympathetic blocks, and spinal cord stimulation.
At the Yale Smilow Cancer Center, we aim to develop a comprehensive cancer pain program that will offer multidisciplinary care and cancer pain treatments which will include the latest interventions such as peripheral nerve blocks, neurolytic and neuroablative procedures using advanced image guidance, and implantable intrathecal drug delivery systems to treat patients with a variety of cancer at a variety of stages in their cancer care.
We also plan on opening a new self-standing facility that will be the home base of CAMP and focus on the assessment and management of the wide variety of painful conditions not related to spine or cancer such as Trigeminal Neuralgia, Post-Herpetic Neuralgia, and Complex Regional Pain Syndrome. There will be numerous exciting future programs on the horizon associated with this site such as a Ketamine infusion program for patients with refractory Complex Regional Pain Syndrome (formerly known as Reflex Sympathetic Dystrophy).
Lastly, at all our CAMP sites, we again emphasize the Biopsychosocial approach to treating chronic pain and strive to strongly incorporate the role of Primary Care, Psychiatry, Pain Psychology, Neurology, Neurosurgery, and Physical and Occupational Therapy services in the treatment of any patient with chronic pain.
The Division of Pediatric Anesthesia has a long tradition of excellence in the clinical care of children, providing anesthetic and analgesic care for children undergoing surgery in the Pediatric Surgery Center, and pain management for patients in the Children's Hospital.
Our interests are safety, patient care, education and research. We provide pre-anesthesia care, anesthesia for children undergoing operative procedures as well as cardiac catheterization, and various imaging procedures, and postoperative pain management. All of our anesthesiology staff are dedicated specialists who have completed fellowships in pediatric anesthesiology.
We conduct research in collaboration with research faculty within the department.
Pediatric Pre-Admission Program
Entering the hospital for a surgical or diagnostic procedure is stressful for children and their families. The Yale Pediatric Pre-Anesthesia Evaluation Clinic is designed to allow the anesthesiologist the opportunity to learn about the child (especially with regard to any prior medical problems) and to allow the child the opportunity to learn about what to expect from their anesthesia and surgery experience. Since children often require anesthesia for procedures other than surgery (such as MRI or CT scan), our clinic is designed to evaluate these patients as well.
We have experienced pediatric RN's who call the family in the days to weeks prior to their procedure to review the medical history of the patient and the preoperative instructions. If a child has a complex medical history or is coming for a complex procedure, an appointment will be scheduled to come into our Pre-Anesthesia Evaluation Clinic to be seen by a nurse practitioner, or a child life specialist, and a pediatric anesthesiologist, as well as to have any relevant tests or studies done (blood tests or x-rays, for example). A surgeon can also schedule an appointment with our clinic if needed. If a child is otherwise healthy and a parent feels that the child would benefit from a chance to become acquainted with the hospital surroundings and equipment, we offer orientation to the operative experience classes given by our child life specialist. These can be scheduled through our office at 203-688-5573.