Lisa Leffert, MD, sees patients at a pivotal time in their lives—when they are delivering babies. As a specialist in obstetric anesthesiology, she is privy to some of the most vulnerable and intimate moments in medicine. As chair of Yale’s Department of Anesthesiology, physician-in-chief of anesthesiology at Yale New Haven Hospital and Bridgeport Hospital, and Nicholas Greene Professor of Anesthesiology at Yale School of Medicine, Leffert is also responsible for anesthesiology and pain management across the entire Yale New Haven Health System.

In addition, she is an editor or editorial advisor for several anesthesiology journals and recently completed a term as the president of the Society for Obstetric Anesthesia and Perinatology.

We sat down with Leffert to learn more about her approach to medicine, what she’s most proud of since joining Yale in 2021, and what makes the Yale Department of Anesthesiology stand out.

Pain relief is so fundamental to how a patient experiences delivery. What is it like to be part of this major life event for your patients?  

I’ve had someone holding a baby literally run up to me at a rest stop on the turnpike and say, “Oh, you did my anesthesia!” It’s incredible to witness a birth. As anesthesiologists, we see more of the actual births in cesarean deliveries than in vaginal deliveries, but it’s so remarkable. It’s no less remarkable now than it was when I first began to practice. It’s a time of joy, but there’s also a lot of anxiety and a sense of lack of control for many people. A huge part of obstetric anesthesiology is offering not only physical pain relief, but also emotional support and partnership. When people think of anesthesiology, they often think, “Oh, all your patients are asleep.” Well, it’s rare for my patients to be asleep, as it turns out!

You also work with high-risk obstetric patients. What is that like? And what are the unique challenges in caring for pregnant patients?

We see all kinds of patients: people with neurologic diseases, lung disease, genetic disorders, cancer, and many other comorbidities. The commonality is that they’re all coming to have a baby. In obstetric care, you typically cannot choose the optimal moment of delivery. If someone in labor has COVID or they’re in heart failure, we can’t say we’re going to treat that condition and then have you come back later for your delivery, the way we might delay some other procedures with similar complications. It’s pretty much a situation of you get what you see, and that’s challenging but also very rewarding.

You’re known nationally and internationally not only for your clinical expertise in obstetric anesthesiology, but also for your specialization in patients with neurologic disorders. Can you talk about that? 

There are two sides to this. Patients with neurologic conditions and their physicians often worry that they cannot have the same options (such as labor epidural pain management) as patients without such disorders as scoliosis, back surgery, and even brain tumors or other brain abnormalities. In fact, many of these patients can safely have the same anesthetic choices as other patients, as long as they are properly evaluated by their neurologic and anesthesia doctors. Also, some patients are denied these anesthetics because of concern for complications—specifically bleeding in the area of an epidural that causes compression on the nerves and possibly nerve injury. People who are on blood thinners at the time of the procedure or have clotting issues could fall into this category.

In my research, I have led national expert task forces focusing on such situations, where there may be data about patient outcomes but a lack of consensus in the field. I worked to bring together experts from various fields to look at these data and find the best available evidence to reach a consensus recommendation for how to best treat these patients. These recommendations also address how to present this information to patients so they can be part of the decision, which is hugely important. I’ve also had the honor of being the anesthesia representative on other organizations’ pregnancy-related task forces, such as the American Heart Association and the Canadian Stroke Consortium.

How has the opioid crisis impacted the field of anesthesiology?

These medications really came to the forefront when the medical field shifted toward always treating pain—which is very valid—but that led to an extreme reliance on prescribing opioids, which clearly had a negative fallout. Later, it shifted to the other extreme; many practitioners are now wary of using opioids at all. Like most things in life, it’s not all or nothing; it’s important to find that moderation.

As anesthesiologists, we’re lucky to have multiple modalities of treating patients in pain. Pain relief is our business, and opioids are only one of many options in our armamentarium. We treated pain before the current crisis; we’ll continue to treat pain during and after it as well.

You were on the faculty at Harvard Medical School and chief of the division of obstetric anesthesia at Massachusetts General Hospital for many years before joining Yale. What were you aiming to accomplish in this new position?

I had been in Boston for 50 years and I didn’t think I would leave that area, but this opportunity at Yale was really something special. It was an opportunity to build the department with the support of the dean and the chief of surgery, and everyone I met in the department shared this feeling that we needed to transform and do the work together.

One particular challenge we face is that we’re a health system—an academic health center that has joined with community hospitals. And it’s pretty common for that kind of system to be a system in name only, and for the hospitals to function fairly independently. But at Yale, we want true integration across the system, collaborating and figuring out how to meet the needs of the academic center and the community hospitals while providing the best quality of care at all of them.

What are you most proud of in the time you’ve been here? 

I’m most proud that people want to come to our department and stay. There’s a huge deficit of anesthesia providers nationally, so the fact that we have all these people who want to be here means we can care for a large number of patients. We’re not turning patients away because we don’t have enough anesthesiologists—which is, unfortunately, the case in some places.

What makes the Yale Department of Anesthesiology stand out? 

The faculty here can really do anything. You can be anyone you want—an executive, a master clinician, a basic scientist. We realize that for career satisfaction, people need purpose and autonomy, and we can offer those things here. On the patient side, they experience having the best people caring for them. Patients are putting their lives in our hands, quite literally. When you do that, you want to trust that person and know that they have your best interest at heart. They know that we have their backs. That’s what our department embodies.

How does the department approach research? 

Collaboration is the lynchpin to our research, and that’s not the norm for all institutions. Science at Yale is so strong, and it’s extremely important for our department to be able to collaborate with other departments. We have a neuroscience research program, a clinical outcomes research informatics team, and a clinical trials program, among others. It’s a quite diversified group of folks.

What advances do you see coming in the field of anesthesiology in the next few years?

Anesthesiology was an early adopter of AI and large language models, in particular, because we generate a tremendous amount of physiologic data in our work that can be harnessed for predictive models. Rather than waiting to see whose blood pressure or oxygen levels will drop, we can use past data to predict these outcomes and decide who may need to be treated preventatively.

These models are going to become much more pervasive in the next few years; they will help us personalize what we do for patients. Because there’s a nationwide shortage of anesthesiologists, I think the anesthesiologists themselves will focus more and more on the complex patients, and use the models to help with more standard care. It’s not like AI is going to take off and have a life of its own; we’ll still be involved with all our patients’ care.

On the surgery side, more procedures are taking place outside of the operating room, and more laparoscopic and robotic approaches are being used. As surgery changes, anesthesiology changes as well in partnership with surgery. There is a growing list of regional blocks available to patients, and the goal is increasingly focused on rapid recovery from surgery and anesthesia. Anesthesiologists also play an important role beyond the operating room and labor and delivery floors. We’re intensivists in the ICU. We’re also expert pain management physicians in and outside of the operating room, and that area is expanding as well. Things are very much at an inflection point in the field, and it’s very exciting.