Department of Anesthesiology
Letter from Director
Life at Jeff
Lectures & Conferences
Cardiothoracic Anesthesia | Critical Care | Neurosurgical Anesthesia | Obstetric Anesthesia
Outpatient Anesthesia | Acute Pain Management | Chronic Pain Management | PACU
Pediatric Anesthesia | Preadmission Testing Center
Thomas Jefferson University Hospital has a busy cardiac surgery service that has been ranked as one of the best in the nation. Our residents spend a minimum of two months on the cardiac anesthesia service. During this time they acquire the knowledge and technical skills needed for the anesthetic management of complex cardiac surgery patients. Our residents are exposed to a wide variety of cardiac surgical procedures including minimally invasive techniques, repair of simple congenital heart defects, the use of biventricular assist devices as a bridge to cardiac transplantation, as well as cardiac transplantation. The cardiac rotation enables the resident to become familiar with cardiac pathopysiologic conditions including severe left ventricular dysfunction, myocardial ischemia, pulmonary hypertension, and cardiac dysrhythmias. Residents have the opportunity to gain expertise in the placement of arterial lines, central venous pressure lines, and pulmonary artery catheters. Bispectral electroencephalographic analysis is used in many patients and transesophageal echocardiography is used in most patients. During the third year of anesthesia training residents can elect to spend 3 to 6 months on the cardiac anesthesia service allowing a more in-depth experience. Research is encouraged and supported though not required. In past years, many residents in our program have had the opportunity to publish and present their research at national meetings. Fellowships are available for the individual interested in preparing for a career as a cardiac anesthesiologist.
Each resident spends a minimum of two months in the Intensive Care Units developing an understanding of the diagnosis and treatment of complex critical illnesses. Residents develop the additional skills required for the care of critically ill patients with multiorgan system failure. The resident has day to day experience in airway management, mechanical ventilation techniques, intravenous administration of potent and rapidly acting drugs, blood and fluid administration, and both non-invasive and invasive monitoring of vital organ function. Residents are "at the head of the bed" for all critically injured trauma patients on arrival to the Emergency Department, actively managing the initial resuscitation in the trauma team setting. Residents gain experience with the ethical and legal considerations as well as cost effectiveness in the management of patients in an Intensive Care Unit. During the CA-3 years, interested residents may gain extra critical care training and participate in research projects.
The active Neurosurgery Department generates an operating room schedule that requires the use of sophisticated anesthetic techniques. While on this service, the resident learns about the complex interactions between anesthetics and altered cerebral physiology. Specialized monitoring techniques include Somatosensory Evoked Potentials and Electro-encephalogram. Jefferson's designation as the Regional Spinal Cord Injury Center of the Delaware Valley provides extensive experience in dealing with problems of compromised airways, spinal shock and neurologic deficits. Residents can obtain additional exposure to neuroanesthesia during the CA-3 year.
Thomas Jefferson University Hospital has an active obstetrics service with approximately 2200 deliveries each year. As a high-risk referral center, we routinely care for women with complicated obstetric problems. Residents learn how to furnish labor analgesia as well as anesthesia for routine elective and emergency cesarean delivery. They develop the manual skills to perform epidural and subarachnoid anesthetics reliably. In addition, residents work in close consultation with obstetric residents in managing severely ill parturients in the High Risk Obstetric Care Unit. In the CA-3 year, we offer further clinical and research training in obstetric anesthesia. Interested residents have ample opportunities to develop and participate in clinical and laboratory research projects.
In a few years, 80% of all surgeries are expected to be performed in an outpatient setting. We provide anesthesia for such cases at the freestanding Jefferson Surgical Center (JSC), in the Thomas Jefferson University Hospital main operating rooms, in a gastrointestinal endoscopy center, and in a non-invasive cardiology suite. The JSC has four operating rooms, each equiped with new, state of the art physiologic patient monitors and anesthesia machines. Our patients range in age from 6 months to 90 years, and from ASA physical status I through IV. Many categories of surgery are represented, including pediatric, ENT, gynecologic, urologic, oralmaxilofacial, cosmetic, and general. Resident education centers around choosing and performing safe anesthesia in an environment of rapid turnovers, while ensuring that patients are ready for discharge in the shortest time possible.
Acute Pain Management
The Pain Management Section in the Department of Anesthesiology is composed of two divisions: One division treats patients with acute postoperative pain while the other deals with patients suffering from chronic pain syndromes. The Acute Pain Management Service (APMS) manages pain in the acute postoperative period. The census is typically between 20 and 40 inpatients that are seen daily. Pain management techniques include patient controlled analgesia, infusions through epidural and intrathecal catheters, and continuous peripheral nerve blocks. The use of adjunctive pain medications is stressed as well. Didactic teaching occurs daily on rounds in addition to a weekly conference.
The PACU rotation provides a curriculum of structured didactics and direct patient care supervised by Anesthesiologists with research interest in postoperative care. Residents learn to diagnose and effectively treat both common and uncommon postoperative complications, while simultaneously learning basic principles of resource utilization, triage, and bed allocation.
Chronic Pain Management
A separate medical group based at the Jefferson Pain Center manages those patients suffering from chronic pain. The chronic pain team manages patients suffering from a wide spectrum of diseases including chronic low back pain, cancer pain and neuropathic pain. Jefferson is a major referral center for patients with reflex sympathetic dystrophy and other neuropathic conditions. Therapies include the use of medication, nerve blocks, psychotherapy and/or physical therapy. Appropriate referrals are made to other medical personnel in the surrounding area for therapies such as biofeedback, hypnosis, relaxation training and acupuncture. Weekly interdisciplinary meetings take place where specific patients are discussed. These meetings form the basis for cooperative efforts from the Departments of Neurology, Neurosurgery, Vascular Surgery, Psychiatry and Pharmacy. Residents in the CA-2 year spend at least one month on the service. The option exists for advanced training in the CA-3 year.
Exposure to pediatric anesthesia occurs throughout the residency. A Jefferson, the faculty includes several fellowship-trained pediatric anesthesiologists who provide the expertise to care for infants with severe medical problems. In addition, each resident spends two months during their CA-2 year at the duPont Hospital for Children for an intensive pediatric anesthesia experience. DuPont Hospital is a 128 bed multidisciplinary pediatric facility and is affiliated with the Jefferson Health System. During the rotation residents have the opportunity to participate in a wide array of pediatric surgical procedures, ranging from neonatal emergencies to routine outpatient procedures. Many surgical specialties are present and active at duPont, including otorhinolaryngology, urology, general surgery, orthopedic surgery, ophthalmology and neurosurgery. The fellowship-trained faculty at duPont has clinical expertise in caring for high-risk neonates, infants, and children. Residents may also return to duPont for an elective rotation of 3-6 months during their CA-3 year to further develop their skills and knowledge of pediatric anesthesia.
Preadmission Testing Center
Members of the anesthesia department in our preadmission testing center evaluate virtually all patients who undergo elective surgery. Jefferson was one of the first medical centers in the Delaware Valley to establish such a sophisticated preoperative evaluation center. Anesthesiologists (including members of the resident staff) decide on appropriate laboratory studies, consultations, etc. in preparation for the planned surgery. Studies from our own center and others have shown that preadmission testing and evaluation is a cost effective way to prepare patients for surgery. The Center prepares patients psychologically for surgery and allows them to discuss special anesthetic concern directly with an anesthesiologist.