- Vice-Chairman, Education
- Program Director,
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. Residents are exposed to a wide variety of cardiac surgical procedures including minimally invasive procedures such as TAVR and MitraClip, repair of simple congenital heart defects, implantation of ventricular assist devices, as well as cardiac transplantation itself. In addition, residents will perform anesthetic care during electrophysiologic procedures such as atrial and ventricular arrythmia ablations. The cardiac rotation enables the resident to become familiar with cardiac pathophysiologic 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 pressure lines, and pulmonary artery catheters. Bispectral electroencephalographic analysis, cerebral oximetry and transesophageal echocardiography are used routinely. During the third year of anesthesia training, residents can elect to spend additional time 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.
Additionally, residents will spend at least one month doing thoracic cases wherein regional anesthesia skills are taught, as well as various lung isolation techniques.
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 Jefferson Neurosurgical Department generates a busy operating room schedule that requires the use of sophisiticated anesthetic techniques. While on this service, the resident learns about the complex interactions between anesthetics and altered cerebral physiology. The resident will provide anesthesia for many delicate procedures including awake craniotomies, aneurysm clippings, as well as an abundance of tumor resections. With the onset of the COVID-19 pandemic, residents have participated in an increasing number of neurosurgical emergencies in the Interventional Neuroradiology Suite.
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 may also obtain additional exposure to neuroanesthia during the CA-3 year.
Thomas Jefferson University Hospital has an active obstetrics service with approximately 3000 deliveries each year. As a high-risk pregnancy referral center, we routinely care for women with complicated medical and obstetric problems. These include patients with complex cardiac disease (cardiomyopathy, congenital cardiac disease, valvular disease), neurological disease, hematologic disorders, pre-eclampsia/eclampsia and patients utilizing medication assisted therapy (MAT) since we support a peripartum methadone clinic. In addition, we are a referral center for parturients with abnormal placentation including placenta accreta/increta/percreta. Also, we routinely care for COVID-19 parturients throughout their labor and delivery using a well-established protocol. Residents learn how to furnish labor analgesia and to provide anesthesia for operative procedures including elective and emergency cesarean delivery, postpartum tubal ligation (PPTL), and cervical cerclage. They develop the manual skills necessary to reliably perform epidural and subarachnoid anesthetics. Our residents work in close consultation with obstetric residents to manage severely ill high risk parturients. 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 equipped 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.
The Acute Pain Management Service (APMS) manages a wide variety of pain in the in-patient setting. The daily patient census is typically between 30 and 40 in-patients with severe acute pain, acute on chronic pain, opioid tolerance, substance use disorder (SUD), ICU sedation in the most challenging patients, burn, trauma and sickle cell crisis pain. APMS also maintains an in-patient infusion service for challenging chronic pain syndromes such as refractory migraine and CRPS. APMS has taken an aggressive role with the opioid crisis to initiate buprenorphine in patients with active SUD as well as opioid tapering. Pain management techniques include patient controlled analgesia, epidural analgesia, continuous peripheral nerve blocks and infusion therapies (ketamine, lidocaine). APMS champions non-opioid multimodal techniques. Medical students, residents and fellows participate in daily teaching rounds. 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. The Department of Anesthesiology has a vibrant fellowship in regional anesthesia and acute pain management.
Our regional anesthesia service provides the gamut of advanced regional anesthesia techniques consisting of single injection and continuous peripheral nerve blocks, epidurals and spinals, and compartment blocks usually placed with ultrasound guidance. These techniques are employed for surgical anesthesia, postoperative and trauma pain control. This section also provides point of care ultrasound assessments (PoCUS). Residents spend at least one month on the regional anesthesia service.
The Jefferson Pain Center manages those patients suffering from chronic pain primarily in the outpatient setting from a wide spectrum of diseases including chronic neck and back pain, cancer pain and neuropathic pain. Jefferson is a major referral center for patients with chronic regional pain syndrome (CRPS) and neuropathic pain. Therapies include pharmacological, interventional injections, nerve blocks, neuromodulation and intrathecal techniques. When possible multidisciplinary approaches are employed. Referrals are made for cognitive behavioral therapy, mindfulness, biofeedback, hypnosis, relaxation training and acupuncture.
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. Jefferson maintains a chronic pain fellowship.
The PACU rotation provides residents with the opportunity to care for patients in the immediate postoperative period recovering from a wide variety of surgical procedures. Through a combination of bedside instruction as well as web-based teaching modules, residents learn to diagnose and manage postoperative complications under supervision of a dedicated PACU attending Anesthesiologist. Recognizing that perioperative care of surgical and procedural patients outside of the operating room is increasingly relevant in our specialty, the PACU rotation also teaches basic principles of resource utilization, bed allocation, and perioperative efficiency.
Exposure to pediatric anesthesia occurs throughout the residency. At Jefferson, the faculty includes a team of 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 and one month during the CA-3 year at Nemours Children's Hospital, for an intensive pediatric anesthesia experience. Nemours Children's Hospital, located in Wilmington, Deleware, 38 minutes away from Center City Philadelphia, is a 128 bed multidisciplinary pediatric facility affiliated with the Jefferson Health System. During their rotation at Nemours, 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 Nemours, including otorhinolaryngology, urology, general surgery, orthopedic surgery, ophthalmology and neurosurgery. The fellowship-trained faculty at Nemours have clinical expertise in caring for high-risk neonates, infants, and children. Residents may also return to Nemours for an elective rotation of 3-6 months during their CA-3 year to further develop their skills and knowledge of pediatric anesthesia.