Cardiac Anesthesiology Division, UPMC Presbyterian

Erin Sullivan, MD
Director

The Division of Cardiac Anesthesiology at UPMC Presbyterian Hospital provided anesthetic care for approximately 1,139 cardiac surgical patients during the FY 2002 (academic year 2001-2002). These cases include the full spectrum of adult cardiac surgical practice: coronary artery bypass grafting (including minimally invasive techniques such as Mid-CAB and OP-CAB); valve replacement and repair; thoracic aorta repair/reconstruction; arrhythmia ablation; pulmonary thromboendarterectomy; repair of ventricular and atrial septal defects; removal of cardiac tumors/myxomas; placement and removal of artificial ventricular assist devices as a bridge for transplantation (Heartmate, Abiomed, Novacor and Thoratec); and heart, single lung, double lung and heart- double lung transplants. Of the 1, 139 cardiac surgical procedures, 1,053 operations were performed for acquired heart disease; 392 of these operations were performed for conditions other than coronary artery bypass grafting. UPMC Presbyterian Hospital continues to be recognized as a world leader for heart and lung transplantation. Patients with end-stage cardiac disease who are awaiting cardiac transplantation may receive a mechanical ventricular assist device as a bridge to transplantation. 22 mechanical ventricular assist devices were implanted during the FY 2002. There were 86 transplants performed consisting of 38 heart transplants, 20 single-lung transplants, 26 double-lung transplants, and 2 heart/double-lung transplant.

Faculty

The cardiac anesthesiology faculty is comprised of eight talented members who are experts in their subspecialty. Several faculty were promoted to new positions during FY 2002: John P. Williams, M.D. was appointed as Chair of the UPMC Department of Anesthesiology; Joseph J. Quinlan, M.D. was appointed as the Chief Anesthesiologist at UPMC Presbyterian Hospital; John C. Caldwell, M.D. was appointed as Director of Cardiac Anesthesiology at UPMC Presbyterian Hospital.

Erin A. Sullivan, M.D. was appointed to the Board of Directors of the Pennsylvania Society of Anesthesiologists (September, 2001) as well as an Alternate Delegate from Pennsylvania to the House of Delegates for the American Society of Anesthesiologists (September, 2001). She served as the President of the Western Pennsylvania Society of Anesthesiologists (July, 2001-June, 2002). Dr. Sullivan served a second term as a member of the Education Committee and Workshop Chairman for the Society of Cardiovascular Anesthesiologists (May 2001-May 2002).

Echocardiography

Intraoperative transesophageal echocardiography is performed on all patients undergoing cardiac and transplant surgery by the cardiac anesthesiology faculty at UPMC Presbyterian Hospital. We are afforded substantial equipment resources and have established an excellent rapport with the UPMC Presbyterian Hospital echocardiologists. Intraoperative transesophageal echocardiography is a fruitful area of research for cardiac anesthesiology faculty and trainees alike at UPMC Presbyterian. CA-3 residents and cardiac anesthesiology fellows have the opportunity to obtain extensive experience with the use of intraoperative transesophageal echocardiography. All cardiac anesthesiology fellows spend a minimum of one month in the echocardiography laboratory learning introductory principles of echo under the direction of the echocardiologists.

Education

The Division of Cardiac Anesthesiology offers world-class opportunities for both basic and advanced training in adult cardiac anesthesia. The majority of CA-2 residents receive their initial exposure to cardiac anesthesiology at UPMC Presbyterian Hospital. CA-3 residents are offered elective clinical rotations such as one month of transesophageal echocardiography or perfusion as well as a 3 month elective in advanced adult cardiac anesthesiology. Residents and fellows receive course goals and objectives at the beginning of their clinical rotation along with a list of required reading material. The resident and cardiac fellowship didactic program consists of intraoperative clinical teaching by the cardiac anesthesiology faculty, lectures and problem-based learning discussions based upon topics related to cardiac anesthesiology within the core resident lecture series, mock oral exams administered at the conclusion of the clinical rotation and a monthly subspecialty conference moderated by a cardiac anesthesiology faculty member that follows an interactive evidence-based medicine journal club format.

Research

The Cardiac Anesthesiology faculty maintains a national profile in research. Foci of special expertise include intraoperative transesophageal echocardiography (Fried, Ranier, Caldwell, Quinlan), anesthetic management of minimally invasive coronary surgery in the spontaneously breathing patient (Williams, Sullivan, Quinlan), cardiac surgery for adults with congenital cardiac defects (Sullivan, Gelzinis), use of thoracic epidural anesthesia during cardiopulmonary bypass and for treatment of unstable angina (Williams, Sullivan), anesthetic management of lung volume reduction procedures (Sullivan), analgesia after cardiac surgery with non-narcotic agents (Quinlan), red blood cell substitutes (Williams, Sullivan), and simulators as educational tools (Gelzinis). Dr. Erin Sullivan is the primary investigator for a clinical trial entitled “A Phase III Randomized, Double-blind, Controlled Clinical Trial To Evaluate the Efficacy and Safety of Hemolink (o-raffinose cross-linked human hemoglobin) in Patients Undergoing Coronary Artery Bypass Grafting.”

Children's Hospital of Pittsburgh: [top]

Peter J. Davis, MD
Chief, Pediatric Anesthesiology
Director, Pediatric Anesthesia Fellowship Program

The Department of Anesthesiology at Children's Hospital provided anesthesia service for over 16,000 surgical, diagnostic, or radiological procedures for the 2001-2002 academic year. The number of cases increased modestly from the previous year; these increases were seen in most surgical services at the satellite centers.

Anesthesia services were also provided in off-site outpatient surgical centers in Wexford, Bethel Park, and Monroeville. The Bethel Park and Monroeville surgi-centers are time-shared with staff from the UPMC Health System; surgical care exclusively for children is provided 6 days per month at the Bethel Park facility and two Saturdays/month at the Monroeville site. The award-winning Wexford surgical center was specifically designed for family-centered care for the surgical patient; anesthesia services are provided four days per week in the Wexford facility. Pediatric anesthesiologists and nurse anesthetists from this hospital are responsible for the peri-anesthetic care. Dr. Jackie Morillo-Delerme is the medical director of the satellites and continues to allow the delivery of efficient, cost-effective care. More than 3,500 infants and children received anesthesia at the various off-site surgical centers during 2001-2002.

The perioperative pain control service continued to serve a large number of patients under the guidance of Dr. Iris Soliman. The other faculty members of the anesthesia pain service include Drs. Brandom, Borland and Fine. In addition to the pain service, these attendings also provide hands-on anesthesia service for children requiring radiation therapy. The use of patient-controlled analgesia, epidural narcotics, epidural local anesthetics, and pediatric caudal anesthetics is now routine. It is becoming increasingly common to provide thoracic epidurals for postoperative analgesia for older patients following thoracic and upper abdominal surgery. In infants, it is possible to provide similar high thoracic epidural analgesia, by placement of the catheter from a caudal approach. The perioperative pain control service improved patient care and provided opportunities for training residents and fellows.

Teaching activities -- including mini-lectures, core lectures, and case conferences -- were prepared and presented by Fellows with faculty supervision. Faculty actively participated in medical student courses, including introduction to medicine, the first-year course, clinical problem-based learning (second year), clinical skills (third year), and various anesthesiology clerkships for third- and fourth-year students. The pediatric anesthesia education programs continued to provide special training for critical care medicine (CCM) fellows, pediatric dentists, emergency medical residents, and nurse anesthesia students on rotation through the service. In addition, faculty members have participated in an oral board preparation course for senior residents (CA-3 and CA-4). Peter J. Davis, MD served as director of the Pediatric Anesthesia Fellowship program, while James A. Greenberg, MD served as Medical Student Coordinator, and Jacquelyn Morillo-Delerme, MD served as Resident Coordinator.

Research efforts at Children's include pediatric anesthetic pharmacology, respiratory physiology, and outcomes-based protocols. Dr. Barbara Brandom continued to work with the pharmacy and ICU nurses to acquire data in the study of muscle relaxants in the pediatric ICU. Drs. Brandom and Woelfel completed a clinical study of predicting reversal of neuromuscular recovery from rocuronium. Dr. Chakravorti, in the Rangos Research Center anesthesiology laboratory, also supported these efforts. The anesthesiology laboratory has moved from the Rangos Research Center to the fourth floor at Children’s Hospital.

Other studies included:

Determination of lung mechanics in anesthetized children; Pharmacokinetics of remifentanil in infants and children; The pharmacodynamics of remifentanil in infants; A dose-response study of oral midazolam in children; The stress response of infants undergoing repair of congenital heart defects; Regional perfusion of neonates undergoing aortic arch surgery; Rate of rise of end-tidal CO2 in anesthetized infants and children.

Additional information on studies in respiratory physiology can be found in the Research section of this Report. Other accomplishments of the faculty this year include the successful negotiation of Dr. Barbara Brandom with the Malignant Hyperthermia Association of the United States (MHAUS). MHAUS has now located its registry at the Children’s Hospital of Pittsburgh. Dr. Brandom, who serves as the Chair of the Quality Assessment Committee for the MHAUS Hotline, will be the Registry's Director. Finally, Dr. Peter J. Davis continues as President of the Society for Pediatric Anesthesia.

PUBLICATIONS:

Baykara N, Woelfel S, Fine GF, Solak M, Toker K, Brandom BW. Predicting recovery
from deep neuromuscular block by rocuronium in children and adults. J. Clinical Anesth
14(3):214-7, 2002.

Brandom BW, Fine GF: New concepts and techniques in pediatric anesthesia: Use of neuromuscular blocking agents in children. Anesthesiology Clinics of North America, edited by LJ Mason and MS Kim, WB Saunders, Philadelphia, PA, March 2002;20:1.

Cook DR, Dhaliwal DK, Davis PJ, Davis J: Anesthetic interference with laser function
during excimer laser procedures in children. Anesth Analg 2001;92:1444-5.

Coté CJ, Cohen IT, Suresh S, Rabb M, Schreiner MS, Weldon BC, Davis PJ, et al.
Comparison of three doses of a commercially prepared oral midazolam syrup in children.
Anesth Analg 2002;94(1):37-43.

Davis PJ, Galinkin J, McGowan FX, et al: A randomized multicenter study of
remifentanil compared with halothane in neonates and infants undergoing
pyloromyotomy. I. Emergence and recovery profiles. Anesth Analg 2001;93(6):1380.

Davis PJ, Stiller RL, Wilson AS, McGowan FX, Egan TD, Muir KT. In vitro
Remifentanil metabolism: the effects of whole blood constituents and plasma
butyrylcholinesterase. Anesth Analg 2002;95:1305-7.

Fine GF, Brandom BW, Yellon RF: Unmasked residual neuromuscular block after
administration of vecuronium for days. Anesth Analg 2001;93:345-7.

Fine GF, Brandom BW: Neuromuscular blocking drugs in pediatric anesthesia, in
Anesthesiology Clinics of North America, Mason L, Kim M (guest eds), New Concepts
and Techniques in Pediatric Anesthesia 30(1):4-14, 2002.

Fine GF, Motoyama EK, Brandom BW, Fertal KM, Mutich R, Davis PJ: The effect on
lung mechanics in anesthetized children with rapacuronium: A comparative study with
mivacurium. Anesth Analg 95:56-61, 2002.

Galinkin JL, Davis PJ, McGowan FX, et al: A randomized multicenter study of
remifentanil compared with halothane in neonates and infants undergoing
pyloromyotomy. II. Perioperative breathing patterns in neonates and infants with pyloric
stenosis. Anesth Analg 2001;93(6):1387.

Gruber EM, Laussen PC, Casta A, Zimmerman AA, Zurakowski D, Reid R, Odegard
KC, Chakravorti S, Davis PJ, McGowan FX, Hickey PR, Hansen DD: Stress response in
infants undergoing cardiac surgery: a randomized study of fentanyl bolus, Fentanyl
infusion, and fentanyl-midazolam infusion. Anesth Analg 2001;92:882-90.

Huang J, Soliman I. Case report. Anaesthetic management for a patient with Dejerine
Sottas disease and asthma. Paediatr Anaesth 11:225-227, 2001.

Landsman I, Davis PJ: Aortic coarctation: Anesthetic considerations. Seminars in
Cardiothoracic and Vascular Anesthesia, 5(1):91-97, 2001.

Motoyama EK, Nenninger C: Managed Health Care and Academic Anesthesiology in the
United States. J Anesth 16:310-318, 2002.

Pigula FA, Sandhi SK, Siewers RD, Davis PJ, Webber SA, Nemoto EM: Regional low
flow perfusion provides somatic circulatory support during neonatal aortic arch surgery.
Ann Thorac Surg 2001;72:401-407.

Ross AK, Davis PJ, deL. Dear G, et al: Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures. Anesth Analg 2001;93(6):1393.

Sei Y, Brandom BW, Bina S, Hosoi E, Gallagher, KL, Wyre HW, Pudimat PA, Holman
SJ, Venzon DJ, Daly JW, Muldoon S: Patients with malignant hyperthermia demonstrate
an altered calcium control mechanism in B lymphocytes. Anesthesiology. 97(5):1052-8,
2002.

UPMC Magee-Womens Hospital: [top]

Sivam Ramanathan, MD
Chief Anesthesiologist

Patient Care

The staff of 12 faculty members, 18 CRNAs, and one CRNP provide care throughout the operating and delivery suites, at the Pre-Admission Testing Center and the Acute Postoperative Pain Service (APS). The Division provides in-house, 24-hour anesthesia coverage in two primary anesthetizing locations: the Womancare Birthing Center and the main Surgical Services Center.

The Womancare Birthing Center, which opened in April 2000, includes 18 birthing suites (Labor-Delivery-Recovery rooms, or “LDRs”), two LDR/telemetry suites, and three operative delivery rooms. This facility provides state-of-the-art anesthesia and obstetric care to the patients at Magee. Maternal data, and fetal heart tracings as well, can be accessed from the Birthing Center’s centrally located computer station, which is linked to a database engine. In Academic Year 2000-2001, Anesthesiology personnel cared for 7,423 obstetrical cases (1,455 by Cesarean delivery) – up from 6,792 in the previous year. Anesthesia was provided for an additional 330 procedures, such as bilateral tubal ligation, performed in the Center in the immediate postpartum period.

The Surgical Services Center consists of 10 general operating rooms, a cystoscopy suite, and two minor-procedures rooms. The Division provided anesthesia coverage for 8,997 cases at the Center – up from 8,410 the previous year. When Magee embarked on a program to provide modern aesthetic surgery to women who choose this option, the Anesthesiology team developed techniques for intravenous analgesia for these patients. An increase in plastic and reconstructive, general surgical, colorectal, and gastrointestinal procedures completed the expansion initiative. In the Pre-Admission Testing Center, the Division provides for a CRNP, who is available Monday through Friday for pre-anesthesia consultation and evaluation. Approximately 30% of surgical patients were evaluated preoperatively in the Center.

The Acute Postoperative Pain Service (APS), under the direction of Dr. Shannon, provides pain-management services, primarily through specialized neuraxial techniques, to approximately 180 patients per year.

Education and Training

Magee-Womens Hospital is a primary educational site for medical students, nurse-anesthesia students (SRNAs), residents, and fellows from programs within the University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center. The Division provides both rotations in both obstetrical anesthesia and general gynecology anesthesia. In addition, anesthesiology residents from other programs in the city rotate through for subspecialty training in obstetrical anesthesia.

Under the direction of Dr. Finegold, all residents attend weekly didactic lectures covering topics in obstetric and gynecologic anesthesia. The residents are tested in each separate area, and the examinations are thoroughly discussed. Mock oral examinations, given by faculty members to the residents, are a highlight of the educational experience. Quality Assurance and formal case-discussion conferences are held each week. Informal case-management discussions that relate to obstetrical anesthesia complement the didactic program. A list of the topics covered is kept in a database and is repeated during each resident rotation. Dr. Vallejo, in addition to overseeing the dental anesthesia rotation, assists Dr. Mandell and Ms. Mary Altmeyer with coordinating the SRNA programs. Dr. Dalby supervises the medical student rotation.

Magee-Womens Hospital serves as the principal site for the Department’s Obstetric Anesthesiology Fellowship. This CA-IV training program offers a broad exposure to clinical obstetrical anesthesiology as well opportunities for pursuing research interests in the field. Alaedin Darwich, MD began this advanced training in February 2001.

Research

Recent research interests of Division faculty members include: improved hemostasis during abdominal hysterectomy; postoperative vomiting and abdominal hysterectomy; spinal headaches with obstetric anesthesia; quality improvement and anesthesia outcomes; analgesia during second-stage labor and labor outcome; “walking” epidurals and their effects on labor outcome; maternal body-temperature changes with labor analgesia; and comparison of ropivacaine vs. bupivacaine for analgesic efficacy.
Below, please find the Magee-Womens Hospital Anesthesiology Department’s Presentations for the 35th Annual SOAP Meeting, May 14-17, 2003. They are listed in alphabetical order, by presenter.

Patricia Dalby, MD
Urinary Catheterization Requirement of Women with Labor Epidural Anesthesia

Alaeldin Darwich, MD
A Comparison of 0.125% Bupivacaine, 0.1% Ropivacaine and 0.125% Levobupivacaine with Fentanyl for Epidural Labor Analgesia

Helene Finegold, MD
Enoxaparin and Regional Anesthesia during Labor; -and- Plasma Oxytocin and Uterine Contraction Rates in Women Receiving Labor Analgesia

Kristy A. Golebiewski, RN
Recruitment Rates of Parturients to Participate in OB Anesthesia Research Projects

Bupesh Kaul, MD, FRCA
Elective Induction vs. Augmentation: The Impact of Patient Demographics on Cesarean Section under Epidural Analgesia,

Venkat R. Mantha, MBBS, FFARCSI
Delayed Removal of Epidural Catheters in Preeclamptics due to Thrombocytopenia-Incidence in a Case Series

Sivam Ramanathan, MD
A Web-Based Orientation Package for Residents Starting Obstetric Anesthesia Rotation

Neera B. Sah, MD
Comparison Between Intrathecal Racemic Bupivacaine and Levobupivacaine for CSE for Analgesia during Labor,

Brent H. Suddeth, BSN
Von Willebrand's Disease and Regional Anesthesia in the Parturient

Manuel Vallejo, MD, DMD
Oral-Umbilical-Placental Bacteremia and Preterm Labor; -and- The Association of Prevotella Intermedia and Fusobacterium Nucleatum with Preterm Labor

Pain Medicine Update: [top]

www.pain.pitt.edu

By Doris K. Cope, MD
Clinical Director

In keeping with its mission, during academic year 2001-2002, the UPMC Pain Medicine Program treated the entire spectrum of pain conditions, including:

• Persistent post-surgical pain
• Chronic back pain
• Complex regional pain syndrome (reflex sympathetic dystrophy)
• Fibromyalgia
• Cancer pain
• Musculoskeletal injuries
• Headaches
• Post-herpetic neuralgia (shingles)
• Cumulative trauma syndromes

We have now added inpatient services at Shadyside and St. Margaret’s Hospitals and an outpatient clinic at Magee Women’s Hospital, specializing in the treatment of pelvic pain disorders, headaches, neuropathies, among other pain syndromes common in women. New procedures performed this year include:

• Radio-frequency dorsal root ganglion ablations
• Surgical implants of catheters
• Pumps
• Dorsal column stimulators

The Division of Pain Medicine offers a one-year Pain Medicine Fellowship program that is fully accredited by the Accreditation Council of Graduate Medical Education. Fellows rotate through the outpatient services at UPMC St. Margaret and PETI and provide inpatient consultation at UPMC St. Margaret. The Division of Pain Medicine has active educational and research programs. Additional information can be found at www.pain.pitt.edu.

Perioperative and Trauma Pain Service, UPMC Presbyterian: [top]

David G. Metro, MD
Director

The Perioperative and Trauma Pain Services (POPS) provides both thoracic and lumbar epidural analgesia for relief of perioperative and trauma-related pain, as well as management assistance for difficult cases of patient-controlled analgesia (PCA) and opioid "conversion" for certain perioperative patients. POPS also played a major role in developing a safer naloxone policy at UPMC Presbyterian. In conjunction with the Department of Orthopaedics, the Service provides postoperative pain relief via indwelling nerve-plexus catheters.

During calender year 2002, the Perioperative and Trauma Pain Service cared for a total of 675 patients. Of this total, 80 percent (542 patients) received continuous epidural infusion or peripheral nerve catheter infusion as the primary mode of post-operative analgesia and 20 percent (133 patients) were seen for consultation for patient-controlled analgesia (followed for a minimum of two days). In addition to these 664 cases, POPS physicians were requested to assist with approximately 150 cases of simple opioid conversion during the year.

POPS continues its program of didactic training for incoming surgical residents, centering on opioids and PCA-management techniques. The Service plays an active role in the PCA Task Force as well as the Sleep Apnea and the Opioid Tolerant Task Force. Members have presented a number of lectures to house staff on the topic of management of patient-controlled analgesia.

There were some new initiatives in the 2002 academic year. This included the implementation of a patient satisfaction/ QI system. In this system, patients concerns were obtained and addressed on a daily basis for improvement of patient care. A surgeon feedback system was also developed to allow the primary service of patients to have a voice in the type of care that their patient receives. A patient controlled epidural analgesia program was also started to allow patients to directly control their epidural pain management without having to wait for a nurse intervention.

UPMC Shadyside: [top]

Hudson, Mark, MD, Associate Professor
Chief Anesthesiologist

2003 presents many exiting changes and challenges to The Department of Anesthesiology, UPMC-Shadyside Hospital. The completion of the Hillman Cancer Institute, umbilicaled to UPMC-Shadyside and the relocation of surgical oncology to the Shadyside campus has resulted in a dramatic increase in surgical oncologic cases. The completion of the Posner Wing with its 5 state of the art operating rooms including two minimally invasive suites and one angio suite promises to add significant volume to our surgical services. Last year the University of Pittsburgh Physicians, Department of Anesthesiology, provided clinical anesthesiology services at UPMC-Shadyside for 15,742 patients in our operating theatres, with 10,555 cases performed in our main operating room and 5,187 cases performed in UPMC-Shadyside’s Ambulatory Surgical Center. Case load includes major thoracic, cardiovascular, neurosurgical, orthopedic, urologic, gynecologic, oncologic, and general surgical procedures for the adult surgical patient in our main Ors and outpatient orthopedic, ophthalmologic, plastic, dental, gynecologic, and general surgical procedures in our Ambulatory Surgery Center. In addition to these, anesthesiology care was provided for more than 200 cases in all procedural areas when required, including radiology, cardiac catheterization lab, electrophysiology lab, echocardiology lab, and gastrointestinal medicine procedure rooms. Another 500 anesthetics were performed in Obstetrics, as labor epidurals and anesthetics for surgical deliveries. The Department of Anesthesiology also provided 24-hour in-house coverage for emergency surgical cases, obstetrical anesthesia, and emergency airway management. The addition of Dr. Jacques Chelly as Director of Acute Pain Management has had a tremendous impact on pain management services at UPMC Shadyside, with improved pain control, increased patient satisfaction, and recognition throughout the hospital as a successful program implemented in a very short period of time. The increase in complex cardiac surgical procedures performed at UPMC-Shadyside has necessitated improvements in our transesophageal echocardiography service and we currently provide 24/7 support for perioperative transesophageal echocardiography.

Teaching

The Department of Anesthesiology UPMC-Shadyside provides educational opportunities to its staff and faculty, as well as to a diverse set of students from other departments. The department sponsors monthly education conferences and a monthly Morbidity and Mortality conference, with active participation of the faculty. UPMC-Shadyside is designated as a primary instruction site for the Nurse Anesthesia program of the University of Pittsburgh School of Nursing. Our certified registered nurse anesthetists and faculty anesthesiologists actively participate in the education of these students, both as clinical instructors and through didactic educational sessions. In addition, the department provides instruction in clinical skills, airway management, and invasive monitoring to residents rotating in the department from UPMC-Shadyside’s Family Practice and Internal Medicine residencies. Department faculty members also participate in the didactic educational program, and provide the Medical Director for the UPMC Shadyside School of Perfusion.

UPMC Southside : [top]

By Steven Orebaugh, MD
Staff Anesthesiologist

Significant changes have occurred in the physical plant at the UPMC-Southside operating room. Two new, state-of-the art sports orthopedics operating rooms were installed and opened amid much fanfare in December 2002. Features include voice-activation, movable equipment booms, and numerous cameras and monitors. The rooms are spacious and bright, and represent the first step in a restructuring and refurbishing plan for the entire operating room. The two rooms are separated by an observation area that allows direct or television viewing of intra-articular orthopedic procedures. This has significantly reduced traffic in the operating suites. New anesthesia machines and monitors have been provided for these sites as well.

In addition, the old operating rooms are receiving upgrades. These will be improved with new flooring, new interior colors, and surgical equipment. Renovations to enlarge these operating rooms are also under consideration. The surgical scheduling area has been enlarged and new male and female locker rooms are being constructed, along with lounge and break areas for the staff. The old anesthesia office has been incorporated into the new locker room area, and new anesthesiology offices were constructed. These are significantly more spacious than the old area, and contain a secretary/reception desk. Appropriate computer support was graciously provided in timely fashion by the information technology service from both UPMC Southside and the Department of Anesthesiology.
The stimulus for construction of new operating suites and support areas is the transfer of sports medicine cases from UPMC Montefiore to UPMC Southside. This transition has occurred gradually since April of 2001, and is now virtually complete. This has resulted in a doubling of the number of surgical cases at Southside in the past two years. To accommodate the changes in volume, there have been corresponding changes in personnel and support staff in anesthesiology. One part-time anesthesiologist, Dr. Stephen Mosier, has become a full time staff member at Southside, and another may be added soon.

UPMC Southside currently serves as the main site for the Regional Anesthesia CA3 elective, and provides training for third and fourth year medical students, as well as podiatry residents. Currently, the regional anesthesia curriculum for the residency is being reviewed and restructured, such that additional residents from the CA2 year may soon begin to rotate at Southside.

Follow up to the First Regional Anesthesia Symposium

In August 2002, the first UPMC Regional Anesthesia Symposium was held at the Westin Convention Center in downtown Pittsburgh. The conference was well attended and successful, especially since it was our first meeting. Drs. Brian Williams and Michael Kentor of UPMC Southside and Dr. Jacques Chelly of UPMC Shadyside, Vice Chairman for Clinical Research and Professor of Anesthesiology organized the Symposium. Numerous faculty from the department of anesthesiology provided educational presentations. On the first day of the conference, presentations included live demonstrations of preoperative regional anesthesia blocks conducted on closed-circuit television at UPMC-Southside.

Other News from Southside

Faculty accomplishments include the promotion of Dr. Brian Williams to Associate Professor. In addition, Dr. Williams, Dr. Kentor, Dr. John Williams, et al, published an article in the Economics section of Anesthesiology in the October, 2002, issue, entitled “PACU Bypass after Outpatient Knee Surgery is Associated with Fewer Unplanned Hospital Admissions but More Phase II Nursing Interventions.” Dr. Brian Williams has had a retrospective research study related to pain management in outpatient knee surgery accepted by Anesthesiology (in press). His other recent achievements include being an invited speaker for the Fourth Annual International Symposium on Regional Anesthesia, in Orlando in October 2002, and an invited speaker for the upcoming annual meeting of the American Society of Regional Anesthesia and Pain Medicine in San Diego, in April of 2003.

Dr. Steve Orebaugh served as a speaker on a medical panel at the first annual Save A Life Foundation National Summit, and is involved in integrating Save A Life teaching (first aid and CPR) in the local community. In addition, he has been invited to speak at the American Academy of Emergency Medicine annual scientific assembly in New Orleans, in the area of airway management. Dr. Orebaugh has worked with Drs. William McIvor, Ryan Romeo and Terry Edwards to create a series of simulations for the fourth year anesthesiology medical student elective, which have been met with very good feedback by the students.

UPMC South Surgery Center: [top]

By Jason Kao, MD
Medical Director

Gregory J. Godla, MD

UPMC South Surgery Center is an active outpatient facility, providing a full range of anesthetic care to patients of all ages. The Surgery Center is in a period of rapid growth, experiencing a 33% increase in patient volume during 2002.

Proper preoperative evaluation enables us to maintain our goal of a low postoperative inpatient admission rate. During 2002, the Center had a transfer/admission rate of less than 0.001%. Thorough preoperative evaluation also enables us to maintain a low rate of day-of-surgery cancellations.

Because patient satisfaction is important to our continued growth, we monitor this quality monthly by means of a patient survey. During 2002, our survey response rate was 49%, with a 99% satisfaction rate among patients responding.