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UPMC Presbyterian
CLINICAL

UPMC Presbyterian/Montefiore

Joseph J. Quinlan, MD

Chief Anesthesiologist

UPMC Presbyterian/Montefiore is the largest quaternary care hospital of the UPMC Health System and the largest in Western Pennsylvania. The Division of Anesthesiology at UPMC Presbyterian/Montefiore is larger than many entire academic departments found elsewhere in the country. It comprises 55 faculty members who cover 41 operating rooms and up to nine additional, non-OR anesthetizing locations. The site is staffed by 111 Certified Registered Nurse Anesthetists (CRNAs), and up to 15 residents and 10 student nurse anesthetists (SRNAs) rotate through UPMC Presbyterian/Montefiore at any one time. Six Certified Registered Nurse Practitioners (CRNPs) provide care throughout the site as well as at the Pre-Anesthesia Evaluation and Testing Center, which conducts pre-anesthesia consultations and evaluations. In fiscal year 2010 (FY10), UPMC Presbyterian/Montefiore anesthesiologists supervised 35,757 anesthetic procedures. Anesthesia services are highly subspecialty-oriented and include cardiothoracic, ENT, thoracic, trauma, neurological, and liver transplantation anesthesiology. In FY10, 521 transplants were performed in Presbyterian/Montefiore ORs, a 5% increase over the previous year. UPMC Presbyterian/Montefiore also remains the top lung transplant center in the world, with 126 lung transplants performed in FY10 — nearly a 2% increase from the previous year.

Cardiac Anesthesiology Division

Hepatic Transplantation Anesthesiology Division

Neurosurgical Anesthesiology and Supportive Care Division

Same Day Services

Cardiothoracic Anesthesiology, UPMC Presbyterian

Erin A. Sullivan, MD

Director

The Division of Cardiothoracic Anesthesiology provides anesthetic care for the full spectrum of adult cardiac surgical practice, including coronary artery bypass graft surgery (CABG); minimally invasive coronary artery bypass (Mid-CAB); off pump coronary artery bypass (OP-CAB); cardiac valve replacement and repair; thoracic aorta repair/reconstruction; arrhythmia ablation; pulmonary thromboendarterectomy; repair of ventricular and atrial septal defects; removal of cardiac tumors / myxomas; and heart, single lung, double lung, and heart-double lung transplants. The 11 cardiothoracic faculty provided anesthetic care for 718 cardiac surgical patients in FY09. UPMC Presbyterian/Montefiore is a world leader for heart and lung transplantation; in FY09, 186 transplants were performed, consisting of 60 heart transplants, 25 single-lung transplants, 101 double-lung transplants, and three heart / double-lung transplants. UPMC Presbyterian Hospital was the leading center in the nation for the number of lung transplants performed at a single center in FY09 with a total of 126. The Division offers opportunities for both basic and advanced training in adult cardiac anesthesia. Fellows (CA-4) receive advanced training in adult and pediatric cardiothoracic anesthesiology inclusive of emergency and elective surgery, TEE, perfusion/ventricular assist device theory and operation, cardiothoracic critical care medicine, and heart/lung transplantation, and those who successfully complete the training program are eligible to take the PTEeXAM administered by the National Board of Echocardiography.

Hepatic Transplantation Anesthesiology, UPMC Presbyterian/Montefiore

Raymond M. Planinsic, MD

Director

The Division of Hepatic Transplantation Anesthesiology (HTA) provides anesthetic care of patients undergoing liver, intestinal, multivisceral, kidney, and pancreas transplantation at UPMC. The primary responsibilities of HTA include: 1) preoperative assessment of transplant candidates, 2) participation in candidate selection, 3) intraoperative management of patients, and 4) postoperative visitation. Through the HTA preoperative consultation service, all transplant candidates at UPMC Presbyterian/Montefiore are evaluated by an HTA staff anesthesiologist and a trainee at the Frank Sarris Outpatient Clinic located in UPMC Montefiore. In FY09, 310 solid organ transplants were performed by HTA faculty, including over 100 liver transplants. UPMC continues to be a referral center for high-risk patients because of our diverse expertise and multidisciplinary approach to managing patients with multiple organ dysfunction. UPMC continues to expand of the adult living related liver and kidney transplantation program; over 40% of kidney transplants performed in the United States are from live donors, and this trend is reflected at UPMC. A live liver donor continues to be an option for patients with end stage liver disease requiring transplantation and is available at UPMC due to the expertise of our transplant surgeons and anesthesiologists. Education in the HTA service consists of a mandatory four-week rotation for CA-2 trainees and an elective three to nine month rotation for CA-3 and CA-4 trainees. Residents carry out anesthesia for liver transplantation with a level appropriate to their level of training.

Neuroanesthesiology and Supportive Care, UPMC Presbyterian

Ferenc E. Gyulai, MD

Director

The Neuroanesthesiology service at UPMC Presbyterian provided anesthetic care for nearly 6,000 neurosurgical procedures during FY10. Operations included: expanded endonasal approaches, craniotomy for tumor, retromastoid craniectomy for microvascular decompression of various cranial nerves, and spinal surgery. Two separate Neurosurgical Intensive Care Units at UPMC Presbyterian facilitate innovative approaches to the acute care of cerebral vascular pathologies and promote optimal care for patients with neurotrauma and other acute neurological injury. The Division provides anesthetic management for patients in the UPMC Center for Endovascular and Exovascular Therapy. Services provided by this combined interventional neuroradiologic practice include: embolization of cerebral vascular aneurism, arterio-venous malformations, tumors and dural and cavernous sinus fistulae, treatment of refractory epistaxis, sclerotherapy, temporary balloon occlusion testing with blood flow evaluation, stroke thrombolysis and thrombectomy, dural sinus thrombolysis and thrombectomy, petrosal sinus sampling, carotid, vertebral artery, sublcavian artery and intracranial arterial stenting, vessel sacrifice, Wada testing, vertebroplasty (methylmethacrylate vertebral body injections), alcohol sclerotherapy, and routine angiography. The Center is part of the Minimally Invasive endoNeurosurgery Center (MINC), which pioneers cutting-edge endoscopic minimally invasive craniotomy techniques. The MINC team performed close to 500 procedures in FY10, attracting national and international recognition.

Same Day Services UPMC Presbyterian/Montefiore

Patrick J. Forte, MD

Medical Director

Same Day Services at UPMC Presbyterian/Montefiore includes both Same Day Surgery (SDS) and the Preoperative Evaluation Center (PEC). During FY10, 15,225 patients went through SDS either as same day admit patients (8,471) or outpatient surgery patients (6,754), and 5,051 patients were seen in the PEC. Most patients scheduled for outpatient surgical procedures at UPMC Presbyterian or Montefiore are cared for at the SDS unit at Montefiore Hospital. The PEC receives referrals from surgeons for prior anesthetic problems, complex medical conditions, or patient concerns. All preoperative testing and consults are then combined with a detailed pre-anesthetic history and physical examination conducted by an anesthesiology resident or CRNP. An attending anesthesiologist is available to review complicated patients or testing results with the PEC staff. Patients who are not seen in the PEC are called and evaluated the day before surgery by SDS nurses. The goal of the unit is 100% patient review prior to surgery, resulting in minimal unforeseen delays and cancellations on the day of surgery.