Jonathan H. Waters, MD
Chief Anesthesiologist

Overview

The Division of Anesthesiology at Magee-Womens Hospital of UPMC staffs 21 faculty members, 20 Certified Registered Nurse Anesthetists (CRNAs), and 2 full-time Certified Registered Nurse Practitioners (CRNPs). The staff provides care throughout the operating and delivery suites, at the Pre-Anesthesia Evaluation and Testing Center, and via the Acute Interventional Postoperative Pain Management Service (AIPPS). The division provides emergency airway management in conjunction with members of the Department of Critical Care Medicine at all cardio-respiratory arrests, and peripheral intravenous access is provided as a consultative service.

The primary focus of the division, however, is providing in-house, 24-hour anesthesia coverage in two primary anesthetizing locations: the Womancare Birthing Center and the main Surgical Services Center.

Patient Care & Clinical Activities

In Academic Year 2007-2008 (AY08), the Section of Anesthesia for Obstetrics (directed by Dr. Manuel Vallejo) oversaw 9,964 deliveries in the Womancare Birthing Center, representing an 8.6% increase from the previous year. Deliveries included 7,355 vaginal births and 2,609 cesarean deliveries, with a cesarean rate of 30.1%. Additional procedures performed in the Birthing Center include combined cesarean / abdominal hysterectomy, external cephalic version (ECV), percutaneous umbilical blood sampling (PUBS), manual placental extraction, urogenital laceration repair, and postpartum tubal ligation (PPTL). Fetal surgery continues to increase as the hospital focuses its resources on this activity.

In AY08 the Surgical Services Center provided anesthetic management for 16,063 cases, representing a 7% increase from AY07. The site total (including deliveries) was 23,981 cases – also an increase of 7% from the previous year. The Surgical Services Center consists of consists of 14 general operating rooms, a cystoscopy suite, and two minor procedure rooms. Of these, four state-of-the-art minimally invasive suites (MIS) accommodate a growing variety of minimally invasive surgical procedures. In addition, a new endoscopy suite will have two endoscopy rooms and a pre- and post-anesthesia recovery area.

The Division provides two CRNPs in the Pre-Anesthesia Evaluation and Testing Center. The goal of the center is to identify high risk patients and medically optimize them prior to surgery. In AY08, approximately 40% of surgical patients were evaluated preoperatively in the center. Due to the rapidly increasing growth of the surgical services, the center has been redesigned to incorporate a computerized screening system, which allows appropriate triage and preoperative workup.

Education & 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 of Anesthesiology at Magee provides both obstetrical anesthesia and general gynecology anesthesia rotations. In addition, anesthesiology residents from other programs in the city rotate through the division for subspecialty obstetrical anesthesia training. All residents attend daily didactic lectures covering topics in obstetric and gynecologic anesthesia, and separate examinations on each of these areas are administered by Dr. Vallejo.  Mock ABA oral examinations are given by the faculty, and continuous quality improvement and formal case discussion conferences are held weekly. Residents perform monthly journal clubs that review recent literature in obstetrical anesthesia. All residents rotating through obstetrical anesthesia become certified in neonatal resuscitation by Dr. Ryan C. Romeo.

Drs. Vallejo and Krohner and Mr. Matt Nypaver, RN, CRNA coordinate the nurse anesthesia student (SRNA) program at Magee. These students rotate through both labor and delivery and the general operating suites. The program has doubled in size over the last year with increasing focus on training in epidural and spinal blocks.

Dr. Patricia L. Dalby supervises the anesthesia clerkship for third-year medical students during their surgery and perioperative care rotation. In addition, many fourth-year medical students opted to take a one-month elective to further expand their knowledge of anesthesia.

Magee-Womens Hospital serves as the principal site for the Department’s CA-4 fellowship in Obstetric Anesthesiology. Two fellows are undergoing training in AY09. The fellowship encompasses a broadened exposure to clinical obstetrical anesthesiology as well as opportunities for pursuing research interests in the field.