The cardiac anesthesia service at St. Elizabeth's Medical Center provides intraoperative care to 700 to 800 patients annually. Our service specializes in adult cardiac surgical procedures with two dedicated operating rooms. We have a challenging case mix, including coronary bypass, valve repair and replacements, and emergent re-operative procedures. Our patients are primarily high-risk with multi-system disease. Our cardiac case mix includes multiple arterial bypass grafts, combined bypass-valve procedures, off-pump coronary artery bypass procedures (OPCAB) and mini-thoracotomy bypass (MIDCAB). In conjunction with our interventional cardiology colleagues, we have a robust minimally invasive percutaneous aortic valve replacement program which includes transfemoral, transapical and transaxillary approaches. We participate in and benchmark our performance against the National Society of Thoracic Surgeons (STS) database. We use invasive monitoring, including pulmonary artery catheters, continuous cardiac output (CCO) and mixed venous oximetry. The cardiac anesthesia team performs intraoperative transesophageal electrocardiography (TEE) on almost all cardiac procedures.
Staff anesthesiologists are assigned one-on-one with the residents for each cardiac surgical procedure. The junior residents (CA-1 and CA-2) have a two-month rotation in cardiac anesthesia. They are expected to evaluate all assigned cases and discuss them preoperatively with staff members. At the end of this rotation, the resident should be facile with the insertion and use of pulmonary artery catheters and comfortable with the principles of hemodynamic management of cardiac surgical patients.
CA-3 residents demonstrating a keen interest in cardiovascular anesthesia have an opportunity to select additional clinical time in cardiac anesthesia. The residents are expected to be well versed in cardiac physiology and pharmacology, the management of CPB, and understand the principles of myocardial preservation. The residents can expect to develop a basic understanding of intraoperative tracheoesophageal echocardiography. The residents participate in cardiac call on nights and weekends and share call with the cardiac anesthesia fellows.
The St. Margaret's Center for Women and Infants on the St. Elizabeth's Medical Center campus treats about 1000 routine and high-risk parturient patients from eastern Massachusetts. Residents are exposed to many patients with pregnancy-induced hypertension, multiple gestation, prematurity, diabetes, and other medical and obstetrical comorbidities.
St. Elizabeth's provides full training in obstetric anesthesia. New residents are taught the physiologic and pharmacologic characteristics of parturient patients. CA-1 residents are assigned to the obstetric suite for a one-month rotation during inwhich they administer all the anesthetics requested. Lectures and case conferences on obstetric anesthesia take place throughout the year. All residents have additional experience in administering obstetric anesthetics as part of their on-call responsibilities during their tenure at St. Elizabeth's Medical Center.
Most cesarean sections are performed with the patient under spinal anesthesia, whereas most of the vaginal deliveries in which anesthesia is used involve an epidural block. During a typical three-year residency, each resident participates in approximately 175 deliveries, far more than are offered during a one-month rotation at a high-volume obstetric hospital. Opportunities exist for residents to participate in clinical research projects in obstetric anesthesia.
The St. Elizabeth's Medical Center Pain Management Center is a comprehensive pain center providing services for patients with acute, chronic non-malignant and malignant pain. Residents and fellows have the opportunity to treat chronic pain patients through the use of multiple interventional modalities with a goal of minimizing chronic narcotic use. Residents and fellows become familiar with applying the appropriate modalities to reduce and control the pain associated with their underlying conditions. Training in chronic pain management in the outpatient center includes the expertise from specialties of anesthesia, Physical Medicine & Rehabilitation (PM&R), neurology, and psychiatry. Patients are provided with an individualized pain management treatment plan after comprehensive review has been completed.
Our services and treatments include:
- Comprehensive assessments for determination of treatments that focus on attaining positive long-term outcomes.
- Emphasis on interventional pain therapies with minimal systemic narcotic use.
- State-of-the-art fluoroscopic- and ultrasound-guided spinal, peripheral nerves and joint injections for diagnostic and therapeutic applications.
- Spinal cord stimulation trials and implants to treat failed back surgery syndrome and complex regional pain syndrome.
- Peripheral nerve stimulation trials and implants to treat various neuropathies.
- Minimally Invasive Lumbar Decompression (Mild®) procedures used for patients who have significant lumbar spinal stenosis due to thickening of the ligamentum flavum, or ligaments of the spine.
- Platelet Rich Plasma (PRP) injections for degenerative disc disease, facet joint pain and low back pain, as well as for painful muscles, shoulders and knees.
Critical Care/Intensive Care
Residents are scheduled for two one-month rotations during the second year with an additional month in the third year if desired. One month will be at St. Elizabeth’s Medical Center and one will be at the Lahey Clinic, located approximately 15 miles from St. Elizabeth's Medical Center. These ICU experiences offer a stimulating educational environment for fellows, residents, medical students, nurses and paramedical personnel. The anesthesia resident rotation is specifically designed to provide a broad clinical experience in the care of the critically ill surgical and injured patients. The educational program consists of daily bedside teaching, organized didactic lectures, and directed study, utilizing recommended texts and an assigned reading list. On completion of the rotations, the resident will have acquired the fundamental knowledge and technical skills necessary to diagnose and manage acute life-threatening single-organ dysfunction as well as complex multisystem failure.
During their second year of training, residents acquire two months of neuroanesthesia training, one month at the Lahey Clinic and one month at either the Massachusetts General Hospital or St. Elizabeth’s Medical Center. Ample experience is offered in providing anesthesia for intracranial tumors, aneurysms, shunts and other neurosurgical procedures. In addition, the resident will gain experience caring for interventional neurovascular radiology procedures such as catheter based treatments for intracranial aneurysms and arteriovenous malformations. Residents will also care for patients having complex spine surgery including scoliosis repairs and multilevel hardware instrumentation.
Post Anesthesia Care Unit
A structured one-month postanesthesia care experience combines direct patient care in the post anesthesia care unit, ambulatory surgical unit, and intensive care units with responsibilities for management of acute postsurgical pain, hemodynamic compromise, and emergencies related to the post anesthesia care patient.
Boston Children's Hospital
Anesthesia residents rotate to Boston Children’s Hospital for two one-month rotations. Residents work with pediatric anesthesiologists and fellows on cases that range from simple out-patient ENT and urologic procedures to complex repairs for congenital heart disease to neonatal congenital emergencies. Additional months are available to residents who wish further pediatric experience.
Massachusetts Eye and Ear Infirmary
A one month elective is offered at the Massachusetts Eye and Ear Infirmary. Residents work closely with highly specialized staff on complex ear, nose and throat (ENT) surgeries, as well as eye surgeries. Additional pediatric experience is also a large component of the MEEI experience.