Department of Anesthesiology, Perioperative and Pain Medicine

The Department of Anesthesiology, Perioperative and Pain Medicine's Division of Cardiothoracic (CT) Anesthesia provides anesthetic care to more than 2,000 adult and pediatric patients each year, in seven cardiothoracic anesthetizing locations daily. All of our full-time divisional faculty are board certified in perioperative transesophageal echocardiography, and we perform approximately 1,400 transesophageal echocardiogram exams each year. Our division continues to expand in the research domain, building on its long history of excellence in clinical care.

The Mount Sinai Health System is a major source of referrals for aortic reconstruction and mitral valve repair. On an annual basis, our cardiac surgical colleagues manage in excess of 1,000 cases requiring cardiopulmonary bypass, of which approximately 30 percent are myocardial revascularizations; another third or so are complex and minimally invasive valve repairs; another 30 percent are divided equally between major operations on the thoracic aorta and congenital heart surgeries. The remainder include a variety of complex cases, including implantation of ventricular assist devices, surgical ventricular restorations, and cardiac transplantation.

Each year, we also provide care to approximately 300-400 adult and pediatric patients undergoing diagnostic or interventional electrophysiological procedures and pediatric cardiac catheterizations. We treat 700-800 patients annually for a variety of thoracic procedures as well. The vast majority of our thoracic cases are performed using video-assisted thoracoscopic techniques, and we always place a particular emphasis on minimally invasive procedures for all lung conditions and esophageal surgery.

Research

As a division, we are flourishing in our research. Because of the wide variety of disease states in the cardiac surgical population, ours is an environment in which almost every patient can participate in a clinical trial, if desired. Our ongoing and recently completed projects include new monitoring techniques (such as 3-D echocardiography, near infrared spectroscopy, non-invasive cardiac output monitoring, and pulse contour analysis), medical informatics, techniques specific to pediatric and geriatric cardiac anesthesia, new pharmacologic agents (new anti-hypertensive drugs, heart failure drugs, and anti-inflammatory strategies, among others), coagulation and hemostasis, platelet function monitoring, transfusion algorithms, hemostatic substances for infusion and topical use, and evaluation of new anticoagulants.

The Department of Anesthesiology, Perioperative and Pain Medicine is integral to the care of critically ill patients at The Mount Sinai Hospital. We have a total of eight Anesthesiologist Intensivists with Certificates of Special Qualification in Critical Care from the American Board of Anesthesiology, or its equivalent.

This group also participates in the care of patients in the 15-bed Neurosurgical Intensive Care Unit. Combined, these units admit more than 3,500 patients per year. They are particularly well known for their expertise in caring for patients undergoing liver transplant, mitral valve repair, LVAD insertion, craniotomy, and major spine surgery. They also treat any patients in surgical services suffering from septic shock, respiratory failure, decompensated heart failure, acute kidney injury, or hemorrhage.

In addition to clinical care, our faculty excels in both teaching and research in the area of Critical Care Medicine. Our residents gain intense experience while rotating through these units, with mandatory rotations in the CA-0, CA-1, and CA-2 years. This training is in line with the direction the specialty of Anesthesiology is taking (i.e., integrating the concept of the perioperative home into current anesthesia practice). We cover all aspects of critical care management, including triage, asset management, neurological monitoring, hemodynamic assessment, mechanical ventilation, extracorporeal membrane oxygenation, renal replacement therapy (including continuous veno-venous hemofiltration), nutrition (including parenteral and enteral routes), blood product administration, infectious disease, and point-of-care ultrasound.

The Division of Liver Transplant Anesthesia is one of the most active clinical programs worldwide, performing 100-150 liver transplants per year. Our team consists of a core group of six attending anesthesiologists. Since the inception of the liver transplantation program, more than 3,000 patients have received cadaveric or living donor transplants at The Mount Sinai Hospital. Ours is also a leading entity for living donor hepatic transplantation. The division has five pediatric anesthesiologists to cover pediatric liver transplantation as well. The Recanati-Miller Transplantation Institute has a long history of excellence in clinical care and research. It is one we continue to build on and advance.

Our anesthesia team is ever-advancing best practices, with increasing utilization of thromboelastography, intraoperative use of transesophageal echocardiography, and a concerted effort to reduce blood-product administration. Our dedicated staff ensures optimal adherence and communication between the specialties by maintaining a close working relationship with the surgical team. We are seeing continual progress in academic productivity of the Transplantation Institute’s anesthesia team. In addition to several presentations and national and international meetings, the group is currently conducting a number of retrospective and prospective trials.

Our division is at the forefront of clinical care and research and continues to set the standard for excellence in the care of these patients. Liver transplantation anesthesiology is a tremendous clinical challenge—the ultimate step in the integration of knowledge and technical skills. We rise to this challenge every day, with every patient.

The Division of Neuroanesthesia provides care for approximately 1,200 neurosurgical patients per year. We perform a wide variety of procedures in four dedicated neurosurgical operating rooms. These range from spinal surgery for herniated disks and tumors, to intracranial tumors and cerebrovascular operations. We work closely with The Mount Sinai Hospital Department of Neurosurgery, which has developed a national and international reputation for pituitary and neuroendocrine operations, skull base surgery, and major spine procedures. That department’s position in surgical treatment of cerebrovascular disorders, endoscopic neurosurgery, and surgical treatment of movement disorders and Parkinson's disease, is ever expanding.

The Division of Neuroanesthesia has formed active collaborations in clinical research with the Department of Neurosurgery, in order to enhance patient safety and improve care. We have concurrently monitored motor and somatosensory evoked potentials in more than 600 patients undergoing spinal cord operations over the past year, and we reported the first use of adenosine-induced asystole to facilitate the surgical management of a basilar tip aneurysm.

Other research and academic interests include anesthesia equipment and delivery systems, use of video-laryngoscopy and other airway devices, anesthesia simulators, strategies for selective hypothermic cerebral and organ protection, and techniques for intraoperative neurophysiologic monitoring. We are also pleased to offer a Neuroanesthesia fellowship position.

The Division of Obstetric Anesthesiology provides anesthetic care for approximately 6,000 patients per year, of which roughly 25 percent are high risk. We staff our labor floor with a combination of attendings, residents, and fellows.

Approximately 90 percent of all patients receive labor analgesia. Most women are treated with either epidural analgesia or the combined epidural-spinal technique. Because The Mount Sinai Hospital is a tertiary referral center, we care for many high-risk patients including women with cardiac lesions, disorders of coagulation, preeclampsia, abruptio placenta, and placenta previa.

All first-year residents devote one month to the obstetric service. We supplement clinical work with didactic lectures, resident presentations, journal club, and oral examinations. As a resident, you may also devote a block of time, usually three to six months, during your third year, to advanced training. We also offer a fellowship in obstetric anesthesia. As a fellow under the supervision of the attending anesthesiologist, you help direct patient care on the labor floor. We also highly encourage you to participate in ongoing research projects and to initiate your own.

Our research is expanding at a rapid rate. We have conducted approximately 30 studies, some sponsored by industry and competitive grants. Many of these projects have been presented at national meetings and have culminated in publication in peer-reviewed journals.

The Division of Orthopaedic Anesthesia offers our residents the opportunity to administer a wide variety of regional anesthetic techniques. We routinely perform upper extremity blocks for shoulder, elbow, and hand surgeries, as well as lower extremity blocks for procedures on the foot and ankle, using the latest ultrasound guided technology. We place indwelling catheters to provide in-hospital postoperative analgesia and facilitate rehabilitation. For hip and knee procedures, we use epidural, spinal, and combined epidural-spinals, offering patients alternatives to traditional general anesthetics.

Our residents take orthopaedic rotations during the CA-1 year of training. You may choose to return for concentrated blocks of regional training during your CA-3 year, as many other residents do.

If you are a patient who is about to undergo an orthopaedic surgical procedure and would like to discuss your anesthetic options, please contact us.

Mount Sinai's Pain Management and Integrative Medicine physicians utilize both traditional and complementary therapies to decrease pain—caused by injury, cancer, or other chronic or acute ailments—and improve overall function. Our specialists provide diagnosis and treatment with a focus on minimally invasive procedures (as opposed to potentially harmful narcotic medications) to relieve discomfort so that patients can participate in physical therapies. By increasing functionality we help patients to re-engage in activities important to them, thereby improving the very quality of their lives.

The Division of Pediatric Anesthesia consists of several anesthesiologists with specialty training in pediatric anesthesia. We perform approximately 2,000 pediatric cases per year. All pediatric surgical subspecialties are represented, including general surgery, cardiac surgery, otolaryngology, urology, gynecology, orthopedic surgery, ophthalmology, oral surgery, dental surgery, plastic surgery, neurosurgery, and organ transplantation. In addition, we provide anesthesia services for non-operating room procedures such as bone marrow aspirations and biopsies, lumbar punctures for chemotherapy, radiologic procedures (MRI, CT scan, nuclear medicine, and interventional), and radiation therapy. We also offer various modalities for postoperative pain control in conjunction with the Pain Management Service.