Section on Critical Care Anesthesiology
Section Head - Keith Scott, MD
The Section on Critical Care provides critical-care-specialist (Intensivist) care to all patients in our Neuro-Intensive Care and Cardiothoracic Intensive Care Units. There are 11 faculty members in the Section. We work closely with our Neurologists, Neurosurgeons, and Cardiothoracic surgeons to ensure the delivery of the highest quality care to each of our patients. The exemplary quality of care provided has been recognized externally by receipt of the Beacon Award for Critical Care Excellence from the AACN. There is an attending Intensivist available 24 hours, 7 days a week in these ICUs. Each of our Intensivists is board certified or eligible in Critical Care and/or Neurocritical Care. Our Intensivists have varied training backgrounds and expertise and bring a wealth of experience to the bedside. The areas in which our Intensivists have primary training and board certifications include Internal Medicine, Anesthesiology, Emergency Medicine and Neurology, and Pulmonary Medicine. For our residents and fellows, this cross-training gives a range of experience not available anywhere else in the region.
Section on Cardiothoracic Anesthesiology
Section Head – Thomas Slaughter, MD
The Section on Cardiothoracic Anesthesiology provides care for patients requiring cardiac (heart), thoracic (lung), or vascular (blood vessel) surgery at Wake Forest Baptist Medical Center. The faculty within the Cardiothoracic Anesthesiology Section are highly experienced in providing care for both adult and pediatric patients requiring these types of surgeries. After college, each of our physician faculty has completed 4 years of medical school, 4 years of residency training in anesthesiology, and an additional 1-2 years specializing in Cardiothoracic Anesthesiology. In addition, our faculty are nationally recognized for their efforts to improve the care for patients undergoing cardiothoracic and vascular surgery through research and education endeavors.
Although the risk associated with receiving anesthesia remains low, cardiothoracic surgery carries greater risks than many other surgeries. Our faculty will employ state-of-the art monitoring technology to minimize any risk associated with your surgery. For example, during surgery on the heart, our faculty use echocardiography (imaging using sound waves) to monitor the function of the heart and heart valves. One activity that you, as a patient, can do to improve your chances of doing well with surgery is to quit smoking. Chemicals within cigarette and cigar products constrict (squeeze smaller) blood vessels in the heart and may even lead to a heart attack. Stopping smoking before your surgery will improve your health – even if you have smoked for many years. Should you have any specific concerns regarding the anesthesia for your upcoming surgery, please do not hesitate to contact our faculty within the Department of Anesthesiology.
Section on Inpatient General Anesthesia
Section Head – Scott Miller, MD
Director, Inpatient Ors – Randy Calicott, MD
Director, Post-Anesthesia Care Unit – Lorraine Arias, MD
Needing surgery for any reason is anxiety-provoking for most of us. We understand this concept exceedingly well because our profession, universally, is primarily dedicated to bringing people safely and comfortably through this experience. Providing anesthesia is our privilege and the dozens of anesthesiologists in our department have dedicated their lives to its proper performance. Your anesthetic will always be performed by a team headed by an anesthesiologist. All anesthesiologists are doctors of medicine who have completed four yours of medical school, 3 to 4 years of anesthesia residency, and many have done extra years of training in particular subspecialties to include neuroanesthesia, cardiac anesthesia, obstetric, pediatric, and regional anesthesia.
Our primary concern is patient safety, always. We are continuously assessing and monitoring every patient in our care to make certain everything that proceeds in the safest manner possible. From this foundation of safety ensures our other primary objectives: patient education and preparation for procedures, prevention, and treatment of pain and nausea, and assurance of a complete lack of awareness for procedures requiring complete or “general” anesthesia.
All anesthetics performed here will have a preoperative assessment completed before proceeding that includes a thorough review of all pertinent medical history, the explanation of all anesthetic options and the acquisition of your informed consent to proceed once all of your questions are answered. Upon completion of the procedure, patients are followed in a recovery area to ensure a safe emergence, optimize any nausea relief and transition pain treatment from surgery through to your next destination.
Section on Neuroanesthesiology
Section Head – John Reynolds, MD
Should you require a neurosurgical procedure, our anesthesia department has an entire section dedicated to providing care in this unique arena. This includes any procedure on your head, neck, brain, spine, or spinal cord. We are comfortable with the considerations required for these cases because we focus on them every day. The most unique aspect of neuroanesthesia is the requirement to emerge quickly regardless of case duration. We accomplish this by altering the ratios of intranevous pain medications and inhalational gases. Our sole purpose is to make the procudure as safe and comfortable as possible.
Should you have any questions regarding neuroanesthesia, you may contact me at 336-716-4498.
Section on Obstetric Anesthesiology
Section Head – Robert D’Angelo, MD (Forsyth Medical Center)
The 11 members of the Section on Obstetric and Gynecologic Anesthesiology provide anesthesia coverage for approximately 7,000 deliveries and 3,000 cases per year. Approximately 80% of vaginal deliveries utilize regional anesthesia, and over 90% of patients receive spinal or epidural anesthesia for cesarean section. In-house call by faculty and resident physicians ensures top-level service 24-hours a day. The section is internationally known for its research on spinal and epidural anesthesia and analgesia. Faculty members are board certified by the American Board of Anesthesiology and have completed fellowships in obstetric anesthesia. Physicians come from all over the country to train within the Section on Obstetric and Gynecologic Anesthesiology.
Director - Robert Weller, MD
Orthopaedic surgery represents nearly 20% of inpatient, and over 30% of outpatient surgical volume at North Carolina Baptist Hospital, totaling over 5000 cases per year. Subspecialties include orthopaedic trauma, pediatric orthopaedics, orthopaedic oncology, and total joint replacement with a dedicated inpatient unit and total joint program. The anesthesiologists who concentrate in orthopaedics employ a variety of regional anesthesia techniques and coordinate these with acute pain management service to optimize perioperative analgesia and rehabilitation. Opportunities for resident education in regional anesthesia and research in perioperative analgesia are abundant.
Section on Outpatient and Office-Based Anesthesia
Section Head – Timothy Harwood, MD
The Section on Outpatient and Office-Based Anesthesiology provides service to over 6,500 patients per year in an 8 operating room suite. There are 4 full-time and 4 part-time members of this section. Resident education consists of both required and elective rotations which provide opportunities for learning aspects of care unique to the ambulatory surgery setting. Two section members have served or are currently serving as officers in the National Society of Ambulatory Anesthesia.
Section on Pediatric Anesthesiolgoy and Pediatric Critical Care
Section Head - Joseph Tobin, MD
Resident education in Pediatric Anesthesiology is accomplished by 3 months direct care of both healthy and critically ill children. During the second year of anesthesia training at Wake Forest Baptist Medical Center, residents work on a daily basis with one of 8 Board Certified anesthesiologists in the care of children for all forms of general, urologic, orthopaedic, ophthalmologic, plastic and reconstructive, otolaryngologic, cardiothoracic, and neurosurgical procedures. Care of premature infants and critically ill children is emphasized. The Brenner Children’s Hospital (located within the Medical Center) provides outstanding pediatric care and facilities, and functions as an independent pediatric hospital within a large general hospital environment. For one month during the CA-2 year, residents may elect a rotation at Children’s Hospital of Philadelphia (CHOP), which provides additional experience. This high volume environment provides extensive experience to residents in a private practice setting within academia. Additional pediatric experience is acquired with a one-month rotation in the Pediatric Intensive Care Unit (PICU) at Brenner Children’s Hospital. During this month, the resident provides the day-to-day care of critically ill children and is supervised by pediatric anesthesiologists and critical care physicians providing hands-on experience with cerebrocardiopulmonary resuscitation, multidisciplinary critical care, and long-term management of complicated diseases. During the 3 required months of pediatric anesthesia experience, residents generally perform more than 100 individual anesthetics for children, newborn to 12 years of age. The combined ambulatory OR, PICU, out of OR (remote location), and inpatient OR experience provides extremely valuable resident education in the preoperative assessment, intraoperative care, and postoperative management of children.
Pediatric Intensive Care Unit
Director – Thomas Nakagawa, MD
The pediatric intensive care unit (PICU) at Brenner’s Children’s Hospital is a state-of-the-art, high-level, 12-bed unit with a separate 7-bed intermediate care unit. The PICU has 8 full-time board-certified/board-eligible pediatric intensive care specialists who provide 24-hour in house coverage caring for critically ill and injured children ranging in age from birth to 21 years of age. The PICU averages 570 admissions per year. Additionally, over 1000 children are admitted to the intermediate care unit. The intensivists provide consultation and care for surgical patients and manage medical patients collaborating with pediatric surgical and medical sub-specialists. The intensivists are actively involved in the cardiac surgery program caring for infants and children with congenital heart disease. Additionally, the intensive care team is involved in the management of medical emergencies, neurosurgical diseases, pediatric trauma, airway management, mechanical ventilation, vascular access, and ECMO. A pediatric sedation service run by the pediatric intensivists provides IV anesthesia for more than 1,000 children each year who require sedation for various procedures such as burn debridement, diagnostic and therapeutic lumbar punctures, endoscopy and colonoscopy, wound closures, hearing and ocular exams, and central line placement. A pediatric mobile intensive care team is available 24 hours a day to provide transport of critically ill and injured children to Brenner Children’s hospital. PICU BROCHURE
Preoperative Assessment Clinic
Angela F. Edwards, MD (pictured far left)
Daniel Forest, MD (pictured left)
The Preoperative Assessment Clinic (PAC) is an innovative, efficient, and newly remodeled, patient-friendly clinic. The PAC provides preoperative preparation and evaluation for over 16,000 ambulatory surgery patients each year. Evidence-based testing is utilized to choose tests wisely and avoid unnecessary "routine" testing. The Anesthesiology Department has an attending anesthesiologist, physician assistants, nurse practitioners, and residents ensuring patients are ready for surgery. Anesthesia and Internal Medicine services work together to ensure patients receive complete perioperative care. While we routinely obtain our own testing, including noninvasive cardiac and pulmonary tests, a variety of consultants are available for more complex patients. An electronic Preoperative Assessment system is currently in use with electronic consents and signatures in the clinic.
Section on Regional Anesthesia and Acute Pain Management
Section Head - Robert Weller, MD
The Section on Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain Management (RAAPM) has 2 complementary focuses to its provision of patient care, resident education, and clinical research. The first is the application of regional anesthetic techniques for surgery with an emphasis on peripheral nerve blockade and continuous catheter techniques. The faculty in this section work closely with residents during a dedicated month-long RAAPM rotation to provide patients with 2000-3000 peripheral nerve block procedures a year. Each resident places and manages 60-100 regional anesthetics during this month of intensive training which also includes the management of continuous thoracic and lumbar epidural regional anesthetics.
The Acute Pain Service (APS) is a division of the Section of Regional Anesthesia and Acute Pain Management, which manages all inpatient pain management problems and conditions ranging from perioperative pain management, trauma-related pain, chronic pain, and cancer-related pain. The APS cares for both adult and pediatric patients, with 24 hour a day, 365 days a year management and consultation service. Over 150 new patient consultations are seen per month. Continuous epidural analgesia, continuous peripheral neural blockade, IV patient-controlled analgesia, and opioid and non-opioid analgesic therapies are widely used with an emphasis on multimodal analgesic regimens and preventative patient care facilitating postoperative and post-injury rehabilitation. Resident and fellowship level education through twice daily attending rounds, didactic discussions, and case presentations, as well as clinical research are integral components of the APS.