The Department of Anesthesiology’s mission is to “provide better care tomorrow,” through state-of-the-art, high-quality perioperative anesthesiology, pain management and critical care for our patients. Through interprofessional collaborations with our colleagues at the Albert Einstein College of Medicine, we leverage our energy to inform decisions in clinical operations, education and quality improvement to continually elevate our patient care at Montefiore.
Our national and international collaborations enable us to contribute to the progress of perioperative medicine around the world through multicentric studies that can be generalized to patients anywhere undergoing surgical procedures or with critical illnesses that require immediate treatment. Our clinical research is the direct consequence of our colleagues’ experience in the operating room and the intensive care unit.
We use the generation and analysis of highly granular pharmaco-physiological patient data to understand the effects of new medications on patients’ recovery from surgery or critical illness. We regroup, validate, and utilize available health care data from more than 1 million patients who underwent surgery at Montefiore or at one of our collaborating health care networks including Beth Israel Deaconess Medical Center of Boston. This powerful information helps us identify rare complications – and is the foundation for individualized perioperative treatment. We then confirm our results through clinical studies, improving the efficacy and future implementation of promising treatment strategies.
Basic Science and Pediatric Anesthesiology Research
As a graduate of the Clinical Research Training Program (CRTP) at Montefiore Einstein, Dr. Jerry Chao designed prospective studies of the effects of anesthesia on infants’ developing brains and parental perceptions of commonly employed anesthetic techniques, particularly regional anesthesia, for intraoperative and postoperative analgesia. Dr. Chao’s NIH-supported research focuses on obtaining and interpreting the non-invasive electroencephalogram (EEG) during general anesthesia and spinal anesthesia. He collaborates with and receives mentorship from a multidisciplinary team with expertise in epidemiology, pediatric neurology, biostatistics and computational neuroscience. We work with national experts as well as our own Department of neurosurgery to better understand the mechanisms of sleep and anesthesia in infants and children.
Clinical and Observational Research
How can we create an optimal treatment plan to minimize the risk of a stroke after surgery? Which patients are at high risk and should receive a new treatment? Our digital health databases allow us to answer these questions in a standardized manner and test hypotheses around potentially improved treatments.
During the last 15 years, we have established and validated hospital registries in Boston and New York City. These databases are unique since they provide a granular picture of patients’ perioperative risks. These risks are analyzed based on patients’ comorbidities, medications, and the severity of the primary diseases leading to hospital admission and surgery. The database records also allow us to integrate information about any added risks based on the surgical procedure performed. For example, did the patient have a major bleeding complication? Did the patient develop heart problems, low blood pressure, or a pulmonary complication during the operation? Was the patient admitted to the intensive care unit?
One of our team’s primary research focuses is interprofessional quality improvement. A current project in collaboration with Dr. Jeff Freda, Vice Chair of Perioperative Medicine, and Dr. Richard Smith, Chair of the Department of Otorhinolaryngology, Head & Neck Surgery, has resulted in a decreased risk of case cancellations. Case cancellations are unpleasant for patients who were scheduled to receive a procedure. Further, same-day cancellations reduce utilization of operating rooms, affect surgeon productivity and staff morale, and result in extra costs for patients, physicians, and hospitals.
As such, our Research team developed a never-before used automated tool to help determine which patients are at high-risk for case cancellation. In collaboration with Surgical Services and the Pre-Anesthesia Testing team, we then work to mitigate these cancellations by providing interventions that allow patients to get the treatment they need on time. These interventions include consultations with patients who have a history of anxiety disorder as well as arranging free transportation to and from the hospital for those that have a barrier to accessing transportation.
The Department of Anesthesiology provides support for faculty, residents, students, and pharmaceutical sponsors conducting research within the field of anesthesiology and its subspecialties at Montefiore and the Albert Einstein School of Medicine. During the last 18 months, the Department of Anesthesiology started enrolling participants in nine randomized controlled trials, four of which are supported by the National Institutes of Health.
Our clinical research core assists with study design, protocol development, contract executions, budget development, data collection, and statistical analysis. The team works as a liaison between subspecialties within the department and other research organizations at Montefiore Einstein. Our staff is experienced in preparing IRB applications, preparing informed consents, submitting amendments, and fulfilling other various IRB and research requirements. Our clinical trial staff support researchers on how to obtain assistance from the Montefiore Institute for Clinical and Translational Research (ICTR) facilities such as the Montefiore Office of Clinical Trials (OCT), the Clinical Research Center (CRC), and the Biostatistics and Study Design Department. The OCT assists investigators in budget negotiations, contract executions, invoicing for services, subject recruitment, and retention planning. The CRC provides a space for expert staff to conduct outpatient research studies and assists in collecting, processing, and shipping biological specimens. The Biostatistics and Study Design Department offers expertise in designing complex study protocols and providing analytical solutions for preparing manuscripts.
Department of Anesthesiology
Recent Department Publications
The effects of sugammadex vs. neostigmine on postoperative respiratory complications and advanced healthcare utilisation: a multicentre retrospective cohort study
PMID: 36562202 DOI: 10.1111/anae.15940 December 23, 2022
Comparison of the effects of sugammadex versus neostigmine for reversal of neuromuscular block on hospital costs of care
S0007-0912(22)00586-4. PMID: 36564246 DOI: 10.1016/j.bja.2022.10.015 December 21, 2022
Subjective Assessment of Motor Function by the Bedside Nurses in Mechanically Ventilated Surgical Intensive Care Unit Patients Predicts Tracheostomy
Volume 38, Issue 2 https://doi.org/10.1177/08850666221107839 First published online June 12, 2022
Implementation of an instrument to predict and reduce same day case cancellations in ambulatory surgery
The American Journal of Emergency Medicine.
Incidence and predictors of case cancellation within 24 h in patients scheduled for elective surgical procedures
Journal of Clinical Anesthesia, 2022-12-01, Volume 83, Article 110987, Copyright © 2022
Agitated Patients in the Intensive Care Unit: Guidelines for Causal Rather Than Symptomatic Treatment are Warranted
Volume 38, Issue 2 https://doi.org/10.1177/08850666221138234 First published online November 13, 2022
Decreased Electroencephalographic Alpha Power During Anesthesia Induction Is Associated With EEG Discontinuity in Human Infants
Anesthesia & Analgesia 135(6):p 1207-1216, December 2022. | DOI: 10.1213/ANE.0000000000005864
Should asymptomatic patients testing positive for SARS-CoV-2 wait for elective surgical procedures?
VOLUME 128, ISSUE 5, E311-E314 DOI: https://doi.org/10.1016/j.bja.2022.02.005 MAY 01, 2022
Association Between Intraoperative Arterial Hypotension and Postoperative Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort Study
Anesthesia & Analgesia 134(4):p 822-833 DOI: 10.1213/ANE.0000000000005739 April 2022
Differential Effects of Gamma-Aminobutyric Acidergic Sedatives on Risk of Post-Extubation Delirium in the ICU: A Retrospective Cohort Study From a New England Health Care Network
Crit Care Med. 50(5):e434-e444. PMID: 34982739 DOI: 10.1097/CCM.0000000000005425 May 2022
Reintubation After Lung Cancer Resection: Development and External Validation of a Predictive Score
Ann Thorac Surg. S0003-4975(22)00804-9. PMID: 35690135 DOI: 10.1016/j.athoracsur.2022.05.035 Jun 2022
Preoperative Treatment of Severe Diabetes Mellitus and Hypertension Mitigates Healthcare Disparities and Prevents Adverse Postoperative Discharge to a Nursing Home
Annals of Surgery 276(3):p e185-e191 DOI: 10.1097/SLA.0000000000005544 September 2022
Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study
Anesthesiology. 137(1):41-54. PMID: 35475882 DOI: 10.1097/ALN.0000000000004256 Jul 2022
Association between intraoperative tidal volume and postoperative respiratory complications is dependent on respiratory elastance: a retrospective, multicentre cohort study
British Journal of Anaesthesia Volume 129, Issue 2, Pages 263-272 https://doi.org/10.1016/j.bja.2022.05.005 August 2022
Association Between Intraoperative Dexamethasone and Postoperative Mortality in Patients Undergoing Oncologic Surgery: A Multicentric Cohort Study
Ann Surg. PMID: 35837889 DOI: 10.1097/SLA.0000000000005526 July 2022
On-admission anemia predicts mortality in COVID-19 patients: A single center, retrospective cohort study
The American Journal of Emergency Medicine. March 2021
Successful Use of Peripheral Nerve Blocks as the Primary Anesthetic in High-Risk Patients Undergoing Hip Surgery: A Case Series
A A Pract. 2021 Jan 14;15(1):e01367. doi: 10.1213/XAA.0000000000001367
Electroencephalographic Assessment of Infant Spinal Anesthesia: A Pilot Prospective Observational Study
Paediatr Anaesth. 2021 Sep 12. doi: 10.1111/pan.14294. Epub ahead of print. PMID: 34510633
On the Importance of Language in Reports Discussing Racial Inequities
Anesthesia & Analgesia. June 2021 - Volume 132 - Issue 6 - p e117-e118 doi: 10.1213/ANE.0000000000005534
Difficult Airway Management in Adult Covid -19 Patients, A Statement by the Society for Airway Management
Anesthesia & Analgesia. March 12, 2021 - Volume - Issue - 10.1213/ANE.0000000000005554
Association Between Intraoperative Arterial Hypotension and Postoperative Delirium After Noncardiac Surgery: A Retrospective Multicenter Cohort Study
Anesth Analg. 2021 Sep 13. doi: 10.1213/ANE.0000000000005739. Epub ahead of print. PMID: 34517389
International Early SOMS-guided Mobilization Research Initiative. (2016) Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial
The Lancet. 388(10052), 1377-1388.
Association of Preoperatively Diagnosed Patent Foramen Ovale With Perioperative Ischemic Stroke
JAMA. 2018;319(5):452–462. doi:10.1001/jama.2017.21899
Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 (COVID-19) at a Tertiary Care Medical Center in New York City
J Pediatr. 2020 Aug; 233:14–19.e2-e164. doi: 10.1016/j.peds.2020.05.006. PMID: 32407719 PMCID: PMC7212947
Electroencephalographic Findings and Clinical Behavior During Induction of Anesthesia with Sevoflurane in Human Infants: A Prospective Observational Study
Anesth Analg. 2020 Jun; 130(6):e161-e164. doi: 10.1213/ANE.0000000000004380. PMID: 31453873 PMCID: PMC8456618
Foundation for Anesthesia Education and Research (FAER) – Summer Program
The Medical Student Anesthesia Research Fellowship Summer Program provides students with a challenging and rewarding experience that exposes them to the opportunities within the medical field of anesthesiology and research.
Medical students who participate in the summer anesthesia research fellowship can expect:
- Eight weeks of focused research related to anesthesiology.
- A dedicated mentor who will provide guidance and training in research techniques and scientific methods.
- The opportunity to make a scientific poster presentation at the American Society of Anesthesiologists annual meeting, during the FAER MSARF Symposium.
- A $400 per week student stipend, ASA student membership dues, plus additional funds to help cover the costs of travel to the ASA meeting.
Diversity, Equity, and Inclusion Education and Research Program
Dr. Alexander Bastien and Dr. Tracey Straker have worked with Dean Kerrigan, Dean of Admissions at AECOM, to formalize a mentoring program for African American and Latin students. This initiative includes recruitment, mentor/mentee pairs, virtual and in-person meetings, and a structured plan of action from student acceptance until graduation.
ASA Mentoring Grants/Research received in department 2021:
- Alex Bastien, MD and Terry-Ann Chambers, MD – Tackling Inequities in Perioperative Healthcare Delivery – “there’s an app for that!”
- Sujatha Ramachandran, MD, MACM and Camille Fontaine, MD – Enhancing Recruitment Processes to Facilitate a Diverse Work Force
- Shamantha Reddy, MD, FASA and Karen Paltoo, MD – COVID-19 Vaccine Hesitancy Among Healthcare Workers- Does Age, gender, level of education, occupation and racial /ethnic background play a role?
- Adela Aguirre-Alarcon, MD, MS and Felix Dailey Sterling, MD – The Association Between a Patient’s Race and Ethnicity and the Loss of the Ability to Live Independently after Surgery - A hospital Registry from a healthcare network in the Bronx
ASA Mentoring Grants Received in 2022:
- Vilma Joseph, MD - A National Medical Student Mentoring Program and Microaggression Leadership Program to Nurture and Empower the Next Generation of Underrepresented Anesthesiologists
- Yelena Spitzer, MD - Building a Pipeline for Mentorship Amongst Female Anesthesiologists: From Medical School and Up
Clinical Research Training Program (CRTP)
Since 2011, the Montefiore-Einstein Anesthesiology Department has sponsored at least one junior faculty in the mentored research training, funded through the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Through these and other funding mechanisms, Anesthesiology faculty are enrolled in and have graduated from Master of Science programs in Public Health and Business Administration at Columbia University, Georgia Tech and the Albert Einstein College of Medicine.
We are actively seeking qualified faculty and fellows to continue this initiative.
Current Enrolled Faculty
Michael E. Kiyatkin, MD, Albert Einstein College of Medicine
Jerry Chao, MD, MS (2016), Albert Einstein College of Medicine
Adela Aguirre-Alarcon, MD (2016), Albert Einstein College of Medicine
Cardiothoracic Fellowship Research Program
The Division of Adult Cardiothoracic Anesthesiology are active educators and researchers in the areas of perioperative echocardiography, blood management, point of care testing, mechanical assist devices, neuromonitoring during cardiopulmonary bypass, and remote patient monitoring (RPM). In 2020, Dr. Jonathan Leff received a Clinical and Translational Science Award (CTSA) catalytic grant for the study of RPM in COVID-19 patients. In addition, Dr. Leff was P.I. at Montefiore for the Transfusion Requirements In Cardiac Surgery (TRICS III) trial, a multicenter international randomization transfusion trial funded by the Canadian Institute of Health Research (CIHR) and will be participating in the upcoming TRICS IV trial. Moreover, funded research is ongoing through collaboration with Edwards Lifesciences for data collection on predicting right ventricular failure.