obstetric anesthesia

The Division of Obstetric Anesthesia is responsible for anesthesia care in the Labor and Delivery Suite at the Sloane Hospital for Women in the Children’s Hospital of New York (CHONY) on the main campus at 168th Street, and the L&D Suite at the Allen Hospital at the northern tip of Manhattan. In addition, we provide a high-risk consultation service, and coordinate with the Department of Obstetrics and Gynecology to run the Critical Care Obstetric service.

In 2012, there were about 4500 deliveries at the Children’s Hospital Of New York (CHONY) main campus and about 2200 at the Allen Hospital, our “community hospital.” Many patients, especially at CHONY, are high risk or critically ill parturients, requiring close consultation and cooperation between the Obstetrics and Gynecology and Anesthesiology Departments. At our main campus, where most resident training takes place, the labor analgesia rate is ~85%; it is ~70% at the Allen Hospital. The cesarean section rate is 30-35% at both campuses, reflecting the referral nature of much of the practice. There is a special emphasis on Critical Care Obstetrics, with three high-risk double-bedded room on the labor suite equipped for full hemodynamic monitoring and other aspects of critical care for parturients with cardiopulmonary and other critical diseases. In addition, our labor suite utilizes an electronic anesthesia record for all cases, including labor analgesia cases, which includes automated acquisition of maternal and fetal data into the anesthesia record, which is rare (perhaps even unique) among US labor and delivery suites.

The Division of Obstetric Anesthesia provides residency and post-graduate fellowship training in state of the art techniques and strategies of labor analgesia and obstetric anesthesia. Approximately 96% of the cesarean sections are performed using regional anesthesia. A variety of techniques of regional analgesia for labor are utilized, including epidural, spinal, and combined spinal epidural (CSE), and there is extensive use of patient controlled epidural analgesia (PCEA) for labor. Subspecialty Obstetric anesthesia faculty provide coverage of the main campus Labor and Delivery Suite 24 hours a day, 7 days a week, and for the Allen during daytime hours. The provision of patient care and resident supervision 24/7 by subspecialty obstetric anesthesiologists is only practiced at a handful of institutions, and is a major strength of the Division. Most residents rotate through the CHONY labor suite three times (4 week rotations) during their 3 years as clinical anesthesia residents, and there is a 2 week rotation, usually in the CA-2 year, at the Allen Hospital to increase exposure to “community hospital obstetrics.” The residents care for all patients on the Labor and Delivery floor, including the most complex obstetric or medical cases, and perform consultations along with the Fellow and/or Attending. A typical distribution of cases for a resident during a 4-week rotation is:

  • Epidural analgesia for labor: 30-40 (~70 % will be combined spinal-epidural)
  • Cesarean section: 20 (~15 spinal, 5 epidural, 0-1 GA)
  • Assisted deliveries (forceps/vacuum) or other procedures: 1-3
  • Cervical cerclage (spinal): 2-4
  • Postpartum tubal ligation (spinal or epidural): 2-4
  • Anesthesia for external cephalic version: 1-2

The lecture series and other educational programs are strengths of the Division. Didactic lecture/ discussions or case presentations take place each morning during teaching rounds, and significant efforts are made to protect resident learning time while clinical needs are covered by Attendings and Fellows. A syllabus of topics is covered during the rotation and a CD of the outlines and discussion questions from the syllabus is given to each resident, along with a variety of other recommended reading materials. When residents on the rotation are mostly senior residents, rounds are geared toward more advanced and/or research topics.

We have an active research program. Recent and current research in the Division and in the Department relevant to obstetric anesthesia include a variety of studies of drug combinations and techniques for labor analgesia and post-partum pain relief, a program of research into the role of genetic polymorphisms of pregnancy complications and issues (preterm labor, preeclampsia, labor progress, postoperative pain) and response to anesthesia, studies of gender differences in pain sensitivity and the effectiveness of different treatments, and investigations in weight regulation in pregnancy. Our digital database of labor analgesia and cesarean section cases is beginning to provide a resource for health services research.  Over the past decade, abstracts from this Division have competed in the Best papers at the Society for Obstetric Anesthesia and Perinatology (SOAP) meetings, and we have won the “Best Paper of the Meeting” award 4 times, and have received a similar award at the International Society for Anesthetic Pharmacology annual meeting. To see a selected list of recent publications from the Division, please click here.

Faculty:
A. Robin Brown, MD
Charles Cain, MD, MBA
George Gallos, MD 
Stephanie Goodman, MD, Administrative Director, Fellowship Program Director
Allison Lee, MD
Suzanne Mankowitz, MD
Laurence Ring, MD
Richard Smiley, MD, PhD, Division Chief

Current Fellows 2013/14:
Jaime Aaronson, MD - Residency: Weill-Cornell/NewYork Presbyterian Hospital
Adam Sachs, MD - Residency: New York University Medical Center

For further information, write or contact:
Richard Smiley, MD, PhD
Professor of Anesthesiology at CUMC
Columbia University Department of Anesthesiology
Chief of Obstetric Anesthesia
Columbia University Medical Center
630 West 168th Street PH-5
New York, NY 10032
Tel: 212-342-2028
Fax: 212-342-2742
Email: rms7@cumc.columbia.edu

 

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Columbia University Medical Center Department of Anesthesiology