The Department of General Anesthesiology is the largest clinical department within the Anesthesiology Institute. We provide a wide range of professional services and staffing for more than 60 anesthetizing sites, including:
- Out-of-OR locations in interventional radiology, MRI, CT, Gamma Knife, electrophysiology laboratory, bronchoscopy suites, GI endoscopy suites, outpatient surgery and ophthalmologic surgery
- 52 non-cardiac operating rooms on main campus
- The Special Delivery Unit on Cleveland Clinic main campus
Our clinical expertise spans:
- State-of-the-art regional anesthesia techniques (e.g., catheter techniques and TAP blocks)
- Anesthesia for high-acuity surgery (e.g., major neurological and vascular surgery)
- Perioperative services for one of the country's busiest liver and intestinal transplantation programs
- Anesthesia for ENT, general and colorectal surgery, as well as bariatric, urological, orthopedic, obstetric and gynecological procedures
Letter from the Chairperson
The Department of General Anesthesiology (GENA) is the largest department in the Anesthesiology Institute of Cleveland Clinic's main campus. Our department consists of more than 70 anesthesiologists, more than 100 certified nurse anesthetists, residents, fellows, student nurse anesthetists, technicians, administrators and administrative assistants. Together, we are a team that is dedicated to providing world-class patient care and outcomes to our patients.
We strive to provide compassionate, high quality, outcome-oriented patient care, foster innovative research, and educate tomorrow's leaders in anesthesia and perioperative medicine.
- Provide the highest quality, compassionate care to our patients in a cost-effective manner
- Improve patient safety in the perioperative period through research and innovation
- Cultivate excellence through collegiality and teamwork
- Train outstanding residents, fellows, and SRNAs
- Pursue the right team members; nurture, and develop them
Superb patient care is our highest priority, and we recognize that research and education are essential for us to achieve best practices. Our employees are our most precious resource and we create an environment of respect, integrity and professionalism so that all are able to excel. We acknowledge that each individual has unique interests, strengths, and abilities; therefore, we work to foster their professional development by helping them achieve excellence in clinical care, research and teaching.
The Department of General Anesthesiology performs approximately 50,000 anesthetics per year, out of which 35% happen in procedural areas outside of the main operating room pavilion. Although our faculty is qualified to provide care for all patients, the culture of the department is to pair subspecialty training and the interest of our personnel to specific subspecialty patient populations. Thus, our subspecialty sections are able to work more closely with our surgical colleagues to improve patient care and outcomes.
We embrace the concept that the practice of anesthesia is the practice of perioperative medicine. Our Pre-Anesthesia Clinic (PACE) prepares 15,000 patients per year for surgery. Our Acute Medical Emergency Team (AMET) services hospital inpatients and has resulted in a noteworthy improvement in outcomes of not only surgical, but also medical hospital inpatient populations, with more than 5,000 activations per year. Our Surgical Intensive Care Unit (SICU) has around 60 beds on the Cleveland Clinic Main Campus, as well as in our regional hospitals, and 20 staff in support of approximately 5,000 patients per year. Our acute pain team cares for 5,000 patients per year in all surgical sub-specialty areas. Our Center for Perioperative Intelligence is advancing perioperative medicine to provide high quality and efficient care for surgical patients by supporting the practice of evidence-based medicine through utilizing data, analytics and decision support systems.
The foundation of resident education in the Anesthesiology Institute is also found in GENA. Our faculty not only prepares the trainees for their educational journey in the subspecialty areas, but also organizes a significant portion of the didactic lectures, problem-based learning discussions, journal clubs, workshops, and simulations. In the same context, the School of Nurse Anesthesia has its base and majority training of the future Certified Nurse Anesthetists within GENA. A noteworthy number of GENA staff members have academic appointments within the Cleveland Clinic Lerner College of Medicine; some are also involved in the training of medical students.
Many staff members are involved in clinical research. The Department publishes approximately 70 papers per year, and at any given point in time, performs, or is involved in, about 30 studies. Thousands of patients are part of these research studies. Our goal is to test perioperative interventions to improve intermediate and long-term patient outcomes. Academic and professional development are two of the most important goals of our department.
General Anesthesiology Physician Leadership
- Wael Ali Sakr Esa, MD, PhD - Anesthesia for Orthopaedic Surgery
- Andrew Zura, MD - Anesthesia for ENT Surgery
- Jacek Cywinski, MD - Anesthesia for Liver and Multivisceral Transplantation
- Allen Keebler, DO - Anesthesia for General Surgery
- Tatyana Kopyeva, MD - Anesthesia for Colorectal Surgery
- Loran Mounir Soliman, MD - Acute Pain/Regional Anesthesia
- Mauricio Perilla, MD - Anesthesia for Urologic Surgery
- Karen Steckner, MD - Anesthesia for Obstetric and Gynecologic Surgery
- David Traul, MD, PhD - Anesthesia for Neurosurgery
- Hinda Abramoff, DO - Anesthesia for Interventional Radiology
- Allen Kuhel, MD - Anesthesia for Nonoperating Room Radiology Locations (NORA)
- Dawn Schell, MD - Anesthesia for Ophthalmologic Surgery
- Kenneth Cummings, MD, MS, FASA - Pre-Anesthesia Consultation Clinic
- Samuel Irefin, MD - Anesthesia for Electrophysiologic Procedures (EPS)
- Miguel Cruz, MD - Postoperative Anesthesia Care Unit and Same Day Surgery
- Joseph Foss, MD - Anesthesia for Endoscopic Procedures
- Basem Abdelmalak, MD - Anesthesia for Bronchoscopic Procedures
- Ehab Farag, MD, FRCA, FASA - Director of Clinical Research
Ambulatory Cole Eye
The section for Ambulatory Anesthesia provides anesthetic services in the Cole Eye Institute. Our goal is to provide ophthalmology patients with an efficient ambulatory anesthetic experience with minimal side effects.
Ambulatory anesthesia requires a unique set of focused skills. We take great pride in applying our skills and experience to serve the needs of patients by providing excellent, state of the art ambulatory anesthesia. Additionally, the close proximity of our unit to the resources of the main campus allows us to care for complex medical and surgical encounters that might not normally be cared for in free-standing ambulatory surgery centers. We are able to coordinate with other services to expedite care for patients with serious and complex medical conditions including LVAD pumps, end-stage renal disease and complex cardiomyopathies.
Our trainees receive exposure to ambulatory anesthesia and learn the skills of rapid turnover and efficient evaluation/ treatment that are required to be successful in a busy ambulatory surgery center. Accordingly, our staff are very active in the Society for Ambulatory Anesthesia (SAMBA) and are passionate about teaching the skills required to provide excellent ambulatory anesthesia care.
The Adult Medical Emergency Team (AMET)
AMET is a hospital-wide rapid response team that provides prompt medical assistance to patients, visitors, and caregivers. The purpose of AMET is to intervene early in a situation to lessen the incidence of decompensation. AMET can be activated by anyone, including patients and family members. AMET consists of an LIP, a registered nurse, and a respiratory therapist. The team carries equipment and medications enabling it to definitively respond to nearly any medical emergency anywhere. AMET responds to situations that include, but are not limited to cardiopulmonary arrest, chest pain, dysrhythmias, respiratory difficulties, altered mental status, and hypotension. One of the goals of AMET is to respond to a call for assistance within 10 minutes. AMET does not “take over” care of the patient, but assists when immediate intervention is necessary, such as airway management and blood pressure support. Providing this extensive AMET infrastructure is a major investment by Cleveland Clinic, providing their patients and caregivers with the highest level and quality of care.
Anesthesia for Colorectal Surgery
Our anesthesia team from Colorectal Section led by experienced anesthesiologists work with the nationally and internationally recognized surgeons from Colorectal Surgery Department. We work closely with the surgical colleagues to ensure that our patients are optimally prepared for surgery, and provide anesthesia and post-anesthesia care for the patients with wide range of diseases of colon and rectum, including inflammatory bowel diseases, cancers, functional bowel disorders, pelvic floor dysfunctions, and anorectal disorders. On a daily basis we take care of the patients who have their surgeries done in a conventional way or with the use of laparoscopic/robotic techniques. Our section participates in education of anesthesia residents and student nurse anesthetists. In close collaboration with the Anesthesia Outcome Research Department, we work on research projects and practice-improvement projects to find ways to take better care of our patients.
Non-operating Room Anesthesia
Endoscopy Electrophysiology MRI/CT/Radiology
The Non-Operating Room Anesthesia (NORA) section the Cleveland Clinic includes the administration of anesthesia for adults outside the traditional operating room setting in the GI Endoscopy Suites [Q3], Electrophysiology Labs, MRI and CT scan and Interventional Radiology. NORA was born out of an increasing demand for providing safe and efficient anesthesia services at sites outside the main operating suites. This increase in the number of cases has resulted from improved technology, growing number of very sick patients who are often not “good surgical candidates”, financial constraints while still maintaining patient and provider satisfaction. The increased complexity of cases at these sites has dictated the need for deeper levels of sedation, general anesthesia with and without airway instrumentation, and hemodynamic monitoring in non-OR settings. This has been reflected in the exponential increase in the NORA cases at the Cleveland Clinic. Most of these locations have been upgraded and revamped to reflect the increasing need for anesthesia services at these locations. In addition, all these locations offer an open access and open scheduling policy. The anesthesiologists at this location are charged with the preoperative, intraoperative and postoperative management at these sites. Protocols and strict selection criteria have been developed to facilitate a good match between the place, patient, procedure and the anesthesia planned.
We have scheduled block times for adult elective and in-patient MRIs 4 days a week. Patients are able to obtain all their periprocedural care within the MRI suite. Pre-anesthesia and Post-anesthesia care are given by PACU trained nurses. Two fully equipped induction rooms have been designed to enable induction of anesthesia in a magnet free space. We often provide anesthesia for patients with claustrophobia, chronic pain, and other reasons that make completion of imaging difficult. Within the same MRI suite, Cleveland Clinic Main Campus has an Intraoperative MRI System (IMRIS). We are able to provide anesthesia for awake or asleep craniotomies in a fully equipped pre-anesthesia, induction, and operating rooms.
Here we have 6 Interventional Radiology (IR) procedural rooms fully equipped for invasive and non-invasive anesthesia care, four rooms for body IR and two rooms for neurointerventional procedures. Like MRI, we have scheduled block times for interventional radiology 4 days per week. Anesthesia consultation is often needed due to procedural requirements (Transjugular Intrahepatic Portosystemic Shunt [TIPS], non-dilated Percutaneous Transhepatic Cholangiogram [PTHC], Sclerotherapy, Aneurysm, Arteriovenous Malformation [AVM], tumor embolization, etc.) or patient comorbidities (chronic pain, obstructive sleep apnea, stroke, etc.). To date IR suites have the capacity for pre-anesthesia care and Phase II [where patients are awake or easily arousable, hemodynamically stable, on room air with adequate oxygen saturation, and minimal pain and nausea symptoms] post anesthesia care. Coming soon is the addition of Phase I [where patients can be somnolent, hemodynamically unstable, require supplemental oxygen/airway adjuncts, and need for pain and nausea interventions] post anesthesia care unit.
Non-surgical tumor treatment by percutaneous tumor ablation is performed by our IR and CT radiologists. The CT scanners in the main campus provide comprehensive procedural and anesthetic care for non-operating room cases. Pre-anesthesia care and Phase II PACU care are also available in our CT suites.
Anesthesia for Ear, Nose, and Throat Surgery (ENT)
The section for ENT anesthesia presents many challenges for the anesthesiologist in order to adjust to both patient and surgical needs. Some of the challenges include evaluating the patient’s airway that can be distorted due to trauma, tumors, complex anatomy, and infection; securing the airway using a multitude of techniques and equipment; sharing the patient’s airway with the surgeon; and deciding on a plan for extubation at the end of the surgery. The section covers a variety of surgical procedures which includes thyroidectomy and parathyroidectomy; tonsillectomies and adenoidectomies; tympanomastoidectomy and cochlear implant; laser surgery of the larynx and trachea; complex head and neck cancers with reconstruction; oral and facial surgeries; laryngectomies; tracheostomies; and endoscopic sinus surgeries.
The Bronchoscopy Suite is designed to provide an ideal environment for patient care and to accommodate our increasing diagnostic and therapeutic bronchoscopy volumes. World-renown for its expertise in bronchoscopy, Cleveland Clinic’s Advanced Diagnostic and Interventional Bronchoscopy Program leads the way in developing new diagnostic and therapeutic bronchoscopy techniques. In collaboration with the pulmonologists, our anesthesiologists co-manage patients with airway complications from lung transplantation, tracheostomy (tracheal tubes), foreign object in the airway, aspirations, lung and metastatic cancers, inflammatory airway diseases, and benign airway diseases.
Anesthesia for Liver and Multivisceral Transplantation
The Section of Anesthesia for Liver and Multivisceral Transplantation provides specialized care for liver for solid organ abdominal transplantation including liver, small bowel, multi-visceral and combined liver-kidney recipients. Both adult and pediatric liver and bowel transplant patients are cared for by members of our team as well as living donor liver transplants. Patients undergoing elective hepatobiliary (HPB) surgery are scheduled with the liver transplant anesthesiology service as well. Common procedures for HPB patients include resection of hepatocellular carcinoma and resection of hepatic metastases of colon cancer. Members of our team are subspecialty trained and highly experienced in providing anesthesia care for high acuity patient population. We utilize state of the art monitoring (including but not limited to transesophageal echocardiography, thromboelastography) and protocols to provide exceptional care for our patients. Our team evaluates transplant candidates in the Preoperative Liver Transplant Clinic and participates in Multidisciplinary Selection Committee providing truly comprehensive perioperative care.
Anesthesia for General Surgery
All of our physicians and nurses come together to provide world class anesthesia care for the patients on the general surgery service. This includes, but is not limited to, anesthesia for abdominal surgery including liver resections, gall bladder removal, appendix removal, and pancreatic surgery. Also included is anesthesia for surgery of the thyroid, parathyroid, and adrenal glands. We also specialize in anesthesia for multiple types of hernia repairs. With the addition of the Acute Care Surgery service we also specialize in providing anesthesia care for the general surgeons who specialize in the emergent and urgent surgical needs of our patients. We also participate in resident education and research. We think you will find our anesthesiologists, residents, CRNAs, and SRNAs to be top notch and we look forward to proving you with world class care.
Anesthesia for Neurosurgery
The section for Neuroanesthesia is one of the largest sections within the department of General Anesthesiology. Members of the section are subspecialty trained and highly experienced in providing anesthesia care for patients with neurological disabilities including patients undergoing a neurosurgical procedure. This section covers anesthesiology services to all neurosurgical, spine and neurointerventional operating rooms. The highly subspecialized and cutting edge neurosurgical procedures performed by Cleveland Clinic's skilled neurosurgical and spine surgery team combined with the exceptional anesthetic care within the section results in an outstanding patient outcome. Most of these surgical procedures have unique anesthetic considerations requiring highly skilled and knowledgeable faculty. The section has initiated the Enhanced Recovery After Surgery (ERAS) pathways to further improve our patients’ outcomes. Many of the faculty members in Neuroanesthesia section are authors and editors in textbooks and research publications in this subspecialty area.
Anesthesia for Obstetric and Gynecologic Surgery
Our anesthesia section for Women's Health (Obstetrics and Gynecology) cares for our patients throughout all the stages of their lives. We staff the "Special Delivery Unit", an obstetric unit designed to provide multidisciplinary care to mothers with complex medical conditions (such as cardiac conditions, Marfa's syndrome, brain tumors), or those carrying infants who would need surgical intervention shortly after birth. We have a close working relationship with the Maternal-Fetal Medicine obstetricians and neonatology teams to create an individualized care plan for each patient. We are involved in the peripartum management of maternal medical issues, collaborating with the OB hospitalist. We use a neuraxial technique for analgesia/anesthesia in over 90% of our Obstetric deliveries.
Our Gynecology operating rooms include surgeries for endometriosis, perimenopausal bleeding, and known malignancies; we will increasingly see more oncology surgery on this service. We have been using Enhanced Recovery After Surgery (ERAS) protocols to help our patients feel better sooner. An experimental protocol for uterine transplantation has just started recruiting patients at Cleveland Clinic. These cases will involve complex multidisciplinary care. Our Women's Health anesthesia care team at Cleveland Clinic employs a broad skill set to provide care to our patients.
Anesthesia for Orthopedic Surgery
The section for Orthopaedic Anesthesia is one of the busiest sections within the department of General Anesthesiology. Our faculty includes highly experienced anesthesiologists, providing anesthesia care using advanced techniques tailored to the individual needs of our patients and the acuity of their illness. We provide anesthesia for all Orthopaedic cases, ranging from the simplest to complex procedures, multidisciplinary resections and high risk cases. Our team includes trained specialists in the field of acute pain management who perform various nerve blocks and utilize multimodal pain management strategies for our patients during their hospital stay. Furthermore, we have initiated the Enhanced Recovery After Surgery (ERAS) pathway to further improve patient outcomes.
We continuously strive to achieve outstanding patient outcomes for all Orthopaedic procedures by combining expert diagnostic methods with unparalleled, personalized anesthesia care. Many of the faculty members in Orthopaedic Anesthesia section are recognized authors, co-authors and textbook editors with active contributions to research publications in this subspecialty.
Anesthesia for Urologic Surgery
The Anesthesia for Urology Section supports the Cleveland Clinic's Glickman Urological and Kidney Institute, recognized worldwide for its excellence in patient care, teaching and research. Our section is focused on the perioperative management of patients who require anesthesia for urology procedures such as Kidney Transplants, Robotic Assisted and Laparoscopic Procedures, Urologic Endoscopic Procedures, and Complex Urological Reconstructive Procedures. Our team is nationally recognized for excellence in education, research and publications in national and international journals and book chapters related to anesthesia and urology surgery.
Pre-Anesthesia Consultation Clinics (PACC and PACE)
Seeing approximately 65,000 patients per year, the combined preoperative clinic systems (Main Campus Preoperative Anesthesia Consultation and Evaluation (PACE) clinic and the Pre-Anesthesia Consultation Clinic (PACC) system) serve a number of roles. Their primary function is to ensure that patients scheduled for surgery have a thorough and appropriate preoperative evaluation to ensure the safest anesthesia and surgery possible. In collaboration with the Internal Medicine Preoperative Assessment, Consultant and Treatment (IMPACT) clinic, our team of physicians, advance practice providers, and nurse specialists works to optimize patients' medical conditions and to provide education about their upcoming surgeries. If postoperative pain is likely to be an issue, we work with the surgeon's office to consult with the Acute Pain Management Service. PACE also works with the Department of Outcomes Research to provide patients with the opportunity to take part in clinical research studies.
Additionally, the PACE clinic has instituted several initiatives to promote patient health beyond the operating room. We work with the Cleveland Clinic Sleep Center to screen patients for obstructive sleep apnea and refer them for further testing and treatment. We also offer referrals and support to help patients quit smoking. Most recently, we have collaborated with our allergists to offer penicillin allergy testing for patients who are documented to have an allergy but are unsure of the reaction.
Cleveland Clinic Anesthesiology resident physicians also rotate through the PACE clinic to enhance their knowledge of perioperative medicine.
Post Anesthesia Care Unit (PACU)
The post anesthesia care unit (PACU) is the postoperative arm of general anesthesia here at the Cleveland Clinic. This is where patients go immediately after their surgery and this encompasses every surgical service. The PACU is staffed with specialized nurses trained in postoperative care, respiratory therapists, resident physician under the medical direction of General Anesthesiology department staff who work collaboratively to ensure that postoperative patients receive world class care and meet PACU discharge criteria before they transition to the regular nursing floor.
Led by the Director of Research, the department publishes approximately 70 papers per year, and at any given point in time, performs, or is involved in, about 30 clinical studies. Thousands of patients are part of these research studies. Our goal is to test perioperative interventions to improve intermediate and long-term patient outcomes. With a focus on academic development, the department encourages all department members to actively participate in research studies. Assistance with protocol development, manuscript editing and overall research is provided.
Departmental staff members provide the majority of teaching for the institute's core program residents and student nurse anesthetists. Fellowships are offered in neuroanesthesia, liver transplantation, and non-operating room anesthesia (NORA)–a new, innovative, and unique program.
The large number and complexity of operative procedures performed at Cleveland Clinic provides our residents with abundant experience in clinical anesthesia and the opportunity to develop sub-specialization skills. Basic and clinical research opportunities further prepare residents to deliver state-of-the-art care to patients.
We encourage you to browse our education site to learn more about our program.