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General Anesthesiology

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 new 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
Andrea Kurz, MD

Andrea Kurz, MD
Department Chair

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.

Vision

We strive to provide compassionate, high quality, outcome-oriented patient care, foster innovative research, and educate tomorrow’s leaders in anesthesia and perioperative medicine.

Mission

  • 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

Values

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

Rafi Avitsian, MD

Rafi Avitsian, MD
Vice Chair
Professional Development

Andrew Zura, MD

Andrew Zura, MD
Associate Clinical Director
of the Operating Room
ENT Section Head

Section Heads

Sekar Bhavani, MD

Sekar Bhavani, MD
Non-Operating Room Anesthesia (NORA)

Jacek Cywinski, MD

Jacek Cywinski, MD
Liver Transplantation

Robert Helfand, MD

Robert Helfand, MD
Ambulatory/Eye

Allen Keebler, DO

Allen Keebler, DO
General Surgery/Vascular

Tatyana

Tatyana Kopyeva, MD
Colorectal

David Traul, MD, PhD

David Traul, MD, PhD
Neurosurgery

Medical Directors

Kenneth Cummings, MD, MS

Kenneth Cummings, MD, MS
Medical Director of PACE Clinic

John Jerabek, DO

John Jerabek, DO
Medical Director of the PACU

Leif Saager, MD

Leif Saager, MD
Medical Director of AMET

Samuel Irefin, MD

Samuel Irefin, MD
Medical Director of EPS

Mariel Manlapaz, MD

Mariel Manlapaz, MD
Medical Director of the PACU

Stacy Ritzman, MD

Stacy Ritzman, MD
Medical Director of Anesthesia Control Desk

Dawn Schell, MD

Dawn Schell, MD
Medical Director of Cole Eye

Sections

Ambulatory Cole Eye

The section for Ambulatory Anesthesia provides anesthetic services to the A60 Ambulatory Surgery Center and The Cole Eye Institute. Our goal is to provide our patients with an excellent anesthetic experience with minimal side effects.

We provide an excellent experience for trainees at all levels of experience. Our environments support rapid turnover. We emphasize the unique benefits of intravenous anesthetic techniques. The closed nature of our units allows us to follow our patients from their admission to their discharge.

In addition, the section sponsors an Ambulatory Anesthesia Fellowship. Highly motivated individuals can experience a broad range of clinical activity across our region with unique emphasis according to their particular interests. Members of the section are active in national groups and we have had past presidents of Society for Ambulatory Anesthesia (SAMBA) from our group.

The close proximity of these units to the resources of the main campus allows us to take care of complex medical and surgical encounters that might not be available to free standing ambulatory surgery centers. We take great pride in coordinating with other services to expedite care for serious medical conditions. Overnight stay, nuclear medicine lymph scintigraphy, and acute pain services are amongst the areas that we consult with regularly.

Ambulatory anesthetic services are a unique set of focused skills. We take great pride in applying our skills and experience to serving the needs of our patients.

Ambulatory Surgery Center (A60)/Cole Eye

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.

Colorectal Anesthesia

Endoscopy Electrophysiology MRI/CT/Radiology

The Non-Operating Room Anesthesia (NORA) division at 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.

General Anesthesiology Endoscopy Suite General Anesthesiology Endoscopy Suite

New Endoscopy Suites

We have scheduled block times for adult elective and in-patient MRIs 4 days a week. Patients are able to obtain all their peri-procedural 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.

In 2014, we opened our new Interventional Radiology (IR) suites. Here we have 6 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. In 2014, the CT scanners in the main campus were also remodeled in order to 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.

Non-Operating Room Anesthesia (NORA)

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.

In 2010, Cleveland Clinic Respiratory Institute opened the most technologically advanced bronchoscopy suite in the world. 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.

ENT Anesthesia

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.

General Surgery Anesthesia

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.

Neurosurgery Anesthesia

OB/GYN

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, Marfan’s syndrome, brain tumors), or those carrying infants who would need surgical intervention shortly after birth. We have a close working relationship with the Materno-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.

OB-GYN Anesthesia

Orthopaedic 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.

Orthopaedic Anesthesia

Urology

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.

Urology Anesthesia

Pre-Anesthesia Clearance and Evaluation (PACE) Clinic

Seeing approximately 13,000 patients per year, the Preoperative Anesthesia Consultation and Evaluation (PACE) clinic serves a number of roles. Its 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 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. Amazingly, 90 percent of patients tested do NOT have a true penicillin allergy, allowing them access to a much broader array of antibiotic options.

Cleveland Clinic Anesthesiology resident physicians and student nurse anesthetists also rotate through the PACE clinic to enhance their knowledge of perioperative medicine. We have had over 30 hospitals send representatives for site visits to gain ideas on how to enhance their own preoperative processes.

Director of PACE Clinic: Kenneth Cummings, MD

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, residents and General Anesthesia staff who work together to make sure that postoperative patients are doing well and meet certain criteria before they transition to the regular nursing floor. In the PACU any issues that patients may be having are dealt with so that by the time the patient is to go to the regular nursing floor, they are stable and comfortable.

Director of PACU: John Jerabek, DO

Surgical Intensive Care Unit (SICU)

The surgical intensive care unit (SICU) is our main intensive care unit for post-operative patients. The SICU provides care for more than 9,000 patient days per year. Critical care in the SICU is directed by staff anesthesiologists who are board-certified in anesthesiology and critical care medicine. They provide management and recovery of post-surgical patients from a wide variety of surgical disciplines including general, head & neck, transplantation, colorectal, gynecologic, orthopedic, and urologic surgery. Furthermore, our SICU provides specialty services to patients recovering from surgery with acute post-operative management needs or those with post-operative complications.

Effective and timely delivery of critical care is a major safety net for Cleveland Clinic and its community hospitals. Our critical care teams provide high-level ICU support, management of mechanical ventilation and respiratory care, invasive ICU procedures and emergency support in non-ICU areas.

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.