Celebrating DAPM's Clinical Excellence in 2024

Celebrating DAPM’s Clinical Excellence in 2024

By Lisa Lewis and Jane Moon, MD

In the past year, physicians and nurse anesthetists in the UCLA Department of Anesthesiology & Perioperative Medicine (DAPM) provided anesthesia for nearly 90,000 patients, including 3,300 deliveries. “We want to celebrate the work done by our clinicians,” said Maxime Cannesson, MD, PhD, DAPM Department Chair. “These cases underscored the depth and breadth of our state-of-the-art surgical and anesthesia practice and our commitment to taking care of patients at all points in the life span, from in utero to 114 years old. And we also provided services in intensive care, chronic pain, palliative care, and hyperbaric medicine.”

Dr. Cannesson noted, “We should all feel very proud of the excellence of care that we provide at UCLA, and of the thousands of lives that we've touched and changed thanks to our skills, expertise, and knowledge. The many comments we’ve received are a testament to these contributions.”

Trauma and Adult Multi-Specialty Anesthesiology 

Members of the Division of Trauma and Adult Multi-Specialty Anesthesiology work at all hours of the day and night to provide safe anesthesia for the bulk of surgical cases at Ronald Reagan UCLA Medical Center, a Level 1 Trauma Center. These clinicians use their comprehensive expertise to tailor individual anesthetic plans for numerous patients who undergo a wide range of procedures each day. 

“Using national trauma benchmark data, UCLA ranks among the highest for low mortality rates in very complex patients. We tend to be a positive outlier in the data,” said David Machado-Aranda, MD, FACS, Associate Clinical Professor of Surgery, Trauma, and Critical Care, and Interim Chief of Surgical Critical Care. He attributed the strong clinical outcomes to effective collaboration between surgeons and anesthesiologists.

Dr. Machado-Aranda described a recent patient rescue as the result of “a combination of effort from the anesthesia team and various surgical teams.” He reflected, “It was one of the most calm, efficient, streamlined ORs I have ever been in.”

Nima Nassiri, MD, Assistant Clinical Professor of Urology, expressed gratitude to his anesthesiologist colleagues for taking “exceptional care of our kidney transplant patients.” “I am proud to work with each and every one of them,” Dr. Nassiri said. “Whether it is in the OR, in the PACU, or in the ICU, I can be certain that our kidney transplant patients receive top-notch care.” 

He continued, “I’ve witnessed our anesthesiologists save critically ill patients, stabilizing them to allow the surgical team to intervene, and addressing complex multi-system problems. These patients offer the greatest opportunity for collaborative effort between surgical and anesthesia teams, and I’m grateful for this experience. It’s an honor to work alongside the talented and dedicated Anesthesia faculty, trainees, and staff here at UCLA.” 

Mark S. Litwin, MD, MPH, Distinguished Professor and Chair of UCLA Urology, similarly noted, “The Urology faculty are extraordinarily appreciative of the outstanding planning, care, and communication routinely provided by the Anesthesiology and Perioperative Medicine faculty. Top-drawer care is business as usual at UCLA.”

Cardiothoracic Anesthesiology and Critical Care

For the Division of Critical Care, highlights included taking care of the first XVIVO heart transplant patient and a post-pneumonectomy patient with VV-ECMO, as well as providing care for patients who underwent emergent Type A dissection repairs and those with severe acute respiratory distress syndrome. Physicians also performed life-saving multidisciplinary cardiac surgery advanced life support (CALS) resuscitation after a complication following minimally invasive surgery.

On an ongoing basis, DAPM intensivists performed numerous procedures for multiple ICUs, including tracheostomy, bronchoscopy, tube thoracostomy, epidural placement, and dialysis catheter placement. They also led or assisted with code blues, airway rescues, invasive line placement, and arrhythmia management throughout the hospital. Critical care anesthesiologists provided medical direction for the CTICU, PACU, ECMO, CST (code blue/rapid response) teams, and participated in hospital pharmacy and therapeutics, quality improvement, code blue, and anticoagulation committees.

“The cardiac and critical care anesthesiology divisions are as good as it gets,” said Peter Downey, MD, Assistant Professor of Cardiac Surgery and Co-Director of the UCLA Center for Aortic Disease. Dr. Downey noted the invaluable support of his anesthesiology colleagues as the volume of aortic procedures has increased. “They’re second-to-none in terms of their clinical judgment and their ability to handle maximum complexity. Beyond all of that, they’re professional, collegial, and a pleasure to work with.” 

“We’ve always had a close partnership—hand-in-glove,” added Richard Shemin, MD, Chief of Cardiac Surgery, Vice Chair of the Department of Surgery, and a Distinguished Professor of Surgery. “The level of sophistication our anesthesiology team has with echocardiography is critical,” he said, “as is the continuity of care of taking care of our patients in the OR and then following through in the ICU.” He characterized the relationship between DAPM and the surgeons as “one of trust.” As he summed up, “We really have a hybrid service where we all learn from each other. We work well collaboratively in helping patients have a smooth postoperative course.”

Pediatric Anesthesiology

For Division of Pediatric Anesthesiology, this past year saw several complex EXIT procedures, as well as an increase in surgeries for neonatal ICU patients.

“We have an incredibly collegial, fantastic relationship with our pediatric anesthesiology colleagues, from the nurse practitioners to the attendings to the fellows,” said pediatric surgeon Shant Shekherdimian, MD, MPH. “Working together, we’ve seen a dramatically improved patient experience and significant improvements in the quality of the preoperative evaluation and management. We’ve also been able to streamline and decrease the length of hospitalization for procedures that would in the past have required four or five days of in-hospital pain management.”

Thoracic Anesthesiology

“We do such complex cases at Ronald Reagan Medical Center, many of which would only be possible with the input of our thoracic anesthesiology colleagues,” said Jane Yanagawa, MD, Associate Professor of Thoracic Surgery. “Having dedicated thoracic anesthesia coverage at Santa Monica Hospital on our block days has also made it possible for our elective practice to thrive there.”

Robert Cameron, MD, Professor of Cardiothoracic Surgery and Surgical Oncology, added: “With the support of our DAPM colleagues, we have been able to completely upgrade the services we provide at the VA, as we can do almost everything we can do in Westwood on patients who are just as sick. We are incredibly lucky to have them covering our needs.”

Liver Transplantation 

The widespread use of machine perfusion fueled a major increase in liver transplant volume, with DAPM participating in 442 transplants in the past year. 

“We not only operate on cirrhotic liver patients, but we also operate on the sickest, most decompensated patients with liver failure, probably, in the country. And because of that, we need a focused and experienced team to help us take care of these patients at all phases of the transplant, from the pre-operative care to the interoperative care and the post-operative care,” said Douglas Farmer, MD, Chief of the Division of Liver and Pancreas Transplantation. 

“Our anesthesia team has evolved with our surgical teams to care for the sickest of the liver patients in the country. With them, we are able to successfully get patients through liver transplant surgeries who would not make it or die on the operating table at other centers.” 

Obstetric Anesthesiology

Highlights in the Obstetric Anesthesiology division included partnerships across various disciplines, including Maternal-Fetal Medicine, Cardiology, Obstetrics, Transfusion Medicine, Fetal Surgery, Nursing, and Intensive Care.

Rashmi Rao, MD, Associate Clinical Professor and Assistant Program Director of Maternal Fetal Medicine, praised the expertise of her obstetric anesthesiology colleagues: “Our OB anesthesiologists possess the skill and knowledge to care for high-risk patients. They offer our patients preconception consultations and the ability to safely offer regional and general anesthesia, while managing high-risk medical conditions. Our OB anesthesiology colleagues safely bridge our patients to intensive care settings and offer advanced pain care options.”

Dr. Rao also said, “The Obstetric Department has always worked in tandem with our OB Anesthesiology colleagues, and we are grateful to have skilled physicians who are deeply committed to the care of the pregnant patient.”

Ophthalmologic Anesthesiology

The division’s anesthesiologists received numerous emails from patients praising their excellent care, and also played a key role in the Stein Surgical Center’s excellent performance in First Case On Time/Early Starts. 

One grateful recipient of cataract surgery recently wrote to her anesthesiology team at Stein: “From the moment I stepped into your offices, I felt reassured. Everyone—doctors, nurses, and staff—was so incredibly kind, compassionate, and professional. I have never experienced such a high level of personalized care.”

She continued, “Your exceptional skill and thoughtful approach made a world of difference, and I am so thankful for the successful outcome of the surgeries. Thank you for giving me not only restored vision but also peace of mind throughout the entire process.”

Tara McCannel, MD, PhD, Director of the UCLA Opththalmic Oncology Center and Professor of Ophthalmology said, “It is truly a pleasure to work with the Anesthesiology team at the Stein Eye Surgical Center. There are few centers with such a high level of expertise in the art of MAC anesthesia. Because of this, I am truly fortunate that our eye patients rarely require general anesthesia. Focusing on the whole patient makes all the difference for those who are anxious about having eye cancer treatment.” 

Non-operating Room Anesthesia 

Being one of the first centers in the country to use the Hepzato Kit procedure was a key accomplishment this past year for the DAPM Non-operating Room Anesthesia (NORA) team—one that required a high level of interdisciplinary coordination. 

Interventional radiologist Siddharth Padia, MD, said, “Interventional Radiology has often focused their attention on highly complex and critically ill patients, especially with the arrival and utilization of new devices.” 

He cited the example of patients with massive pulmonary embolisms, who are often unstable when they undergo procedures to suction out blood clots. “The coordination and collaboration with our anesthesia colleagues has allowed patients to receive timely and exceptional care,” Dr. Padia noted. 

Orthopedic and Regional Anesthesiology

The addition of a dedicated Regional Anesthesiologist at the Ronald Reagan UCLA Medical Center and the Westwood Ambulatory Surgery Center broadened the scope of patients who could receive nerve blocks at these sites. The regional anesthesiology fellow physicians have now begun rotating on this service and incorporating it into their educational profile. As the service has continued to grow and evolve, it has garnered very positive feedback from patients, nurses, surgeons, and the healthcare system at large. 

 “The UCLA Regional team has been a wonderful addition to my practice. Nearly across the board, patients have been reporting improved pain relief and less narcotic use postoperatively,” said Edward Cheung, MD, Assistant Clinical Professor of Orthopedic Surgery. 

Dr. Cheung continued, “I really appreciate the collegial relationship and clear line of communication between the Regional Anesthesia and Orthopedic teams. At the end of the day, this coordination improves patient care, patient satisfaction, and day-of-surgery efficiency.” 

Looking Ahead

The highlights presented here are only a few examples of the excellent care provided by DAPM’s physicians and nurse anesthetists throughout the UCLA Health system. The dedication and skill of our clinicians makes our department truly exceptional, and we look forward to continued success in the years to come.