The Westmead Hospital Anaesthetic department is dedicated in providing an excellent regional anaesthesia service to patients in the perioperative setting and trauma patients on the ward and is well known to be "pro-regional" in the care of all its patients.
Given the high and varied operative caseload, there are ample opportunities to utilise regional anaesthesia in the perioperative setting. These include at least 1-2 orthopaedic lists per day (trauma and elective), regular vascular lists (including fistula formation where regional anaesthesia is used as the sole anaesthetic), breast surgery (for PECS blocks), ophthalmology lists (for eye blocks) and numerous complex upper GI, colorectal and thoracic surgical lists (for thoracic epidurals, TAP catheters, etc).
In addition, the Westmead Hospital Acute Pain Service caters for a large trauma and post-operative population, where regional anaesthesia is a crucial integrated component of care. We frequently assist the Acute Pain Service by performing regional blocks such as thoracic epidurals, fascia iliaca catheters, paravertebral catheters, serratus anterior catheters, etc on the ward.
In addition to the clinical services provided on a daily basis, the Regional Anaesthesia special interest group is involved with regular departmental "hands-on" teaching sessions every six weeks (run by the Regional Anaesthesia provisional fellow and consultant) and we will be holding our first weekend Masterclass Workshop open to all registrars and consultants in October 2018. Furthermore, in conjunction with the Research special interest group, we have an active and ongoing involvement in a number of audits and randomised controlled trials.
22 Sep 2018
With continual advances in medicine and technology, surgeries that were once deemed too high risk are now being performed on increasingly complex and multi-morbid patients. This change in practice puts an added burden on the health care system with higher rates of perioperative complications, longer lengths of hospital stay and increased admissions to high acuity wards.
Here at Westmead Hospital we see approximately 1400 high risk patients a year. The Perioperative Medicine Team and the High Risk Clinic was formed in 2016 to fulfil the needs of this high risk population. It provides multidisciplinary assessment, preoperative optimisation and uses a shared decision making model to aid in the prevention of non-beneficial surgeries.
Extended assessment of patients includes a pre-consult work up, multidisciplinary team assessment and input, frailty and nutritional assessment, risk stratification including CPET if indicated, as well as a post-operative follow up by consultant anaesthetists.
Our aim is to improve the perioperative care and outcome of high risk patients by improving communication, collaboration and continuity of care.
07 Sep 2018
Westmead Hospital is a major tertiary referral hospital for obstetrics for much of Western Sydney and some parts of regional NSW. Nearly 6000 babies are delivered in our birth unit per year, making it the busiest obstetric unit in NSW. We are staffed by a team of dedicated and enthusiastic obstetric anaesthetists and work closely with our obstetrician and midwifery colleagues.
We manage patients ranging from well mothers with normal pregnancies, to mothers with babies that have complex foetal conditions requiring management shortly after birth at our neighbouring The Children's Hospital Westmead. We also look after women who themselves have complex medical conditions.
We pride ourselves on our high risk anaesthetic clinic which an obstetric anaesthetic consultant and fellow attend fortnightly and help develop care plans for these patients. We are well supported by a dedicated number of obstetric focussed sub speciality practitioners, including cardiologists, haematologists, geneticists, nephrologists, psychiatrists and interventional radiologists. We commonly have multi-disciplinary team meetings to discuss management plans for very high risk parturients. Trainees benefit from the regular onsite exposure to such patients.
For those interested in furthering their neonatal skills, there is a dedicated rotation to our neonatal intensive care unit. There is a strong education ethos amongst the obstetric anaesthetists, with a regular teaching programme delivered to anaesthetic trainees, medical students and midwives. We are a department that prides ourselves on best practice and are always looking at ways to deliver the best possible care to our mothers.
28 Aug 2018
Our group is committed to the management of difficult airways both in and out of theatres at Westmead. Being a busy tertiary referral hospital, we have a wide range of surgical and medical specialties including ENT, Head and Neck Oncology and Respiratory Medicine. We frequently see patients who present either electively with a potential difficult airway, or in the emergency setting with a threatened or obstructed airway. We then adopt best practice airway teaching to manage these clinical scenarios, with a focus on the difficult airway algorithms and human factors, and utilise the most up to date airway equipment including Video Laryngoscopes and Bronchoscopes.
We have experience in running workshops locally and regionally, with the most recent being the ANZCA ASM 2018 where we successfully conducted CICO and
16 Aug 2018
Acute pain service
The Acute Pain Service at Westmead Hospital provides 7day a week, 24 hour a day service. The patients we review are predominantly trauma and surgical patients however we also see medical and palliative patients at treating team's requests. The daily APS team consists of an Anaesthetic Consultant, Registrar, Resident and nurse.
Our goal is provide effective and safe analgesia to all patients in our hospital. The modalities we commonly utilise are PCAs, Epidural infusions, Ketamine Infusions, Peripheral nerve block infusions and multi modal oral regimes. We also provide procedural pain management to facilitate minor procedures being performed on ward areas whilst ensuring optimal analgesia for the patient.
Procedures for all our commonly used modalities are kept current and can be found on the Policy and Procedures site on the LHD intranet using the word "pain" in the search.
15 Feb 2018
Westmead Hospital is the major tertiary referral hospital for cardiac surgery for much of western Sydney. As such, there are a large number of cardiac surgical cases—over 500 cases per year involving cardiopulmonary bypass as well as numerous non-bypass cardiac and thoracic procedures. These procedures include elective, emergency and trauma-related cardiothoracic surgery. Our anaesthetists are highly skilled in managing the wide variety of patients covered by our services, including adults with congenital heart conditions having cardiac surgery.
Our expertise extends to providing anaesthetic services to patients in the Cardiac Cath Lab, where there are daily operating lists for complex electrophysiological studies and ablations (adult and paediatric), implantation of pacemakers and defibrillators, and percutaneous structural heart/valvular procedures including TAVI. In addition, our cardiac anaesthetists and perfusionists provide an ECMO (extracorporeal membrane oxygenation) service to appropriate patients.
Our team of anaesthetists, including our cardiac anaesthetic fellow and training registrars, undergo continual training and education, participate in regular audit activity, and are exposed to a variety of research opportunities. They are well-equipped to provide the highest level of care in the safest possible manner to our cardiac patients.
09 Feb 2018
Malignant Hyperthermia Unit
Dr Neil Street (CHW), Dr David Baines (CHW), Dr Margaret Perry(CHW), Dr Mark Lovell (Westmead).
Westmead Hospital is part of the Malignant Hyperthermia Testing Unit run by Dr Neil Street.
The MH Unit covers NSW and Queensland. Adult patients undergo muscle biopsies at Westmead for the diagnosis of Malignant Hyperthermia. Biopsies may be undertaken for diagnosis following a clinical incident or for assessment of those with a family history of MH. Once the biopsy is taken it is transported to the MH testing unit for halothane and caffeine in-vitro contracture testing and then clarification of familial risk factors. Further genetic testing is undertaken by Dr Margaret Perry (CHW) who has expertise in genetic sequencing and of the mutations associated with Malignant Hyperthermia.
09 Feb 2018
At Westmead we have highly skilled and internationally renowned neurosurgeons and interventional neuroradiologists allowing us the opportunity to provide a range of anaesthesia techniques, including for emergency and elective neurovascular procedures, many intracranial and spinal surgeries and a range of innovative techniques including awake craniotomies, insertion of deep brain stimulators and epilepsy surgery. We are also one of only a handful of sites in NSW accredited for urgent clot retrieval procedures in the management of acute stroke. Many of our neuroanaesthetists are skilled in providing a range of intra-operative neuromonitoring techniques, for both spinal surgery and intracranial operations such as microvascular decompressions.
09 Feb 2018