Anaesthesiology

| General Overview |--------------

The Department of Anesthesiology of Huashan Hospital, Fudan University, is one of the earliest professional anesthesiology departments in Shanghai to become independent of the surgical system. As early as the beginning of the 1980s, the hospital formally established the Department of Anesthesiology and, during the same period, opened an outpatient clinic for cancer pain management. Through the dedication and hard work of several generations, the anesthesiology team has gradually grown, with a rational talent structure, standardized management system, strong technical capabilities, and advanced anesthesia facilities. It has now developed into a standardized department advancing in parallel in management, clinical care, teaching, scientific research, and other areas.

The Department of Anesthesiology currently has 171 employees, including 7 with senior professional titles, 8 with associate-senior professional titles, and 56 with intermediate professional titles. There are 3 doctoral supervisors and 7 master’s supervisors. The Department of Anesthesiology has 103 operating units and performs more than 80,000 anesthetics annually; the quality and quantity of its medical services have consistently ranked among the top in China. The department routinely provides anesthesia for highly challenging procedures, including general surgery, urologic surgery, orthopedic surgery, functional neurosurgery (awake anesthesia), cardiovascular and cerebrovascular surgery, transplant surgery (including pediatric liver-transplant anesthesia), infant and young-child surgery, and interventional surgery. The proportion of critically ill and difficult patients classified as ASAⅢ or above has consistently ranked near the top in Shanghai. The department has various types of advanced anesthesia equipment and dedicated equipment administrators. Its equipment includes: high-end anesthesia machines and monitors, transesophageal echocardiography, cell salvage devices, rapid-warming infusion workstations, video laryngoscopes, optical stylets, portable ultrasound machines, neuromuscular-blockade monitors, continuous noninvasive cardiac-output monitors, electrophysiological monitors, fully automated blood-gas and electrolyte analyzers, brain-spectrum anesthesia-depth monitors, and cerebral oxygen-saturation monitors, among others. At present, the department’s overall personnel structure and facility configuration both rank among the most advanced in China.

The current Director of the Department of Anesthesiology, Professor Wang Yingwei, is a Doctor of Medicine, chief physician, professor, and doctoral supervisor. He currently serves as Standing Committee Member and Secretary-General of the Anesthesiology Branch of the Chinese Medical Association; Head of the Anesthesiology Artificial Intelligence Group; Executive Council Member of the Chinese Association of Medical Equipment and Director of its Anesthesiology Branch; Council Member of the Chinese Society for Neuroscience and Director of its Anesthesia and Brain Function Branch; Deputy Director of the Anesthesiology Branch of the Chinese Research Hospital Association; Deputy Director of the Anesthesia and Perioperative Medicine Branch of the China International Medical Promotion Association; incoming Director of the Anesthesiology Specialty Branch of the Shanghai Medical Association; a second-review expert for the National Natural Science Foundation of China; Deputy Editor-in-Chief of the Chinese Journal of Anesthesiology and Resuscitation; an editorial board member and Editor-in-Chief of the Chinese edition of Mol Pain; and formerly a visiting scholar at the University of Washington in the United States, where he obtained a U.S. medical license. He has published more than 70 SCI papers as corresponding author. He is Editor-in-Chief of 9 monographs and Deputy Editor-in-Chief of 3 monographs. As principal investigator, he has led 1 National 863 Program key research project, 1 Ministry of Science and Technology key special project, and 7 National Natural Science Foundation of China projects, including 1 key project. He has received honors including the Ministry of Education’s “New Century Excellent Talents,” the Shanghai Municipal Commission of Science and Technology’s “Rising-Star” and “Post-Rising-Star” awards and “Excellent Academic Leader” title, the Shanghai Municipal Education Commission’s “Shuguang Scholar” title, and the Shanghai Municipal Health Bureau’s “Excellent Discipline Leader” title. He also received the second prize of the “Silver Snake Award” of Shanghai’s health system.

Under the leadership of Professor Wang Yingwei, the department adheres to the medical philosophy of “safety and homogeneity,” vigorously promotes innovation in precision anesthesia and comfortable medical care, and relies on the hospital’s key specialty surgical disciplines to successively establish subspecialty groups for awake anesthesia, cardiothoracic anesthesia, transplant-surgery anesthesia, general and urologic anesthesia, and orthopedic, hand, and sports-medicine anesthesia. It has carried out intraoperative awake-anesthesia techniques and management; organ-transplant anesthesia; low-flow closed-circuit anesthesia with endotracheal intubation for infants and young children; anesthesia management for perioperative neurophysiological monitoring; intraoperative magnetic-resonance anesthesia techniques and management; new-approach peripheral nerve-block techniques guided by ultrasound combined with a nerve stimulator; blood-conservation techniques using autologous blood reinfusion; perioperative goal-directed fluid therapy; and laryngeal-mask general anesthesia. It has also actively developed new technologies and services, such as ultrasound-guided intrathecal nusinersen injection for SMA patients with spinal deformities in collaboration with the Department of Neurology; application of rapid right-ventricular pacing (RVP) in complex intracranial aneurysm surgery; application of dynamic CT-localized targeted blood patches in the treatment of spontaneous cerebrospinal fluid leak syndrome (SCSFLS); and whole-brain magnetic-resonance spectroscopy analysis and treatment for patients with chronic pain.

| Subspecialty Features |--------------

The Department of Anesthesiology’s medical services now cover clinical anesthesia, pain treatment, guidance for sedation throughout the hospital, resuscitation of critically ill patients throughout the hospital, and painless endoscopic examinations. Its routine anesthesia caseload is broad and its quality is high, covering anesthesia for all types of surgery, while it also receives large numbers of difficult and critically ill patients referred from other hospitals for anesthesia. At the same time, relying on the hospital’s key specialty surgical disciplines, it has gradually developed its anesthesia subspecialties and, in clinical work, focuses on supporting the development of each subspecialty, including neurosurgical anesthesia, anesthesia for interventional treatment, cardiovascular and cerebrovascular anesthesia, day-surgery anesthesia, pediatric anesthesia, organ-transplant anesthesia, pain treatment, and the post-anesthesia care unit. The department’s distinctive anesthesia services are described below:

(I) Anesthesia Management for Intraoperative Functional Magnetic Resonance Imaging

Intraoperative magnetic resonance technology has now become an important adjunct to neurosurgery. Precise perioperative localization helps achieve more complete tumor resection and more effective preservation of neurological function. The Department of Anesthesiology of Huashan Hospital is one of the few departments in China that perform anesthesia for intraoperative magnetic resonance imaging. In response to the effects of the ultra-high-field magnetic environment on the effectiveness and safety of anesthesia management, the department has formulated comprehensive regulations for anesthesia management during intraoperative functional magnetic resonance imaging, covering personnel, technology, equipment, and systems, thereby ensuring the smooth performance of intraoperative magnetic-resonance surgery and anesthesia.

(II) Application of Awake Anesthesia in Craniotomy for Functional Neurosurgery

Intraoperative awakening is the most difficult anesthesia technique in functional neurosurgery. The department’s awake-anesthesia technique is mature, and both the number and quality of its anesthetics rank among the best in China. It has formulated detailed and standardized Huashan anesthesia protocols and clinical pathways (the Asleep-Awake-Asleep technique and the MAC technique). At present, the AAA technique is used relatively widely in China and abroad; that is, the airway is controlled during the perioperative period by repeatedly inserting and removing a laryngeal mask or endotracheal tube. Because of the presence of an artificial airway, patients are prone to agitation and unable to cooperate with the operation. After years of clinical practice and exploration, the department has developed an effective MAC anesthesia protocol that preserves patients’ spontaneous breathing throughout the operation and uses technological innovation to ensure airway safety, thereby ensuring the smooth performance of functional neurosurgery. The MAC technique developed and implemented by the department ranks among the international and domestic leaders. The department successfully performs more than 200 cases of awake anesthesia on average each year, and its high-quality anesthesia services have been recognized by both surgeons and patients.

(III) Management of Organ-Transplant Anesthesia, Especially for Critically Ill Patients and Pediatric Liver Transplantation

Organ-transplant procedures are complex and long-lasting and have a tremendous impact on patients’ physiological functions. Accordingly, their anesthesia management is difficult and demanding, particularly in critically ill and pediatric patients. The department organized key professional staff to establish dedicated liver-transplant and pediatric liver-transplant teams, joined the Huashan Hospital Transplant Center team, and actively developed organ-transplant anesthesia services. The number of organ-transplant procedures has increased year by year; the current annual volume is more than 200 adult liver transplants and nearly 50 pediatric liver transplants.

(IV) Pediatric Anesthesia and Obstetric and Gynecologic Anesthesia Management

To meet the medical-care needs of the general public and improve and complete the hospital’s disciplinary development, the Baoshan Campus established the Huashan Hospital Children’s Surgery Center. Led by hand surgery and neurosurgery and supported by anesthesiology, it provides high-quality pediatric surgery and anesthesia services. The youngest infant or young child receiving surgical anesthesia was two and a half months old, and the lowest body weight was 6.5kg. In addition to providing routine gynecologic and obstetric anesthesia, the department also performs general anesthesia for critically ill parturients. It implements the national family-planning policy and vigorously promotes and provides painless childbirth, bringing the rate of painless childbirth in the obstetrics department of Huashan Hospital to 50%.

(V) Anesthesia Management for Weight-Loss Surgery in Patients with Morbid Obesity

With changes in social lifestyles and dietary structures, an increasing number of obese patients are appearing in clinical practice. Some patients with morbid obesity need to undergo weight-loss or other surgery. The incidence of perioperative anesthesia-related complications is higher in these patients, and airway management presents a major challenge to anesthesiologists. For nearly 10 years, the department has implemented a standardized clinical pathway for such patients, established perioperative management workflows, and conducted staff training, forming a relatively complete training and management system. It performs anesthesia for an average of 500–600 weight-loss surgeries each year.

(VI) Clinical Application of Ultrasound-Guided Peripheral Nerve Blocks

The department actively performs ultrasound-visualized nerve-block techniques. Relying on the platforms of Huashan Hospital’s advantageous disciplines, including hand surgery, sports medicine, and orthopedics, it is committed to developing and innovating its scope of services. It provides peripheral nerve-block services including nerve-block anesthesia for the limbs and nerve-block anesthesia for the trunk, for use in clinical surgical anesthesia or as an important component of multimodal analgesic treatment, and has received unanimous praise from patients and colleagues.

| Scientific Research |--------------

The Department of Anesthesiology has always pursued the goal of building a first-class discipline, targeted basic medical research and cutting-edge scientific questions, and strengthened cross-disciplinary penetration and integration between clinical and basic medicine. Under the leadership of Professor Wang Yingwei, the research team has long been devoted to basic research in the main directions of “the molecular mechanisms of action of general anesthetics,” “neuropathic pain and its molecular mechanisms,” “the effects and mechanisms of general anesthetics on the developing brain,” and “anesthetics and the mechanisms of brain protection/injury.” In recent years, the department has published more than 100 SCI research papers as first or corresponding author, including more than 20 papers in Zone 1 journals, such as leading neuroscience journals Neuron, Advanced Science, Molecular Psychiatry, Journal of Biomedical Science, Cell Reports, and Journal of Neuroscience; leading anesthesiology journals Anesthesiology, Journal of clinical Anesthesia, Pain, and Anesthesia Analgesia; and leading critical-care medicine journals Critical Care and Critical Care Medicine. Professor Wang Yingwei was the first in the field to propose three “selectivity” theories concerning general-anesthetic-induced apoptosis of neurons during development: brain-region selectivity, cell-type selectivity, and dose selectivity; this work received funding from a key project of the National Natural Science Foundation of China. Over the past two years, the team used miniature fluorescence imaging to elucidate, at the level of individual cells in vivo, the mechanisms by which general anesthesia regulates vLPO sleep-promoting and arousal-promoting neurons (Advanced Science, 2022); used in-vitro induction and differentiation of pluripotent stem cells to investigate a new mechanism by which ketamine affects neurite development in GABAergic projection neurons (Molecular Psychiart, 2023); revealed for the first time the important role of the Notch signaling pathway in the pathogenesis of neuropathic pain (Pain, 2021); revealed the role of T-type calcium channels in the excitatory behavior produced after sevoflurane anesthesia in neonatal rats (Neurosci Bull, 2020); applied artificial intelligence to brachial-plexus block recognition (European Journal of Anaesthesiology, 2022); and elucidated the brain networks and human-species-conserved molecular and cellular mechanisms underlying rapid awakening in anesthetized macaques induced by deep-brain stimulation of the intralaminar nuclei of the thalamus (Advanced Science, 2023). This article was selected as one of the ten major advances in anesthesiology in 2023. In the past 5 years, the team has received funding for more than 10 National Natural Science Foundation of China projects; among them, Young Researcher Deng Juan received support from the National Natural Science Foundation of China Excellent Young Scientists Fund. In addition, the department has received 2 Ministry of Science and Technology projects and 5 provincial- or ministerial-level projects. In clinical research, each anesthesia subspecialty group serves as the foundation, and the department relies on its advantageous surgical disciplines to form an overall strength with clear central pillars and multiple flourishing areas.

| Teaching |--------------

In 2006, the Department of Anesthesiology of our hospital became one of the first anesthesiology specialist physician training bases approved by the Ministry of Health; in 2009, it became one of the first Shanghai anesthesiology specialist physician training bases; and in 2013, it became one of the first Shanghai anesthesiology specialist physician training bases. It launched the courses “Anesthesia and Physiology,” “Anesthesia and Pathophysiology,” and “FoCUS Assessment by Transthoracic Echocardiography,” which received support from the Huashan Hospital postgraduate education curriculum program. The anesthesiology residency training base strictly follows the Detailed Rules for the Training of Anesthesiology Residents in training residents. To date, nearly 100 physicians have obtained Shanghai standardized residency-training certificates, and more than 100 anesthesiology specialists have been trained. The Department of Anesthesiology also has master’s and doctoral degree programs and a postdoctoral research station in anesthesiology. To date, it has trained more than 50 doctors and more than 150 master’s graduates. While continuously supplying new talent to the field of anesthesiology care, the department has trained a large number of highly skilled and outstanding specialists.

The Department of Anesthesiology has also established a complete employee training and assessment system and improved the department’s teaching and employee files. It provides all employees with various training and hands-on opportunities year-round, including departmental training programs, hospital-level training programs, municipal-level training programs, and international collaborative exchange training. The full-staff training and assessment mechanism has brought development-related pressure and motivation to all employees and driven the common improvement of the entire department. Under the leadership of the department director, the department has conducted teaching programs such as English club, Research club, and Journal club for personnel at all levels, forming a well-trained talent echelon with both professional competence and integrity and laying a solid foundation for the department’s vigorous development in the future. To strengthen academic exchange in anesthesiology, the department has organized the national continuing-education programs “Study Course on Advances in Neurosurgical Anesthesia and Neuroscience” and “Shanghai Huashan–Fuyi Affiliated First Hospital Anesthesia and Quality Control Forum—Study Course on Clinical Problems and Quality Control in the Implementation of Inhalational Anesthesia.” Director Wang Yingwei participated in drafting and publishing 4 expert consensuses of the Anesthesiology Branch of the Chinese Medical Association, 2020 edition (Expert Consensus on the Prevention of Intraoperative Awareness and Electroencephalographic Monitoring, Expert Consensus on Preanesthetic Visits and Assessment, Expert Consensus on Anesthesia Management for Intraoperative High-Field Magnetic Resonance Imaging, and Expert Consensus on Anesthesia Management for Pediatric Liver Transplantation).

| Department Honors |--------------

2014, 2015, 2016, 2020, and 2021 Advanced Collective of Huashan Hospital, Fudan University

2020 Outstanding Medical Team of Fudan University

2021 March 8 Red-Flag Collective of Fudan University