Striving to achieve excellence in all aspects of Anesthesia, Pain Management, and Perioperative Care.
Prior to 1900, anesthesia was supervised and taught by faculty surgeons at both didactic and clinical levels. During the 1920s and 1930s, hospital-employed physicians provided anesthesia as a service function. Even at this early time, Dr. Chauncey Leake was performing pioneer investigative work on anesthetic agents in the Department of Pharmacology, and elective courses in clinical anesthesia were offered to medical students.
In 1940, the first faculty appointment in anesthesia was awarded, and in 1941, a Division of Anesthesia was created in the Department of Surgery. A formal residency program also was introduced at this time. The faculty consisted of 4 members, and there were 10 residency positions. The department provided anesthesia for operative procedures, consulting occasionally for intensive care and obstetric anesthesia. Research activity was minimal and because of World War II, it was difficult to recruit residents.
On September 4, 1957, Julius Comroe arrived in Iowa City. The formal reason was a meeting of the American Physiologic Society, but Comroe, the newly appointed director of the planned Cardiovascular Research Institute (CVRI) at UCSF, had other things on his mind. Comroe – who had been recruited to UCSF as part of an effort to transform what was widely regarded as a third-rate medical school into a truly respected center of academic medicine – believed that the emerging discipline of anesthesia could play an important role both in enhancing UCSF’s reputation and helping the CVRI establish itself as a vital resource and training vehicle for researchers across the UCSF campus.
The chair at Iowa, Stuart Cullen, had built an impressive academic department. Cullen and Comroe met that day; by the end of the meeting, Comroe had asked Cullen to lead anesthesia at UCSF. Cullen was intrigued – he relished the opportunity to improve upon what he had achieved at Iowa – but wouldn’t agree to go unless Comroe could guarantee that anesthesia would have its own department, separate from surgery.
Within hours, Comroe convinced UCSF to meet the demand, and in 1958, Dr. Stuart C. Cullen became the first chairman of the new Department of Anesthesia and Perioperative Care. When Cullen called John Severinghaus (who had just completed an anesthesia residency with Cullen) with the news, Severinghaus immediately agreed to join Cullen at UCSF. Among their initial colleagues were existing faculty members Neri Guadagni and Frank DeBon; Earnest Guy, who was brought on as the chief of anesthesia at San Francisco General Hospital; and a new resident, Walter “Skip” Way.
It was the birth of a department that over the next fifty-plus years would be at the heart of modern anesthesia’s explosive growth, a department that to this day continues to have an enormous impact on surgical practice and the management of pain. The department’s research, education, and clinical care quickly earned and have maintained reputations that are the equal or better of any institution in the world.
Dr. Cullen and his faculty developed a larger, more active residency program offering more broadly based clinical activity, including obstetric anesthesia, Intensive Care Unit, and anesthesia training at San Francisco General Hospital. In addition, undergraduate medical school student teaching began, and an active, productive research unit was developed. In June of 1966, Dr. Cullen left the chairmanship to become the Dean of the School of Medicine. During this period the Department acquired an international reputation for its highly relevant research activity.
Dr. William K. Hamilton became chairman in 1967, and the department's growth continued. An anesthesia unit was established at the Veterans Administration Hospital and the Department assumed responsibility for the intensive care unit at San Francisco General Hospital. Anesthesia faculty began to participate in providing care on the pediatric and newborn intensive care units at the University Hospital. The research base was also broadened in both quality and depth. In 1983, Dr. Hamilton was appointed Vice Dean and Associate Dean for Postdoctoral and Clinical Affairs, and in 1984, just as the department was celebrating its first 25 years, Dr. Ronald D. Miller succeeded him as Professor and Chairman. The first edition of “Miller’s Anesthesia” textbook was published in 1981 and the current 8th edition is now a standard reference book around the world.
During Dr. Miller’s time as chair the department thrived. It dramatically expanded its clinical responsibilities in everything from preoperative evaluation to operating room, recovery, and critical care. It instituted a model outpatient pain management program, assumed formal leadership roles at every UCSF-affiliated facility, and became the go-to department for critical care. Over the same period, the department created one of largest, most prestigious academic anesthesia programs in the world where innovation flourished. UCSF was one of the first anesthesia programs to set up a simulation-based system of learning, and with the realization of Miller’s vision of more flexible and concentrated residencies in research and critical care, the department forged new ground that anticipates how the profession is changing. Miller’s recognition that molecular biology would be the next wave of medical research helped to successfully bring an already legendary research program into the modern era. For many years since, the department has been number one in the country in NIH funding.
Miller stepped down as chair after leading the department through its joyous 50th birthday celebration, and was succeeded by Dr. Mervyn Maze, an outstanding clinical scientist whose studies into the action of general anesthetics have been translated into established therapeutics. Maze also is the co-inventor of dexmedetomidine, an alpha-2 agonist that is widely used for sedation in the perioperative and critical care settings. His innovative research has received numerous awards, including the American Society of Anesthesiology's Excellence in Research award.
When Dr. Maze stepped down in 2014 to further pursue his research, Dr. Michael Gropper, who at that time was the Chief of Critical Care Medicine at UCSF, was appointed to succeed him.
Currently, the Department of Anesthesia and Perioperative Care has over 250 faculty, 82 residents in clinical training, and over 20 research-trainees and fellows. In addition to the Moffitt-Long Hospital, very active units of the department exist at the Zuckerberg San Francisco General Hospital and Trauma Center (inpatient and outpatient, including a very active trauma service), San Francisco Veterans Affairs Medical Center (inpatient and outpatient), Mt. Zion Medical Center (outpatient, including 23 hour stays and the chronic Pain Management Center), the UCSF Orthopedic Institute and the Benioff Children's, Betty Irene Moore Women's and Bakar Cancer (NIH-designated Cancer Center) Hospitals in the Mission Bay neighborhood. The Department now has essential roles in patient care outside of the operating rooms, with active participation in Ambulatory Care, Acute and Chronic Pain, and in the Preoperative Clinic.
Our faculty have a major influence on our specialty both nationally and internationally, including NIH study sections, NIH funding, FDA and Editorial Boards. Many of the graduates of our program hold full-time academic university positions. A number of our graduates have been or currently are chairs of academic departments of anesthesia. The majority of our graduates have become prominent clinicians in private practice, many of whom assume leadership roles in their hospital, community, state, and/or national organizations. Several members of or faculty have been honored by national and international societies for their innovative research. The specialty of Anesthesiology has changed dramatically since 1958 when the UCSF Anesthesia Department was established and during this time our faculty have contributed significantly to these changes.