Keeping Danger at Bay

Anesthesiologist Erin Furey, MD, recently recognized with a “Dinner with the Doc” honor, is on point managing some of surgery’s trickiest airways

UH Clinical Update | November 2021

Erin Furey, MD

Managing the surgical patient’s airway is always high stakes for the anesthesiologist, but perhaps never more so than during surgeries on the head and neck. Putting a breathing tube into the trachea, for example, might not be so straightforward in a patient who has a head or neck tumor.

“The tumor might encroach into their airway and diminish the size of the airway, making visibility of the structures that you need to see to insert the breathing tube very difficult,” says anesthesiologist Erin Furey, MD, Section Head of Otolaryngology Anesthesia at UH Cleveland Medical Center. “In addition, many of these patients have had more than one operation on their head and neck. That can change the anatomy drastically. Many of them have had radiation therapy for their cancer. That changes the whole enterprise dramatically and in a way that’s not entirely predictable.”

Dr. Furey manages challenging cases like this every day as the anesthesiology liaison to the UH Ear, Nose & Throat Institute. He says the key to achieving good outcomes under these kind of less-than-ideal conditions is imagining what might go wrong and communicating with the head and neck surgeon and the rest of the team to prevent it.

“You need to have a high index of suspicion that things are going to go in a way that’s unplanned,” he says. A lot of that has to do with being in very close communication with the surgeon as we perform these procedures to secure their airway. I would say that relationship between the surgeons and the anesthesiologists in our institution, being able to communicate and co-manage these potentially difficult and dangerous situations, that’s really what makes it work as well as it does.”

Dr. Furey, who is also fellowship-trained in critical care anesthesiology and cardiothoracic anesthesiology, has been working with UH head and neck surgeons for the past 10 years. He estimates that these surgeries currently make up about 80 percent of his cases. The UH Ear, Nose & Throat Institute, meanwhile, has reaped the benefits of having a dedicated anesthesiology specialist as part of the surgical team. Chair Nicole Maronian, MD, in fact, credits Dr. Furey with being an important contributing factor behind the service line’s growth.

“Dr. Furey has allowed us to expand to three full rooms, more than 200 free flaps per year, while providing a sound framework for perioperative workup and excellent execution of collaborative airway care for complex patients,” she says. “Mostly, he pays meticulous attention to each patient every time. This overall holistic view is remarkable and speaks to his thoughtful, consistent focus on clinical excellence with every patient every day. We are truly honored to work with an anesthesia partner who makes us better.”

One specific project spearheaded by Dr. Furey, for example, is the implementation in the ENT operating room of Enhanced Recovery After Surgery (ERAS) protocols for fluid, temperature and hemodynamic management. These best practices have had an impact; UH patients  undergoing head and neck surgery have minimal post-operative complications compared to national standards.

Dr. Furey was recently honored for these and other contributions to UH with a “Dinner with the Doc” award from CEO Cliff Megerian, MD. He and Dr. Megerian, in fact, started out as surgical interns around the same time at UH Cleveland Medical Center, after which Dr. Furey opted for a different path to serving the surgical patient – anesthesiology.

“I very much enjoyed the applied physiology and pharmacology that went into the management of the surgical patient,” he says. 

Now so many years later, he continues to be happy with his choice.

“A career in anesthesiology has allowed me to take care of the patient in a way that I find very gratifying and stimulating, too,” he says. “It’s gratifying to take care of patients and their families in their time of need.”