Dr. Alyssa Burgart is a board certified pediatric anesthesiologist and bioethicist.
Dr. Burgart specializes in pediatric anesthesia and pediatric abdominal transplant anesthesia. She has special interest in transplantation, PANS/PANDAS, spinal muscular atrophy, and trauma. Dr. Burgart is committed to finding the most successful way for each child to interact with the anesthesia team, in order to create an overall positive experience. She champions a program specifically supporting children with unique needs, such as those with sensory integration differences.
Dr. Burgart has a joint appointment in the Stanford Center for Biomedical Ethics, serves as the Co-Chair of the LPCH Ethics Committee and as a member of the SHC Ethics Committee. She provides ethics consultation services for people of all ages. Her ethics interests include pediatric ethics, organ transplantation, communication skills, disability rights, women's healthcare access, adolescent decision-making, ethics education, and excellence in ethics consultation.
Dr. Burgart is active on Twitter, where she comments on Anesthesiology and Bioethics issues. @BurgartBioethix
- Pediatric Anesthesia
- Anesthesia for Liver Transplant
Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine
Member at Large, Medical Executive Committee, Lucile Packard Children's Hospital (2020 - 2023)
Co-Chair, Clinical Ethics Committee, Lucile Packard Children's Hospital (2016 - Present)
Member, Ethics Committee, Lucile Packard Children's Hospital (2015 - Present)
Member, Ethics Committee, Stanford Hospital and Clinics (2015 - Present)
Board Certification: American Board of Anesthesiology, Pediatric Anesthesia (2016)
Board Certification, Pediatric Anesthesia, American Board of Anesthesiology (2016)
Board Certification: American Board of Anesthesiology, Anesthesia (2015)
Fellowship: Lucile Packard Children's Hospital (2015) CA
Residency: Loyola University Medical Center (2014) IL
Internship: Loyola University Medical Center (2011) IL
MA, Loyola University Chicago, Bioethics and Health Policy (2010)
Medical Education: Loyola University Stritch School of Medicine (2010) IL
BA, University of Judaism, Bioethics (2003)
Graduate and Fellowship Programs
Pediatric Anesthesia (Fellowship Program)
- Elective Surgery and COVID-19: A Framework for the Untested Patient. Annals of surgery 2020
Parents Demand and Teenager Refuses Epidural Anesthesia.
A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.
View details for DOI 10.1542/peds.2019-3295
View details for PubMedID 32398328
- The opioid crisis should lead pediatric anesthesiologists to a broader vision of opioid stewardship. Paediatric anaesthesia 2019; 29 (11): 1078–80
- Physician Sexual Assault: The Moral Imperative for Gender Equity in Medicine AMERICAN JOURNAL OF BIOETHICS 2019; 19 (1): 4–6
Ethical Challenges Confronted When Providing Nusinersen Treatment for Spinal Muscular Atrophy.
2018; 172 (2): 188–92
The US Food and Drug Administration's December 2016 approval of nusinersen for the treatment of patients with all subtypes of spinal muscular atrophy ushered in a new era for patients with spinal muscular atrophy, their families, and all those involved in their care. The extreme cost of the medication and the complicated logistical requirements for administering nusinersen via lumbar puncture have created practical challenges that raise important ethical considerations. We discuss 6 challenges faced at the institutional level in the United States: cost, limited evidence, informed consent, treatment allocation, fair distribution of responsibilities, and transparency with stakeholders. These challenges must be understood to ensure that patients with spinal muscular atrophy benefit from treatment, are protected from harm, and are treated fairly.
View details for PubMedID 29228163
- Pilot Evaluation of a Multidisciplinary Strategy for Laparoscopic Sleeve Gastrectomy in Adolescents and Young Adults with Obesity and Intellectual Disabilities. Obesity surgery 2021
- Poorly conducted science is unprofessional. Journal of vascular surgery 2020
Donor heart selection during the COVID-19 pandemic: A case study
JOURNAL OF HEART AND LUNG TRANSPLANTATION
2020; 39 (5): 497–98
View details for Web of Science ID 000535430200015
- Machine Learning Implementation in Clinical Anesthesia: Opportunities and Challenges. Anesthesia and analgesia 2020
How Anesthesiologists Experience and Negotiate Ethical Challenges from Drug Shortages.
AJOB empirical bioethics
In the face of ongoing drug shortages, anesthesiologists have been described as having to become "Iron Chefs, challenged to create safe patient outcomes with missing ingredients. Unfortunately, developing responsive ethical guidance for how anesthesiologists should best handle ethical concerns with ongoing and mutable drug shortages is limited by the dearth of studies examining how bedside clinicians actually experience drug shortages and what ethical challenges they encounter. In order to better understand what ethical concerns individual anesthesiologists experience around drug shortages and how they negotiate them, we undertook this qualitative interview study. Methods: We conducted semi-structured interviews with anesthesiologists at three field sites: an academic tertiary care adult hospital that performs approximately 46,000 anesthetics annually comprising cases ranging across all surgical disciplines; the affiliated veteran's affairs hospital that performs 12,000 anesthetics annually; and, the affiliated children's hospital that performs 20,500 anesthetics annually. Results: 29 anesthesiologists were interviewed (17 adult and 12 pediatric anesthesiologists), representing a spectrum of practice areas in clinical anesthesia: general, pediatric, regional, pain, critical care, obstetrics, liver transplant, and palliative medicine. Three themes emerged: (1) uncertainty about responsibility for clinical decisions made in consequence to a shortage; (2) creativity, and its limits, in choosing anesthetic plans; and, (3) disclosure of concerns about shortages (to patients and colleagues). Conclusions: Our data suggests anesthesiologists have unmet needs for ethical guidance on how to approach drug shortages. First is managing responsibility for decisions stemming from a drug shortage. Second, interviewees struggled with disclosure of their concerns, both to patients and to surgical colleagues. A formal shared decision making approach may present the best solution, since the act of structuring a shared decision making conversation or creating a decision making tool will have to incorporate the views of all stakeholders around shortages and their potential clinical consequences.
View details for DOI 10.1080/23294515.2020.1839596
View details for PubMedID 33124970
- Resource Allocation in COVID-19 Research: Which Trials? Which Patients? The American journal of bioethics : AJOB 2020; 20 (7): 86–88
- Scarlet A (Book Review) AMERICAN JOURNAL OF BIOETHICS 2019; 19 (10): W3–W4
- Compassionate deactivation of ventricular assist devices in children: A survey of pediatric ventricular assist device clinicians' perspectives and practices PEDIATRIC TRANSPLANTATION 2019; 23 (3)
Managing Expectations: Delivering the Worst News in the Best Way?
The American journal of bioethics : AJOB
2018; 18 (1): 1–2
View details for PubMedID 29313792
Ethical Controversy About Hysterectomy for a Minor.
One of the most complicated ethical issues that arises in children's hospitals today is the issue of whether it is ever permissible to perform a procedure for a minor that will result in permanent sterilization. In most cases, the answer is no. The availability of good, safe, long-acting contraception allows surgical options to be postponed when the primary goal of such surgical options is to prevent pregnancy. But what if a minor has congenital urogenital anomalies or other medical conditions for which the best treatment is a hysterectomy? In those cases, the primary goal of therapy is not to prevent pregnancy. Instead, sterility is an unfortunate side effect of a medically indicated treatment. Should that side effect preclude the provision of a therapy that is otherwise medically appropriate? We present a case that raises these issues, and asked experts in law, bioethics, community advocacy, and gynecology to respond. They discuss whether the best option is to proceed with the surgery or to cautiously delay making a decision to give the teenager more time to carefully consider all of the options.
View details for DOI 10.1542/peds.2016-3992
View details for PubMedID 28562274
Compassionate Deactivation of Ventricular Assist Devices in Children: A Survey of Pediatric VAD Clinicians' Perspectives and Practices
ELSEVIER SCIENCE INC. 2017: S37–S38
View details for Web of Science ID 000398839800075
Fairness and Transparency in an Expanded Access Program: Allocation of the Only Treatment for SMA1.
The American journal of bioethics : AJOB
2017; 17 (10): 71–73
View details for PubMedID 29020542
- Moral Distress in Clinical Ethics: Expanding the Concept AMERICAN JOURNAL OF BIOETHICS 2016; 16 (12): 1-1
Randomized n-of-1 Trials: Quality Improvement, Research, or Both?
2016; 138 (2)
The regulatory demarcations between clinical research and quality improvement (QI) are ambiguous and controversial. Some projects that were undertaken as a form of QI were deemed by regulatory agencies to be research and thus to require institutional review board approval. In the era of personalized medicine, some physicians may ask some patients to participate in n-of-1 trials in an effort to personalize and optimize each patient's medical treatment. Should such activities be considered research, QI, or just excellent personalized medicine? Experts in research, research regulation, and bioethics analyze these issues.
View details for DOI 10.1542/peds.2016-1103
View details for PubMedID 27385811
Current Use of Pelvic Organ Prolapse Quantification by AUGS and ICS Members
FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
2011; 17 (2): 67-69
: To determine the current use of the pelvic organ prolapse quantification (POP-Q) by members of the American Urogynecologic Society (AUGS) and the International Continence Society (ICS).: Surgically active members of AUGS and ICS completed a Web-based questionnaire about their use of the POP-Q and included queries regarding respondent's clinical training, surgical experience, and practice setting. Users of POP-Q described their POP-Q use including patient's position, tools used to measure or assist with exposure, use of strain, and bladder volume. Strengths and weaknesses of the POP-Q system were also assessed.: The 308 respondents had a median of 8 years (range, 0-35 years) of independent performance of POP surgery. Most were from the United States (70%), in a shared practice (64%), with at least 2 years of fellowship training (61%), and had trainees participating in patient care (81%). Of the respondents, 76% reported using the POP-Q; however, the technique of POP-Q varied. Of the 24% not using the POP-Q, two-thirds reported past POP-Q use. For these individuals, prolapse description was done using Baden-Walker (57%), descriptive words (38%), or other grades (7%). More than 50% of nonusers reported that the POP-Q is "too time-consuming" or that their "colleagues do not use it.": Although most surveyed members of AUGS and ICS are using the POP-Q, we detected variability in the day-to-day practice of POP-Q use. To further advance the communication benefits of the POP-Q, a revision that provides evidence-based guidance may be a worthwhile refinement.
View details for DOI 10.1097/SPV.0b013e318207c904
View details for Web of Science ID 000209176100003
View details for PubMedID 22453690