The Ambulatory Anesthesia Rotation provides an opportunity to develop skills and knowledge for delivering quality anesthesia care to outpatients. Approximately 60% of surgeries may be considered ambulatory, thus making it essential that anesthesiology residents understand the anesthetic management of these patients. The curriculum for this rotation covers pre-operative evaluation, preoperative preparation and premedication, anesthetic management, surgical procedures, and postoperative care. During this rotation residents will receive education and training in the following anesthetic techniques: Total Intravenous Anesthesia, Mask General Anesthesia, Epidural and Subarachnoid Anesthesia, Brachial Plexus Blockade, and Laryngeal Mask Airway.
Residents on the cardiothoracic rotation are involved in the anesthetic management of a variety of surgeries. These include: coronary artery bypass grafts; pediatric and adult valve repair or replacement; congenital heart repair (cyanotic and non-cyanotic); insertion of ventricular assist or artificial heart devices; and heart, lung and heart-lung transplantation. During this rotation residents will become familiar with the use of transesophogeal echocardiography and pulmonary artery catheters. In addition to the two month mandatory rotation, advanced clinical rotations of 2-6 months are available in the CA-3 year.
Critical Care Medicine
This is a two month rotation in the CA-2 year. Critical care rotation is designed so residents will achieve proficiency in the recognition and management of problems encountered in the intensive care unit. This proficiency includes, but is not limited to the management of: sepsis, acute and chronic cardiac disease, acute respiratory failure, acute renal failure, hemodynamic instability, overdoses and poisonings, acute neurologic insults, acute electrolyte and endocrine emergencies, and coagulation disorders. For less common problems, residents should acquire knowledge sufficient to formulate a differential diagnosis, initiate a management plan, and request appropriate consultations. We rotate through both the Cardiothoracic ICU and the Surgical/Trauma ICU.
This is a four-week elective in the CA-1 or CA-2 year. An additional elective of one to three months duration may be taken at the Barrows Neurologic Institute during the CA-3 year. Teaching during this rotation will emphasize preanesthetic assessment, intraoperative management (eg. neurological monitoring, manipulation of cerebral hemodynamics and cerebral protection techniques), and postoperative care of the neurosurgical patient. The neurosurgical procedures with which the residents will become familiar include craniotomy for head trauma, intracranial aneurysms, intracranial vascular malformations, intracranial tumors, transsphenoidal resection of pituitary tumors, CSF shunting procedures and major spine surgery. Upon completing their residency, our graduates should be competent to provide perioperative care for sophisticated neurosurgical procedures.
This is a four-week rotation which usually occurs during the CA-1 year. During this rotation residents will become familiar with the various aspects specific to the delivery obstetrical anesthesia. These include: the physiological changes associated with pregnancy; labor and delivery; neural and pain pathways; and the provision of effective analgesia. Various anesthetic techniques with which residents will become proficient include epidural analgesia, combined spinal epidural analgesia, and continuous spinal analgesia for labor and delivery. Residents will understand the essentials of the pharmacology of local anesthetics, opioids and other analgesic agents as they pertain to the parturient. Effective techniques for the provision of cesarean anesthesia, including post-operative analgesia are emphasized.
This is a four-week rotation usually taken during the CA-2 year. Residents on this service will learn how to evaluate children prior to surgery. The residents should understand pediatric illnesses, congenital abnormalities and the anatomical, physiological and pharmacological differences between children and adults. Residents will also become adept at providing general and local anesthesia for children of all ages. Upon completion of this rotation, residents should be able to care for most pediatric patients who are undergoing surgery.
Post Anesthesia Care Unit
This rotation provides an opportunity to train anesthesia residents to evaluate and manage the care of postoperative patients recovering from anesthesia. The PACU rotation is two weeks and is usually completed during the CA-1 or CA-2 year. Residents learn valuable skills including communication with surgeons and primary care teams, indications, and techniques for invasive monitoring, CPR team responsibilities, discharge readiness and critieria, and post-op patient management skills. Residents learn advanced techniques such as both invasive and non-invasive airway management skills. Four major clinical areas are emphasized; admission criteria, pain management, discharge criteria, and managing post operative complications. Upon completion of this rotation, residents should be able to evaluate most postoperative patients independently and recognize common postoperative complications.
In addition, residents will be involved in the care of patients who have chronic or cancer pain.
This is a four-week rotation on the in-patient surgical pain service with an emphasis on the management of acute post-operative pain and other pain conditions. CA-2 residents will be expected to manage post-operative analgesia in adults and children, and be familiar with the techniques available for acute pain control. CA-2 resident will focus on management and placement of intrathecal opiods, epidurals, and on ocassion regional bloackade.
This is a four-week rotation occuring during the CA-3 year. Residents are to build on their experience from CA-2 year with acute pain, become reaquainted with the peripheral nervous system as it relates to the practice of anesthesiology. Residents are expected to understand the anatomy and physiology of the cervial plexus, airway, brachial plexus, and upper and lower extermity. In addition, residents will be taught to identify and properly treat complications and side effects of regional anesthesia. Residents will become familiar with the equipment commonly used in regional anesthesia (i.e. ultrasonography). They should also understand the pharmacokinetics and hemodynamic effects of agents used to provide regional anesthesia.