As a CA-1, residents rotate at Banner University Medical Center South Campus, where the majority of procedures are scheduled, outpatient procedures. Located approximately 6 miles south of our main hospital, residents become proficient in bread and butter cases and have an early introduction to upper and lower extremity regional anesthesia. The curriculum for this rotation focuses on the perioperative evaluation, preparation and management of patients undergoing same-day surgery.
Residents on the cardiothoracic rotation are involved in the anesthetic management of a variety of surgeries. These include: coronary artery bypass grafts, valve repair or replacement, congenital heart repair, 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 transesophageal echocardiography and pulmonary artery catheters. In addition to three mandatory four-week rotations on cardiothoracic anesthesia, advanced clinical rotations in cardiothoracic anesthesia are available as a senior resident.
The chronic pain rotation provides trainees broad exposure to outpatient pain clinic and chronic pain procedures in state-of-the-art procedural suites. Procedures residents have the opportunity to partake in include but are not limited to: neuraxial based injections, trigger point injections, radiofrequency ablation, and spinal cord stimulators. Residents interested in chronic pain for fellowship work side-by-side with UArizona chronic pain fellows and chronic pain attendings. The chronic pain fellowship program at the University of Arizona is approved for four fellow spots each year and remains highly competitive. Beyond an enriching clinical experience, the chronic pain division encourages innovation through discovery, as demonstrated by recent NIH RO1 funding.
Critical Care Medicine
Anesthesia residents rotate through the intensive care unit (ICU) for four months during their training. The Surgical Trauma ICU (STICU) is a 20-bed unit, where anesthesia residents work with surgical intensivists, critical care fellows, emergency medicine and surgical residents. During their STICU rotation, residents improve upon their procedural skills, post-operative resuscitation and ability to triage. Our resident’s ICU experience is further complemented by rotating through the cardiovascular ICU (CVICU), a 20-bed unit that cares for patients following complex cardiac revascularization procedures, valve replacements, on-pump aortic aneurysm repairs, and ventricular assist devices. This ICU is staffed by anesthesia trained intensivists, where the anesthesia residents on service take the lead on patient care.
Residents are assigned to two four-week rotations in neuroanesthesia during their residency. As a senior elective, residents are given the opportunity to rotate at Barrows Neurological Institute in Phoenix. Residents become proficient in the perioperative management of complex neurosurgical patients, taking part in emergent/urgent craniotomies, endovascular/open intracranial aneurysms coilings and clippings, intracranial vascular malformations, intracranial tumors, transsphenoidal resection of pituitary tumors, CSF shunting procedures, and major spine surgery. The variety and complexity of cases provide ample neuroanesthesia opportunities throughout training, exceeding index case minimums prior to graduation.
Our obstetric department and Level III nursery is a referral base for numerous maternal-fetal comorbidities, providing our residents with rare and complex pathologies to take into consideration while on their obstetric rotation. The labor and delivery floor at the U of A provides care for over 1,800 deliveries, a number that continues to grow by approximately 10% each year. During this rotation, residents become proficient in labor epidurals, combined spinal-epidurals, and the spinals for cesarean sections. In addition, the rotation focuses on the physiologic changes that occur in the parturient woman and the impact these changes have on their anesthetic. Residents rotate on OB for three four-week rotations, where they receive a rich OB anesthesia experience and achieve case-log minimums with ease.
Our residents have exposure to pediatric patients of varying complexity early in their training. In addition to two mandatory four-week rotations in pediatric anesthesia, residents have the opportunity to provide anesthetics for pediatric patients during their non-operating room anesthesia rotation in radiation oncology, MRI, CT and in the GI Endoscopy. Moreover, the pediatric surgical case-mix is diverse, where residents have the opportunity to do complex cardiac cases with neonates (on-pump cardiac surgery, complicated cardiac cath lab procedures), and other specialized pediatric procedures in neurosurgery, ophthalmology, and otolaryngology in children of all ages. Given our program does not have pediatric fellows, our residents work one-on-one with a pediatric anesthesiologist during these intense, fellow-level surgeries.
With faculty guidance, our residents staff the pre-anesthesia clinic, where patients are referred from a variety of services prior to their elective or urgent surgery. Residents become acquainted with the most up-to-date perioperative guidelines, appropriately counsel patients before surgery, and create a pre-anesthetic plan for their patients prior to their date of operation.
Post Anesthesia Care Unit (PACU)
Early into training, residents have the opportunity to staff the PACU, overseeing patients in the immediate postoperative phase of recovery. Here, residents will have the opportunity to work-up postoperative hypotension, airway emergencies, post-operative resuscitation and post-operative pain management with faculty guidance. Upon completion of this two-week rotation, residents are able to appropriately evaluate and manage a wide spectrum of postoperative complications independently.
Residents are exposed to regional anesthesia through a variety of clinical settings. While on the Acute Pain Service at the University of Arizona/BUMCT, residents are placed on a dedicated regional team as perioperative consultants. Through this rotation, residents quickly become proficient in peripheral and neuraxial blocks for thoracic, abdominal, orthopedic, breast, and vascular cases. The regional experience gained through the Acute Pain Service at BUMC is further complemented by the numerous regional opportunities found at the Southern Arizona VA Health Care System and the Banner University Medical Center South Campus, two additional hospital systems residents rotate through during their training. Annually, the University of Arizona/BUMC provides 2,500 regional blockades. As a senior resident, there are additional opportunities to rotate on the Acute Pain Service, acting as a regional pain fellow.
Residents interested in research have the opportunity to work on pre-existing research projects which include work on thromboelastography and the anticoagulant effects of snake venom, anesthesia and consciousness, the antinociceptive impact of green light, and novel adjuncts to pediatric regional anesthesia blocks. Beyond this, residents are encouraged to explore their own research questions with the support of a faculty member. Each year, residents showcase their scholastic achievements at numerous conferences, such as the Western Anesthesia Regional Conference, Society for Obstetric Anesthesia and Perinatology meeting, Society of Pediatric Anesthesia conference as well as the American Society of Anesthesiology’s annual conference. Each trainee can be reimbursed up to $1,000 annually to present their work.