Ambulatory Anesthesia

Ambulatory Anesthesia
Cardiac and Thoracic Anesthesia Service
Critical Care Anesthesia
Neurosurgical Anesthesia
Obstetric Anesthesia
Pain Management
Pediatric Anesthesia

Ambulatory Anesthesia

Residents rotate in the ambulatory service to gain experience in the anesthetic management of both pediatric and adult patients under the supervision of faculty with special expertise in ambulatory anesthesia. CA-3 residents may choose an elective rotation in ambulatory anesthesia to improve their skill and efficiency.

The full-time anesthesia faculty team in the day surgery unit will provide superior guidance during a resident's rotation in the unit. The staff will present informative lectures on a regular basis. Additionally, practical knowledge and techniques, which are critical components of a resident's training within the unit, will prepare a resident for potentially challenging situations. Most importantly, the faculty is committed to educating and training residents to anticipate and identify problems, and to effectively manage situations that occur from the preoperative period to discharge.

The seven thousand cases a year performed in the unit provide the diversity necessary to mastering the field of anesthesia. Most of the surgical specialties and patients with multiple medical problems are well represented in the unit. Furthermore, the pediatric experience in the ambulatory unit completes the pediatric training that is first introduced in the main operating suites.

Both the faculty and resources available in the NYU Day Surgery Unit are geared toward providing an instructive and rewarding environment for resident training. By the end of the rotation, residents will be more equipped to manage cases in both the ambulatory and main operating room setting.

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Cardiac and Thoracic Anesthesia Service

Clinical teaching of residents is an integral part of our responsibility. The service is staffed by 2 CA2s, 2 CA3 residents (elective) and 2-3 fellows. Clinical teaching includes educating the residents in pre, intra, and post-op management and TEE training. Methods of clinical research are introduced.

Pre-operative patient assessment including evaluation of myocardial function interpretation of cardiac catheterization and echocardiagraphic data, and other pre-operative diagnostic tests are stressed. Strong emphasis is placed on complete pre-operative evaluation and the preparation and development of sophisticated anesthetic plans to deal with the intra-operative or post-operative problems. There is close collaboration with the angiographers, echo cardiographers, as well as the cardiac surgeons.

Intra-operative care including TEE and all major types of hemodynamic monitoring is taught. Daily contact with a clinical echocardiographer augments the training in echocardiography. There is also emphasis on the peri-operative management including vaso-active infusions, pacemakers, defibrillators, intra-aortic balloon pumps, and ventricular assist devices.

A CA-4 cardiac anesthesia fellowship is available. Residents assume a more responsible role in evaluation and care of patients. They get to concentrate on the more challenging cases, especially the pediatric cases, Heartport procedures, and circulatory arrest cases. They are also encouraged to participate in the ongoing clinical research.

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Critical Care Medicine

Education of the residents is one of the primary goals of our service. Anesthesiology residents spend 9 weeks on the TRACC rotation, mostly during the CA-2 year. The resident is responsible for non-surgical aspects of the patient care, including clinical decision making, insertion and interpretation of hemodynamic monitors, case presentations, writing daily notes, and prescribing medication including vasoactive drugs and blood products. Residents are on-call an average of 1 out of every 3 nights, 7 days a week. The resident acquires detailed understanding of resuscitation and management of the trauma and neurotrauma patient, airway management, mechanical ventilation, nutrition and infectious disease. The resident is exposed to echocardiography and transcranial doppler.

During the CA-2 and CA-3 years, residents can elect to spend time on the Tisch Hospital ICU service.

A CA-4 Critical Care Fellowship and an 18 month combined Cardiac/Critical Care Anesthesia Fellowship program is also offered.

While on the ICU rotation at Bellevue, the CA-4 Fellow is available to come in from home to assist with management of difficult cases.

Fellows take night call at Bellevue Hospital one out of every 6 to 9 nights.

Research

Fellows are encouraged to develop a research project to be completed during the fellowship year.

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Neuroanesthesia

Residents are assigned to the neurosurgical operating rooms at Tisch hospital for six weeks during CA-2 and during the advanced clinical rotation in CA-3. Residents are introduced to the principles of neurosurgical anesthesia beginning with less complicated cases and moving on to complex craniotomies for supra- and infratentorial lesions, pediatric cases, craniotomies in sitting position, and cases requiring special neurophysiologic monitoring. Residents are also exposed to minimally invasive neurosurgical procedures such as stereotactic tumor biopsy and resection. In addition, anesthetics are provided for procedures of the spine, often requiring advanced airway management techniques.

During the neuroanesthesia rotation each resident receives a copy of The Neuroanesthesia Handbook (Stone D, Sperry R, et al. Mosby, St. Louis, 1996). It is expected that the resident should complete this textbook during his/her rotation. The rotating resident(s) also attend the weekly neuroanesthesia conference, which includes case discussions, lectures on a particular topic, and reviews of pertinent current literature by our faculty. In addition, several prominent neuroanesthesiologists are invited to participate in a departmental weekly visiting speakers program.

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Obstetric Anesthesia

Anesthesiology residents are first exposed to obstetric anesthesia in a six-week block, either towards the end of their CA-1 year, or during their CA-2 year. The first three weeks are spent at Tisch Hospital, where their education is overseen by Dr. Grant, and during the second three weeks they are assigned to Bellevue Hospital, where they are under the tutelage of Dr. Lawrence Susser, the Director of Obstetric Anesthesia at Bellevue.

During their rotation in obstetric anesthesia, residents receive extensive hands-on clinical experience, and also participate in a rigorous didactic program. After completing their formal six-week training, residents have the opportunity to further hone their skills while they are assigned to the call schedule in obstetric anesthesia at both Tisch and Bellevue Hospitals.

Residents also have the opportunity to elect to obstetric anesthesia as part of their CA-3 program. During this year, they are given increased patient care responsibilities and assist in educational activities for CA-1 and CA-2 residents, and medical students.

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Pain Management

The major goal of training is to provide the knowledge and skill needed by an anesthesiologist in order to practice Pain Medicine. A twelve-month Pain Medicine Fellowship, fully accredited by American Board of Anesthesiology and the ACGME, is offered at NYU Medical Center and Bellevue, through the Department of anesthesiology, to candidates who have successfully completed residences in Anesthesiology or other specialties. Each year, three fellows are given comprehensive didactic and clinical training in pain medicine as well as one month selective rotation in the field of Rehabilitation; EMG and MRI. Completion of this program allows the fellows to sit for the American Board of Pain Medicine or for the added qualification in Pain Management of the American Board of Anesthesiology.

All second year anesthesiology residents rotate in the Pain Center to acquire knowledge and develop skills in pain diagnosis, therapeutic judgment, clinical care, teaching, administration, and research in pain management. The multi-hospital experience offers the trainee a broad diversity of clinical pain problems, facilitating the development of the requisite clinical skills and knowledge. Finally, elective rotations are offered to third-year residents who desire increased exposure to Pain Management during their regular residency.

Training is accomplished through didactic teaching as well as clinical responsibilities. Trainees and attendings participate in twice weekly lectures on selected topics, a biweekly journal club, weekly interdisciplinary chart rounds conference, and biweekly case presentation. Clinical responsibilities involve working closely with Pain attendings and assuming major responsibility for clinical care at Tisch, Bellevue Hospitals and the Hospital for Joint Disease in acute and chronic inpatient and outpatient care.

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Pediatric Anesthesiology

The broad range of pediatric surgical illness presenting at Tisch and Bellevue Hospitals provides residents with abundant clinical opportunities. Minimum pediatric case requirements are quantified by the American Board of Anesthesiology, and residents in the NYU Program easily exceed those requirements. Residents begin on the Pediatric Anesthesia Service after completion of one full year of general anesthesia training. Tutorial is provided at the start of the rotation which highlights the many differences between adult and pediatric anesthesia, including equipment, pre-operative evaluation, pre-medication, anesthetic and homeostatic maintenance, and post-operative analgesia. Residents remain on the service at Tisch for four consecutive weeks, during which time these lessons are reinforced by hands-on patient care. Residents then move on to Day Surgery for two additional weeks, providing anesthesia care for more routine "bread and butter" cases. Clinical experience at Bellevue is interspersed throughout the second and third years of the residency program.

The focus of the pediatric anesthesia rotation is to produce residents with a firm grasp of fundamental skills. These skills include pediatric airway evaluation, mask induction, mask airway maintenance, and endotracheal intubation; venous and arterial cannulation; maintenance of physiologic homeostasis; and exposure to regional techniques for anesthesia as well as post-operative analgesia. A schedule of lectures for residents is posted monthly and repeated on that interval; lectures reflect the content coverage suggested by the American Board of Anesthesiology. A reading list is provided and residents are encouraged to read material relevant to patient management that can be discussed pre-operatively or during OR cases. Every effort is made to provide one-to-one attending/ resident staffing in the operating room so that clinical experience is maximized. Lastly, performance feedback is provided weekly to residents during the rotation through both verbal and written evaluations. Every attempt is made to identify weaknesses in basic skills so that improvement can be made in a timely manner.

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