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Anesthesia Resident Clinical Education : CA-3 resident ('03) Jerome Grove, MD, prepares to intubate a patient for a neurosurgical procedure.
The three year residency is devoted to training physicians to become outstanding anesthesiologists. In the first year, residents learn basic anesthesia skills on routine cases under close faculty supervision in the general operating room. Residents spend about half the year at the Stanford University-Packard Children's Hospital complex and the remainder divided between The Veterans Administration (VA) Palo Alto Health Care System and the Santa Clara Valley Medical Center (SCVMC). Residents take night and weekend calls with in-house faculty supervision as soon as their level of training permits.During the second 6 months of the first year, all first year residents receive 2 months of subspecialty experience. Residents are trained in our Preop Clinic and Anesthesia Simulator Center from the beginning of the residency.The second year is devoted to more extensive experience in anesthetic subspecialties.
Pediatric Anesthesia
Anita Honkanen, MD, chief of pediatric anesthesia, discusses the educational opportunities on the pediatric anesthesia rotation.
The Department of Anesthesia of the Lucile Salter Packard Children's Hospital provides care for over 7,500 infants, children, teens and young adults a year, who require anesthesia for a wide variety of surgical and medical procedures including solid organ transplantation, complex cardiac surgery, radiation therapy, and invasive radiological procedures. The department also provides labor analgesia or surgical anesthesia for about 4,300 deliveries a year in the Johnson Center for Pregnancy and Newborn Services. The Pediatric Pain Management Service treats infants, children, and teens with acute surgical pain, pain from trauma, acute and chronic pain complicating medical diseases, and manages children with drug withdrawal or side effects from drug therapies.
The Packard Children's Hospital Department of Anesthesia is the primary pediatric teaching program for the residents of the Stanford University Department of Anesthesia. The Department also participates in the training of residents in the Department of Pediatrics, the fellows of the Pediatric Intensive Care Unit, and the air transport nurses of Stanford Life Flight.
Further information can be obtained from the Pediatric Anesthesia web site.
Obstetric Anesthesia
Ed Riley, MD, chief of obstetric anesthesia discusses the educational opportunities for residents on the OB anesthesia rotation at Stanford.
Obstetric Anesthesia occupies approximately two months in the Stanford Anesthesia residency, usually during the second and third years. The more than 5000 deliveries annually include a significant proportion of high-risk cases and a 30% cesarean section rate. Extensive experience is obtained in regional anesthesia with approximately 75% of laboring patients and 95% of cesarean section patients receiving regional blocks. Educational activities include a didactic tutorial program given by specialist faculty and an obstetric anesthesia journal club presented by residents and fellows. During one of the obstetric anesthesia rotations residents take Neosym, a simulator course on neonatal resuscitation where they become certified in
NALS (Neonatal Advanced Life Support). Additional obstetrical anesthesia experience is obtained at Santa Clara Valley Medical Center, with over 3500 deliveries per year.
Further information can be obtained from the Obstetric Anesthesia web site.
Cardiovascular Anesthesia
Dr. Christina Mora Mangano discusses didactic and clinical educational opportunities for residents on the cardiovascular anesthesia rotation at Stanford.
During rotations on the Cardiovascular Anesthesia service at Stanford University Hospital or the Palo Alto Veterans Administration Medical Center, the resident learns basic anesthesia for cardiac and vascular surgery as well as invasive (PA catheterization, TEE) and non-invasive cardiovascular monitoring techniques. Residents are also exposed to anesthesia for heart and heart-lung transplantation, complex reoperations, AAA stent graft, complex thoracoabdominal aortic surgery, CPB with circulatory arrest, beating-heart CABG and arryhthmia surgery.
Stanford University Pain Service
Ian Carroll, MD, attending physician on the Stanford Pain servce describes the acute and chronic pain rotation at Stanford.
The Stanford University Pain Service sees about 350 patient referrals per month in a multidisciplinary pain clinic which evaluates and treats chronic pain in outpatients. An inpatient Chronic Pain Service is also active and integrates with the Acute Pain Service which consults on hospitalized post surgical patients requiring pain management. Techniques taught include diagnostic and therapeutic nerve blocks, selective spinal analgesia, patient controlled analgesia and other novel analgesic techniques. Residents are given an opportunity for 1 month rotations on each pain service.
For more information link to the Pain Service web site.
Critical Care Medicine
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Critical Care Medicine is an important part of anesthesia residency training and takes place in the 48 bed adult intensive care units at Stanford University Hospital and the 14 bed adult unit at the Palo Alto Veteran's Administration Medical Center. A multi- disciplinary team of residents from the departments of anesthesia, medicine and surgery manage a diverse population of both medical and surgical patients. Residents become the primary physicians for these critically ill patients and are responsible for all aspects of patient care under faculty supervision. All residents receive at least 2 months of Critical Care Medicine training.
For more information see the Critcal Care Medicine website.
ENT / Difficult Airway Rotation
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The ENT rotation gives residents significiant exposure to both simple and complex operations involving the airway. ENT anesthesia division currently includes four designated ENT anesthesiologists. A wide range of surgical ENT cases comprises major head and neck cancer surgery, laryngeal surgery including voice restoration, craniofacial plastic surgery, surgery for obstructive sleep apnea, functional endoscopic sinus surgery, major ear surgery, and combined neuro-/ENT cases for complex skull base surgery.
The ENT/Difficult airway rotation includes a carefully compiled structured
curriculum, addressing a wide variety of the airway management techniques,
and anesthetic techniques utilizing continuous infusions of different types
of opioids and total intravenous anesthesia. Airway Workshops are organized every year for junior and senior residents to enhance airway management educaiton.
Anesthesia for Thoracic Surgery
Jay Brodsky, MD, describes the thoracic anesthesia rotation at Stanford.
Anesthesia for Thoracic Surgery is a valuable rotation to introduce residents to managing patients with significiant pulmonary pathology and limited pulmonary reserve. During this rotation residents are also taught proper use of various endobronchial tubes and single or independent lung ventilation techniques.
Neuroanesthesia
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Residency training in Neuroanesthesia at Stanford includes two rotations at Stanford Hospital / Packard Children's Hospital. Neuroanesthesia I emphasizes anesthesia for intracranial procedures, while in Neuroanesthesia II the emphasis is on anesthesia for spinal surgery, interventional radiology, and movement disorders. In addition, residents rotating through our affiliated hospitals will have further opportunities to participate in the anesthetic care of neurosurgical patients at those facilities.
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Neurosurgery at Stanford is a very active and research oriented surgical service affording residents in Neuroanesthesia a unique opportunity to gain experience with a wide variety of surgical procedures and anesthetic techniques. These include hypothermic and pharmacologic brain protection, awake craniotomies, complex cerebrovascular procedures, interventional neuroradiology and electrophysiologic monitoring.
Faculty research interests include many aspects of neuroprotection, intraoperative monitoring, mechanisms of anesthetic action, pharmacokinetics, pain management and spinal cord function.
Both clinical and research fellowship positions are available.
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Stanford faculty with specific interest in Neuroanesthesia include:
- Richard A. Jaffe, MD, PhD. Professor of Anesthesia and Neurosurgery
- Rona G. Giffard, MD, PhD. Associate Professor of Anesthesia and Neurosurgery
- John G. Brock-Utne, MD, PhD. Professor of Anesthesia
- Hendrikus Lemmens, MD, PhD. Associate Professor of Anesthesia
- Martin S. Angst, MD Assistant Professor of Anesthesia
- Diane McGregor, MBBS, FRCA Associate Professor of Anesthesia
Regional Anesthesia
The one-month Regional Anesthesia rotation provides residents with
intensive exposure to a variety of regional anesthetic techniques for
both ambulatory and inpatient surgical procedures. Residents become
proficient in many ultrasound-guided peripheral nerve blocks including
supraclavicular, axillary, interscalene, femoral, sciatic, and
popliteal blocks. Residents also gain experience placing lumbar plexus
and thoracic paravertebral blocks as well as peripheral nerve
catheters. Supervision is provided by faculty
members with particular expertise in regional anesthesia. In addition
to this rotation, the department sponsors a yearly Regional Anesthesia
Workshop using cadaver dissection and ultrasound examination of live and inanimate models to teach regional anesthesia techniques in an optimal educational environment.
Post Anesthesia Care Unit
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The Post Anesthesia Care Unit (PACU) is a one month rotation available to residents who have completed six months of their anesthesia training. Residents will spend the majority of their time involved in direct patient care in the Stanford University Hospital Main OR PACU. Responsibilities include the evaluation and management of common postoperative concerns such as airway obstruction, hemodynamic instability, nausea and vomiting and pain control using a variety of techniques including epidural catheters and intravenous analgesics. In addition to the focused PACU experience, residents gain additional experience in postoperative pain management through involvement with the Stanford Acute Pain Service. Residents follow patients cared for by the Pain Service after they leave the PACU. This provides the opportunity to manage patients' ongoing postoperative pain using lumbar and thoracic epidurals, intravenous opiates, as well as other regional analgesic techniques. Dr. Cliff Schmiesing and the Pain Service Faculty provide supervision and teaching through bedside rounds, lectures, and case conferences. A comprehensive syllabus is provided.
