The Stanford Anesthesiology residency is devoted to training physicians to become outstanding clinical anesthesiologists, able to provide expert anesthesia care to all patients by the end of their training. In the first clinical anesthesiology year, residents learn basic anesthesia skills under close faculty supervision in the general operating rooms. Residents rotate in the general ORs at Stanford Healthcare, Veterans Administration (VA) Palo Alto Health Care System, and the Santa Clara Valley Medical Center (SCVMC), taking care of a diverse patient population undergoing both elective and emergent cases. 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 and through their second year, residents complete their subspecialty rotations. Our residents have significant exposure to subspecialty cases, far exceeding case minimums set by the ACGME. The third year is devoted to more extensive experiences in anesthesia care and chosen elective rotations.

The Lucile Packard Children's Hospital (LPCH) Department of Anesthesiology is the primary pediatric teaching site for the residents of the Stanford University Department of Anesthesiology. The Packard Children's Hospital’s Department of Anesthesiology provides care for over 12,000 infants, children, teens, and young adults a year. These young patients need anesthesia for a wide variety of surgical and medical procedures, including solid organ transplantation, complex cardiac surgery, radiation therapy, and diagnostic and invasive radiological procedures.

The Pediatric Pain Management Service treats infants, children, and teens with acute surgical pain, pain from trauma, and acute and chronic pain complicating medical diseases, and manages drug withdrawal or side effects from drug therapies in children.

Residents at Stanford complete a 2-month core rotation in Pediatric Anesthesia at LPCH. This is typically done during the CA-2 year, but there is an opportunity to rotate as early as the second half of CA-1 year, allowing residents who may be interested in fellowship early exposure to the pediatric ORs. There are dedicated weekly didactics taught by our pediatric anesthesiologists to supplement the intraoperative learning. Senior residents have an opportunity for 2-week electives in pediatric anesthesia after completing their core rotation, as well as an opportunity for a subspecialty elective in pediatric cardiac anesthesia.

You can find more information on the Pediatric Anesthesiology website.

The Stanford Division of Cardiovascular and Thoracic Anesthesia cares for patients with the most complex cardiopulmonary disease and comorbidity burden in the nation. During their Cardiac Anesthesia Rotation, residents join the team caring for these patients. We have over 1600 annual cases requiring cardiopulmonary bypass (CPB) support, including on- and off-pump coronary revascularization via open, minimally invasive and robotic approaches, single and multi-valve repair and replacement including minimally invasive approaches, complex thoracic aortic procedures, and solid organ transplantation including heart, lung and combined heart-lung, heart-liver transplants. As a national referral center for complex aortic disease, our residents participate in perioperative management of open thoracoabdominal aneurysm repairs, Stanford Type A aortic dissection repairs, aortic arch reconstruction with circulatory arrest, and endovascular approaches including debranching procedures with proximal thoracic aortic stenting.

The Hybrid OR experience includes managing patients undergoing care with the structural heart team. Case variety includes transcatheter aortic, mitral and tricuspid valve replacements (TAVR/TMVR/TTVR), mitral and tricuspid transcatheter edge-to-edge repair (MEER/TEER), left atrial appendage occlusion (LAAO) devices, as well as advanced rhythm management including VT ablation, hybrid atrial arrythmia ablation, and cardioversions. Residents will also assist with the perioperative care of patients with high-risk adult congenital heart disease and pulmonary arterial hypertension. Finally, residents can be exposed to various mechanical circulatory devices such as peripheral and central extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump counterpulsation, temporary and durable ventricular assist devices, and other devices while caring for patients managed by our busy mechanical circulatory support program.

During the rotation, residents have dedicated teaching from fellowship-trained faculty who are board certified in advanced perioperative transesophageal echocardiography (TEE). The educational focus is on the perioperative management of severe cardiopulmonary pathology as well as invasive and non-invasive monitoring techniques such as pulmonary artery catheters, TEE and pulse contour analysis, supplemented by a robust online education curriculum. Please visit the Cardiovascular and Thoracic Anesthesia website for further information about our faculty and their diverse academic and research interests.

Obstetric Anesthesiology occupies 8 weeks in the Stanford Anesthesiology Residency Program, plus an optional 2-week elective. The four-week rotations occur towards the end of the first year, and during the second and third years. Approximately 4,800 deliveries are carried out annually at the Johnson Center for Pregnancy and Newborn Services, with approximately 70% of patients being high-risk and a cesarean delivery rate of 32%. Residents obtain extensive experience in neuraxial anesthesia, with approximately 89% of laboring patients and greater than 96% of cesarean delivery patients receiving neuraxial analgesia and anesthesia, respectively.

Educational activities include daily (protected) teaching by an obstetric anesthesiologist, a weekly QA review presented by residents and discussed with the obstetric anesthesiology team, and frequent teaching in Point-of-Care-Ultrasound. Residents participate in a multidisciplinary obstetric simulation program which has received great feedback. During one of the teaching sessions residents receive neonatal resuscitation training by a Pediatric Anesthesiologist and residents also have the option to attend a course to become certified in NRP (Neonatal Resuscitation Program). Schedule-dependent, residents also have the opportunity to participate in an OBLS (Obstetric Life Support) course. Additional obstetric anesthesiology experience is obtained at Santa Clara Valley Medical Center.

All residents spend 2 months rotating with the Pain Division - one month on acute pain and one month on chronic pain. During acute pain, residents are part of an inpatient team that provides around-the-clock care and consultations for hospitalized post-surgical patients, consultation for complex management of acute on chronic pain, interventional management of cancer pain, as well as other services. In addition, residents assist in the care of admitted chronic pain patients for advanced inpatient care as well as infusion therapies as one of only two inpatient chronic pain services and the only one in the country run by a pain division.

During the one month on chronic pain, residents rotate at the Redwood City Outpatient Medical Center which houses Stanford's multidisciplinary pain clinic. Residents get to work with pain physicians, psychologists, nurses, and physical and occupational therapists with experiences encompassing a broad range of specialties including neuromodulation, neuro spine, pelvic pain, orofacial pain, headache, and others. Residents, during their month, may participate in multidisciplinary conferences, journal clubs, seminars, and even simulation sessions. Residents see patients in the clinic and participate in interventions, seeing a wide range of neuraxial procedures, nerve blocks, advanced procedures, and more, learning about the role of imaging modalities (ultrasound and fluoroscopy) in pain. Residents are welcome to engage fully if interested further in a career in pain by being a part of the division's mission of clinical care, education, and research to advance the frontier of pain management for those dealing with acute or chronic pain problems.

The Division of Pain Medicine at Stanford is renowned for its comprehensive approach to pain management, combining advanced research, innovative treatments, and interdisciplinary collaboration to improve patient outcomes. The division emphasizes education and training to cultivate the next generation of pain medicine specialists.

For further details, you can visit the Stanford Division of Pain Medicine website.

Critical Care Medicine is an important part of anesthesia residency training and takes place in a 100+ bed adult intensive care unit at the Stanford University Hospital as well as the 14-bed adult unit at the Palo Alto Veteran's Administration Medical Center. A multi-disciplinary team of residents from the departments of Anesthesiology, Medicine, Surgery, and Emergency Medicine work together to 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 3 months of Critical Care Medicine training. Rotations are available in the medical, surgical, and cardiothoracic intensive care units.

Educational activities include a daily didactic program given by specialists, monthly journal clubs, monthly Critical Care Medicine Morbidity and Mortality conferences, and weekly ultrasound teachings in conjunction with Critical Care fellows.

For more information see the Critical Care Medicine multidisciplinary website.

Residency training in Neuroanesthesia at Stanford includes two month-long rotations. Neuroanesthesia 1 emphasizes anesthesia for intracranial procedures including tumor, neurovascular, skull-based, functional, and neuro-interventional radiology. Neuroanesthesia 2 emphasizes anesthesia for spinal surgery. In addition, residents rotating through the affiliated hospitals (SCVMC and VA) participate in the anesthetic care of neurosurgical patients at those facilities. Neurosurgery at Stanford is a very active service, affording residents a unique opportunity to gain experience with a wide-variety of surgical procedures and anesthetic techniques.

These include:

• Tumor resections for simple and complex tumor including complex skull-based neurosurgery
• Cerebrovascular procedures including aneurysms, arteriovenous malformations, EC-IC bypass
  Endovascular management of complex brain lesions including tumor embolization, aneurysm coiling, stroke
• Awake craniotomies
• Functional neurosurgery for movement disorders and pain
• Hypothermic and pharmacologic brain protection
• Intraoperative electrophysiologic monitoring

Stanford faculty with expertise in neuroanesthesia:

• Mark Burbridge, MD*
  Clinical Associate Professor
• Sarah Stone, MD, MS*
  Clinical Assistant Professor
• Boris Heifets, MD, PhD*
  Clinical Assistant Professor
• Anthony Doufas, MD, PhD
  Professor of Anesthesia
• Chris Rishel, MD, PhD*
  Clinical Assistant Professor
• Maxim Pochebyt, MD*
  Clinical Assistant Professor
• Karl Zheng MD
  Clinical Assistant Professor
• Ruth Fanning, MD
  Professor of Anesthesia
• Becky Wong, MD
  Clinical Associate Professor
• Brett Athans, MD
  Clinical Assistant Professor
• Zena Knight, MD
  Clinical Assistant Professor
• David Drover, MD
  Professor of Anesthesia
• Martin S. Angst, MD
  Professor of Anesthesia

*denotes faculty has received advanced clinical training in neuroanesthesia

Please visit the Neuroanesthesia website for more information.

The Head and Neck Anesthesia/Advanced Airway Management rotation gives our residents significant exposure to both simple and complex operations involving the airway. This rotation can be two to four weeks long and usually has two to three residents on service at a time. It has consistently been ranked among the highest Stanford-based rotations of the residency program, and residents often choose to return to the rotation for more experience later on in their training. The Head and Neck Anesthesia Division currently includes 10 designated anesthesiologists running 3-6 operating rooms daily. 

A wide range of surgical cases include:

• major head and neck cancer surgery including free flap reconstruction and transoral robotic surgery\
• laryngeal surgery including cases done solely under high-flow nasal oxygenation or jet ventilation
• surgery for obstructive sleep apnea
• functional endoscopic sinus and pituitary surgery
• advanced neurotologic and skull base surgery
• facial cosmetic surgery
• orthognathic and maxillofacial surgery

The Head and Neck Anesthesia/Advanced Airway Management rotation includes a carefully structured curriculum with ACGME-compliant teaching goals and objectives. Residents leave the rotation with a robust understanding of the unique anesthetic considerations for the above surgical procedures, and the acquisition of advanced airway management skill sets in real life situations.

For more information see the Head and Neck Anesthesia/Advanced Airway Management website.

Anesthesia for Thoracic Surgery involves a four week rotation. It introduces residents to:

• Bronchoscopy to assess the lower airway.
• Techniques of Lung isolation using Double Lumen Tubes and Bronchial Blockers and management of One Lung Ventilation in patients with significant pulmonary pathology and limited pulmonary reserve.
• Perioperative management of thoracic patients undergoing Open Thoracotomies and VATS procedures including pulmonary resections, esophagectomies and mediastinal operations.
• Pain management techniques including Thoracic Epidurals, ParaVertebral Blocks and Intercostal Nerve Blocks.
• Management of interventional pulmonary procedures needing fiberoptic and rigid bronchoscopy using jet ventilation.
  

The one-month Regional Anesthesia rotation provides residents with intensive exposure to a variety of regional anesthetic techniques, including ambulatory surgical procedures. Also resident assist at making decisions related to acute pain medicine, drug selections, catheter management and follow up for our ambulatory patients. Residents gain proficiency acute pain medicine and in many peripheral nerve block techniques, such as:

• neuraxial anesthetics
• inter scalene
• supraclavicular and infraclavicular approach
• femoral
• adductor canal
• saphenous
• ankle
• popliteal
• TAP
• paravertebral

Residents are supervised and instructed by faculty members with extensive expertise in regional anesthesia.

In addition to this rotation, the division sponsors regular Regional Anesthesia Workshops (12/year), using cadaver dissections, live and inanimate models, daily short lectures, didactics and other methods to teach regional anesthesia techniques in an optimal educational environment. Residents are expected to participate at the journal club planned during the rotation. Most of our senior residents do an additional 2- week elective in regional anesthesia and an orthopedic senior rotation where they perform the regional blocks for their patients prior to the OR case.

Visit the Regional Anesthesia Website to learn more.