Subspecialty
Training
Cardiothoracic
Anesthesia
The Cardiothoracic anesthesiology curriculum
provides CA-2 and CA-3 residents with a continuum of education
and experience in the subspecialty of cardiothoracic anesthesia.
Residents are exposed to a variety of cardiothoracic surgical
patients, including those requiring conventional coronary
bypass grafts, valve replacements, cardiac transplants,
and implantation of automatic defibrillators. "Off-pump"
coronary bypass grafting is routinely performed in selected
patients. Residents are trained to become consultants in
preoperative evaluation, formulation and implementation
of anesthetic management and postoperative care of cardiac
patients. Residents are instructed in physiology, anesthetic
agents and monitoring devices that are common to cardiovascular
anesthesia. Residents are also given an opportunity to work
in pediatric cardiac anesthesia during the months spent
at the Children's Hospital Medical Center. Clinically based
teaching is provided by trained cardiothoracic anesthesiologists.
Pediatric Anesthesia
The Pediatric Division of the Department
of Anesthesia is in the adjacent Cincinnati Children's Hospital
Medical Center, a 291-bed acute and chronic care institution
where 20,000 anesthetic procedures are performed each year.
Anesthesia is administered for operative and diagnostic
procedures on patients from the premature age group through
adolescence. Every surgery specialty is represented. Surgical
procedures are performed which often require expertise in
anesthetic techniques for premature infants with respiratory
distress syndrome, pediatric patients with congenital anomalies,
in solid organ transplantation, in specialized orthopedic
surgery and in cardiovascular surgery. The center has intensive
care units for premature newborn infants and for older children.
Residents spend four months training during their CA-1 and
CA-2 years at the Children's Hospital and are exposed to
a wide variety of cases under the supervision of fully trained
sub-specialists in pediatric anesthesia. An ACGME accredited
Pediatric Anesthesia Fellowship is also offered.
Obstetrical Anesthesia
The Division of Obstetrical Anesthesia
provides maternal analgesia and anesthesia for 3,500 deliveries
a year and for an additional 700 surgical procedures. Approximately
40% of these patients have maternal and/or fetal high risk
complications. Although the major emphasis is on regional
anesthesia (approximately 85% of all deliveries are performed
under epidural or spinal analgesia or anesthesia), indications
for other blocks and general anesthetic techniques are taught.
The CA-3 year subspecialty rotation
in obstetrical anesthesia is dedicated to the management
of anesthesia care for high-risk obstetrical patients. Trainees
are also provided instruction in the management of an obstetrical
anesthesia unit.
Neuroanesthesia
During the CA-2 year residents spend
two months rotating on the neuroanesthesia service. During
this rotation the resident will gain experience with commonly
employed neuroanesthetic techniques and expand his knowledge
base in neuroanatomy and neurophysiology. Residents will
be instructed on the management of fluids, cerebral volume
reduction, induced hypotension, cerebral protection, as
well as the anesthetic management of intracranial, cerebrovascular
and complex spinal surgery.
Regional Anesthesia/Pain
Control Center
Considerable emphasis is placed on
regional anesthesia and residents are taught special nerve
blocks. This subspecialty training is usually a part of
the CA-2 and CA-3 years. ACGME accredited Fellowships in
Pain Management are also available.
The Pain Control Center is a multidisciplinary
service. The staff includes fully trained sub-specialists
in pain management, as well as specialists from the Departments
of Neurology, Otolaryngology/Maxillofacial Surgery. Other
personnel include nurse case managers, physical therapists
and a clinical psychologist.
Procedures performed include spinal,
epidural, central and peripheral nerve blocks, including
neurolytic techniques. Special modalities utilized consist
of transcutaneous electrical nerve stimulator therapy, psychological
testing, biofeedback and acupuncture. On the University
Hospital based Acute Pain Control Service, in addition to
nerve blocks, the use of regional narcotics and epidural
electrode placement are taught. This inpatient program also
allows residents an opportunity to learn the total management
of the pain patient.
Surgical Intensive
Care Unit – Critical Care
In each of the first and second years
of clinical training, residents rotate for one month through
the Surgical Intensive Care Unit. They have the opportunity
to learn invasive monitoring techniques and, with staff
supervision and direction, to recommend treatment of critically
ill surgical patients. This unit is supervised on a rotating
basis by the critical care trauma surgeons and critical
care anesthesiologists.
Research
The Department has an active research
program which emphasizes both the basic science and the
clinical aspects of anesthesia. Trainees are encouraged
to take part in these projects. The Department's basic science
faculty includes Ph.D.'s and several full-time research
assistants. Clinical research is performed in a number of
areas, including local anesthetics, other analgesic drugs,
anesthesia equipment and anesthetic techniques. A specialized
rotation in anesthesia research is available in the CA-3
year.
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