Rotations

Clinical Rotations

Cardiac Anesthesiology

All residents spend one month on the Cardiothoracic Anesthesiology service at George Washington University Hospital and one month at the Washington Hospital Center. Residents are taught invasive monitoring techniques, applied cardiovascular physiology and pharmacology, and principles of cardiopulmonary bypass. At the Washington Hospital Center, residents perform these same duties in a private practice setting which solidifies their technical skills.

Residents who wish to expand their knowledge of cardiovascular anesthesia may spend up to six additional months on the cardiovascular service during the CA-3 year.

Neurosurgical Anesthesiology

Residents spend a compulsory one month rotation performing anesthesia for a variety of neurosurgical procedures including routine craniotomies, stereotactic brain biopsies, cerebral aneurysm clippings, transphenoidal hypophysectomies, and spinal fusions. In addition, a specialized team of neurosurgeons at The George Washington University Hospital performs skull-based craniotomies for lesions in these anatomically difficult locations. These procedures require sophisticated anesthetic techniques such as burst suppression, controlled hypotension, and hypothermia for cerebral protection. Text Box: One of the Cardiac Rooms at the Washington Hospital Center Occasionally, total circulartory arrest is used. The resident also learns monitoring techniques specific to neuroanesthesia such as precordial doppler ultrasound for venous air embolism, somatosensory evoked potentials (SSEP), brain stem auditory evokes responses (BAER), EEG, and EMG.

Six months of Neuroanesthesia is offered to CA-3 residents who wish to gain more experience in this subspecialty. CA-3 residents acquire a greater depth of knowledge of neuroanesthesia, have supervisory responsibility over junior residents, and participate in clinical research.

Obstetric Anesthesiology

Approximately 1,200 obstetric deliveries occur at George Washington University Hospital per year, 90% of which are performed with a regional anesthetic. All residents rotate for one month on the Obstetrical Anesthesia service with further clinical experience derived from overnight call in labor and delivery. Through a structured lecture series and clinical teaching, residents learn about maternal physiology and pharamacology, fetal assessment, maternal disease states and high risk pregnancy, local anesthetic pharmacology, and management of obstetric emergencies. Residents become adept at regional anesthetic techniques, management of labor analgesia, and management of anesthesia for elective and emergency cesarean section. Since two thirds of our obstetric population is designated "high-risk", residents have the opportunity to care for complicated patients with a variety of disease states including preeclampsia/eclampsia, morbid obesity, and multiple gestation.

Additional months are offered to CA-3 residents who would like additional training in Obstetric Anesthesia. Special emphasis is placed on management of high risk parturients, instruction and supervision of junior residents, and presentation of formal lectures.

Pediatric Anesthesiology

The Department of Pediatric Anesthesiology of The George Washington University is located at Children's National Medical Center. Despite being separated geographically, the Department of Pediatric Anesthesiology is integrated with the Department of Anesthesiology and Critical Care Medicine located on the main campus. Children's National Medical Center is a highly regarded national and regional referral center with outstanding clinicians. Many of the faculty in the Department of Pediatric Anesthesiology are board certified in both pediatrics and anesthesia.

Training in Pediatric Anesthesia consists of a two month rotation at Children's National Medical Center during the CA-2 year, and an additional one month rotation during the CA-3 year. Residents provide anesthesia for a variety of surgical procedures on both healthy children and those with uncommon coexisting diseases. Typical case load averages 60 cases per month and includes all types of general surgery, neurosurgery, orthopedics, urology, ophthalmology, and ENT. Anesthesia services are also required in such non-operative locations as radiology, the cardiac catheterization laboratory, and endoscopy suites. The patient population encompasses the extremely premature to the young adult with such disease entities as cystic fibrosis, malignant hyperthermia susceptibility, severe burns, and craniofacial anomalies. Regional anesthetic techniques for postoperative analgesia are emphasized.

An outstanding didactic conference schedule complements the clinical training. Daily lectures are held from 6:30-7:30 a.m. and are given by faculty who are nationally recognized experts in the field.

For those who wish to advance their skills and knowledge in Pediatric Anesthesiology, a six month rotation is offered to CA-3 residents in our training program. A twelve month ACGME accredited Fellowship (CA-4 year) which is highly sought by residents from all over the country is also offered. Residents at this level combine clinical, supervisory, and teaching responsibilities with the management of more advanced cases including Pediatric Cardiothoracic Surgery.

Ambulatory Surgery

The Department of Anesthesiology at George Washington University was the first in this country to establish a discrete hospital based ambulatory surgery center and is an acknowledged leader in this field of patient care and research. Several faculty are nationally recognized experts in this subspecialty which continues to evolve and grow rapidly. Residents at the CA-2 level spend a one month rotation in ambulatory surgery where they learn to master the special challenges of a fast-paced operating room environment. Residents become adept at a variety of techniques commonly used in this specialty including total intravenous anesthesia, IV regional, brachial plexus blocks, and spinal anesthesia. Residents also may be involved in clinical trails of new anesthetic agents during this rotation.

A six month rotation is offered to CA-3 residents who wish to advance their skills in this type of practice environment.

Pain Management

The Department of Anesthesiology at George Washington University Hospital maintains both an acute and chronic pain service. The Chronic Pain Service has a close working relationship with the departments of neurosurgery, orthopedic surgery, medicine, and neurology and receives a large number of patient referrals from these specialists. CA-2 residents spend one month in this subspecialty where they learn how to examine, assess, and treat patients with chronic pain syndromes. Over 1100 procedures are performed annually including lumbar and cervical epidural steroid injections, celiac plexus and stellate ganglion blocks, lumbar sympathetic blocks, and trigger point injections. Neurolytic blocks are also performed on a large number of oncology patients who present with intractable pain.

Our department has a very active acute pain service since many operative procedures are performed using combined regional and general anesthetic techniques. Residents become facile performing all types of regional anesthetic blocks early on in their training. CA-2 and CA-3 residents participate in daily rounds on acute postoperative pain patients and gain extensive knowledge in the use of local anesthetic and opioid combinations to provide postoperative.

Critical Care

The Department of Anesthesiology and Critical Care Medicine provides the full-time direction of the Intensive Care Unit. The Intensive Care Unit is a combined Medical/Surgical facility staffed by a team of multidisciplinary Intensivists. These Intensivists are highly committed to patient care, resident education, and research. CA-2 residents spend two consecutive months in the Intensive Care Unit caring for critically ill medical and postoperative surgical patients. Residents learn to think and act independently, consolidate their procedural skills, and learn the special challenges of airway management outside the operating room. In addition, ventilator management, invasive hemodynamic management, nutritional support, and human ethical issues are emphasized. Teaching rounds are supplemented by daily didactic presentations by the faculty. Given the wealth of clinical and didactic instruction, residents consistently rate this rotation as one of the most valuable in their training.

Two twelve month Fellowship positions are available leading to subspecialty certification in Critical Care Medicine. Fellows gain experience with all aspects of ICU management, supervise and instruct residents, present formal lectures, and participate in clinical research. Ongoing research projects include multi-institutional sepsis trials and ICU outcome data analysis.