Focus: Ambulatory Anesthesia
An expanding number and variety of ambulatory procedures including orthopedic, ophthalmologic, pediatric, dental and general surgical procedures are performed at UVM Medical Center's Medical Center and Fanny Allen campuses. Throughout their training, residents gain extensive exposure to ambulatory anesthesia with an emphasis on the successful implementation of regional anesthetic techniques and multimodal pain management. The use of ultrasound guided regional blocks and an active clinical research program in regional anesthesia has become an integral part of the ambulatory anesthesia rotation.
Focus: Cardiothoracic Anesthesia
Over 500 cardiopulmonary bypass cases are performed annually, providing an outstanding clinical experience for our residents. Cardiac cases include coronary artery bypass grafting, valvular repair and replacement, as well as complex aortic reconstructive surgery. Thoracic cases include video assisted thoracoscopic procedures, open thoracotomy for lung resection, as well as open and endoscopic esophageal surgeries. Intraoperative transesophageal echocardiography (TEE) is used in the majority of cardiac procedures and this hands-on TEE experience is supplemented by monthly conferences run by four of our TEE certified faculty. During this rotation, residents also become proficient in placement and interpretation of arterial, central venous and pulmonary artery catheters and become expert in management of perioperative cardiac dysfunction. In collaboration with our cardiology colleagues, we are pleased to offer a TEE elective for CA-3 residents.
Focus: Critical Care
The primary goal of the Critical Care experience is to provide physicians with an opportunity to acquire the knowledge, skills, experience, judgment and for optimal care of severely injured and critically ill patients. Residents are supervised by Critical Care Medicine faculty from the Departments of Anesthesiology and Surgery and a full lecture schedule complements daily patient care in the SICU. We view familiarity with critically ill patients as being instrumental in the care anesthesiologists provide in the operating room and essential for creating a foundation of clinical practice in becoming a perioperative physician. Anesthesia trainees rotate for 2 months in the SICU during the CA-1 and CA-2 years, and 1 month in the CA-3 year acting as a fellow-like consultant.
Point of Care Ultrasound (POCUS) has emerged as an important modality for evaluation of patients in the peri-operative setting. Transesophageal echocardiography remains an important part of intraoperative care, but acute care of perioperative patients has expanded to include transthoracic echocardiography, vascular, lung, airway, and abdominal ultrasound. Our program is implementing a longitudinal POCUS curriculum across the training program. A didactic education program was started in 2018 and has been expanded. The practical portions will consist of hands on scanning practice on models and real patients as well as use of state of the art simulators. POCUS training will be spread throughout all 4 years of training and the graduating resident will be facile with the use of this increasingly vital technology.
The Neuroanesthesia rotation provides an extensive clinical experience over the broad range of neurosurgical and neuroradiologic procedures performed at UVM Medical Center/University of Vermont. The scope of the neuroanesthesia experience includes spine surgeries of varying complexity, supra- and infratentorial craniotomies for primary and malignant brain tumors, trauma-related neurosurgical procedures, carotid endarterectomy, and interventions (surgical or neuroradiological) for management of cerebrovascular disease processes. The effects of pharmacological agents on cerebral blood flow and metabolism, critical care neurology, and monitoring techniques including intraoperative EEG and evoked potential monitoring are stressed. The importance of building the knowledge base necessary for successfully approaching the patient with challenging intracranial pathophysiology is emphasized.
Focus: Obstetric Anesthesia
UVM Medical Center serves as the regional referral center for high-risk perinatal patients as well as the community birthing center for low-risk deliveries. Currently, there are approximately 2300 deliveries performed annually and over 75% of births involve regional anesthesia. Our faculty includes 3 anesthesiologists with subspecialty training in obstetrical anesthesia. Residents typically spend one month on the obstetrical anesthesia service in each of their CA-1 and CA-2 years and receive continued exposure to obstetrics throughout their training while on-call.
Focus: Pain Medicine
The multidisciplinary Pain Management Center has five full-time anesthesiologists with subspecialty certification in pain medicine, as well as a physical medicine and rehabilitation specialist, a psychologist, and a full support staff. The pain service offers a full range of inpatient and outpatient consultation services, including care of patients with postoperative pain, chronic non-cancer pain, and cancer-related pain. Rotating residents participate in all aspects of the pain service while on this subspecialty rotation. The CA-1 rotation is designed to give residents a firm foundation in the assessment and treatment of a variety acute and chronic pain conditions. An advanced elective rotation including opportunities for participating in ongoing or investigator initiated clinical research is available for interested CA-3 residents.
Focus: Pediatric Anesthesia
With two general pediatric surgeons as well as pediatric sub-specialists in each of the major surgical specialties, this rotation provides our residents with knowledge and experience in providing general and regional anesthesia for a broad spectrum of pediatric surgeries as well as procedures performed under deep sedation outside the operating room. Our faculty includes six anesthesiologists with subspecialty training in pediatric anesthesia. As in adults, our emphasis in pediatrics is on the successful use of regional anesthesia whenever feasible. Dr. Chris Abajian pioneered spinal anesthesia for infants at the University of Vermont and maintains the largest database in the world on outcomes associated with the use of this technique.
Focus: Regional Anesthesia and Acute Pain Medicine
The use of regional anesthesia for surgery and postoperative analgesia is emphasized throughout training at the UVM Medical Center/University of Vermont. A majority of lower-extremity surgery is performed under regional anesthesia, including spinal, epidural, and peripheral neural blockade. Regional anesthesia is used in a significant portion of anesthetics for upper extremity surgeries as well. Trainees gain exposure to a variety of techniques for neural blockade, including continuous catheter techniques and ultrasound guided regional blocks. Unique to our institution is the extensive use of spinal anesthesia for neonatal abdominal and lower extremity surgery in infants.