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Residency Program

Rotations

Cardiac Anesthesia
Obstetrical Anesthesia
Pediatric Anesthesiology
Anesthesia for Burns
Neuroanesthesia
Vascular Anesthesia
Critical Care
Cardiothoracic Critical Care
Post Anesthesia Care Unit
Acute & Chronic Pain Management
Orthopedic & Regional Anesthesia
Hospital for Special Surgery
Memorial Sloan Kettering
Didactics

Cardiac Anesthesia

The Section of Cardiac Anesthesia is comprised of 10 fellowship-trained cardiac anesthesiologists. The cardiac anesthesia service performs approximately 1700 anesthetics per year across a wide range of cardiac, thoracic and vascular pathologies. Forty percent of cases are for coronary artery disease, thirty percent for valvular heart disease and the remaining thirty percent are split between aortic vascular and pediatric cardiac cases. In addition to the intra-operative care, 4 cardiac anesthesiologists share responsibility for medically and administratively running the Cardiothoracic Intensive Care Unit. The cardiac anesthesia rotation is structured to promote three different degrees of training for CA-2, CA-3 and CA-4 residents.

In the CA-2 year, residents spend two months on the cardiac service. This rotation is designed to introduce the intricacies of managing patients with coronary and valvular heart disease. It provides an opportunity to develop skills in placing arterial, central venous and pulmonary artery catheters, as well as learning to interpret the resultant data. The resident develops a thorough understanding of normal cardiac physiology and the anesthetic challenges resulting from cardiac and vascular pathophysiology. Additionally, CA-2 residents are taught to use intropic and vasoactive drugs in the critically ill patient. Finally, CA-2 residents come away from the rotation with a basic understanding of cardiopulmonary bypass-both the circuit itself and the pathophysiology it creates.

In the CA-3 year, residents are offered two to six month rotations on the cardiac team. The aim of the third year rotation is to allow senior residents a more in-depth experience involving all the facets of cardiac anesthesia. Having developed a basic understanding of cardiothoracic and vascular surgery in the second year, CA-3 residents receive a deeper education in adult valvular and coronary heart disease. The case-load expands to include the pediatric cardiac and complex aortic surgery cases.

For those residents who are interested in pursuing a CA-4 year, afellowship program is available.

Obstetrical Anesthesia

The Section of Obstetrical Anesthesia consists of 6 full-time fellowship-trained anesthesiology attendings who work in the obstetrical suite by day, in addition to 5 anesthesiologists who take night call. Depending on the year, we have a full-time obstetrical anesthesia fellow who takes part in clinical work, teaching, and clinical research. The OB anesthesia rotation for residents consists of 9 weeks during the CA-2 year. This is usually done in 3-6 week blocks. The Department of Obstetrics is an extremely busy one, approaching 6,000 deliveries per year. The Caesarean section rate is 30% and the percentage of patients requiring analgesia or anesthesia is greater than 95%. Because NYPH-WCMC is a tertiary medical center, we care for many high-risk patients, including women with multiparity, advanced maternal age, multiple gestations, cardiac lesions, pre-eclampsia, placental abruption, and placenta previa, but to name a few. Upon arrival on the Labor and Delivery Suite for the first time, residents are issued a "Survival Guide to OB Anesthesia" which outlines duties, responsibilities, and tips to help maximize the educational experience. Research in the Section is both sponsored by industry and competitive grants.

Cases range from routine epidural analgesia and combined spinal epidural analgesia for the labor parturient to the complex care of the critically ill or emergent obstetrical patient. Cases are shared between CA-2 residents, CA-3 residents, and the fellow, based on their complexity and anticipated technical difficulty.

By the end of the rotation, residents understand the differences, both anatomic and physiologic, between the parturient and the non-pregnant patient. They are facile with the technical skills needed to care for a woman in labor, and are able to recognize and treat any complications that might arise.

For those residents who are interested in pursuing a CA-4 year, afellowship program is available.

Pediatric Anesthesiology

The pediatric anesthesiology services at the Weill-Cornell Center are a multifaceted, wide-ranging and provide a complete overview of the subspecialty. The Section of Pediatric Anesthesiology at Cornell provides care for a variety of general and subspecialty areas and locales, including:

• General pediatric surgery: 2 full-time and 3 affiliated surgeons operate on the full spectrum of neonatal, infant and child surgical procedures
• ENT: 2 full-time ENT surgeons perform tonsillectomies and adenoidectomies. Additionally, there is a large referral base for specialized airway surgery. This includes tracheal reconstruction and congenital malformation correction for which jet ventilation and laser surgery are important components.
• Plastic: Craniofacial malformations are done regularly.
• Burns: Due to the largest burn center in the US, residents care for nearly 200 pediatric burn cases each year.
• Neurosurgical: The complete spectrum of pediatric neuro-oncology, meningomyolocele, V-P shunt and arterio-venous malformation surgery occur.
• Ophthalmology: Retinoblastoma care, congential cataract and eye muscle surgery regularly occur.
• Orthopedics: Residents rotate at Hospital for Special surgery where they gain facility with cerebral palsy, scoliosis and a large number of syndromic patients.
• Oncology: Residents rotate at Memorial Sloan Kettering Hospital and participate in anesthetic management of patients with neuroblastoma, rhabdomyoscaroma and other cancers.

In addition to operative experiences, residents participate in non-operative procedures, including sedation for MRI, CAT scan, cardiac cath, endoscopy, bone marrow, eye examinations, burn dressing changes and spinal taps, invasive radiology and neuroradiology. Residents rotate on the pediatric anesthesia service in their CA-1, C A-2 and CA-3 years. Early on, they are exposed to the fundamentals of pediatric anesthesia through a series of didactic lectures and clinical instruction on children undergoing surgery and other procedures. As familiarity is gained in airway and fluid management, procedures, pathophysiology and pharmacology, residents advance to sicker and more challenging patients. CA-2 residents spend one-month at the Children's Hospital of New York, another hospital in the New York Presbyterian Hospital Network. The experience at the Morgan Stanley Children's Hospital of New York Presbyterian provides a very busy and fulfilling overview of a wide range of common and uncommon pediatric surgical procedures in a setting exclusively devoted to the care of children. In the final year the resident may elect a subspecialty concentration in pediatrics for up to 6 months of intensive training. Over the years, many of our residents have chosen to subspecialize as pediatric anesthesiologists and all of these have gone on to fellowships at the most prestigious centers in North America.

Anesthesia for Burns

NYPH-WCMC is home to the largest Burn Center in the United States. As such, residents are involved in the management of patients from the William Hearst Burn Center. These patients range in age from pediatric to geriatric. Typically, one CA-2 resident is assigned to the Burn Service, during which time they learn the principles of thermoregulation, acid-base management, volume resuscitation and transfusion medicine.

Neuroanesthesia

CA-1 Residents obtain a basic understanding of monitors of the CNS as well as their clinical application and interpretation (BAER, EEG, SSEP, MEP, EMG). In addition, residents are expected to understand the dynamics of CSF, to diagnose and treat elevated intracranial pressure/volume, to understand the effect of pH on cerebral vascular resistance, to understand the function/structure of the blood-brain barrier, to understand the concepts of brain volume and compliance, to appropriately manage fluids for the patient undergoing craniotomies, and to develop a basic knowledge of neuroanatomy.

CA-2 and CA-3 residents are expected to learn and understand the application of vasodilators/beta blockers and vasopressor appropriately for controlled hypotension or induced hypertension for intracranial vascular surgery, the diagnosis and treatment of venous air embolus, the pathophysiology of cerebral ischemia pre- and intra-and post-operatively, the rationale and science for choosing cerebral protective anesthetics, the impact of anesthetics on CBF and ICP, and the impact of antiseizure medications on anesthetic management.

Research in the Section of Neuroanesthesia is collaborative with the Department of Neurosurgery and Neurology. Research funding is generated from both industry and competitive grants. The Section also participates in multi-center studies that focus on epidemiologic outcomes. A fellowship in neuroanesthesia is offered through the Division of Neuroanesthesia.

Thoracic Anesthesia

The Section of Thoracic Anesthesia at NYPH-WCMC is comprised of three attendings. Both CA-2 and CA-3 residents rotate through the Section of Thoracic Anesthesia while at New York Hospital and at Memorial Sloan Kettering Cancer Center. The goal is to have residents become familiar with techniques required for thoracic surgical procedures and learn practical application of physiological and pharmacological principles in the management of patients with complex cardiopulmonary disease. Cases that are performed include: lobectomy, pneumonectomy, VATS, tracheal reconstruction, and esophagectomy. Specific areas of technical expertise that are developed include: methods for lung separation, fiberoptic bronchoscopy, airway instrumentation and jet ventilation, paravertebral/intercostal nerve blocks, chest tubes, and tracheostomy care and use. Areas of patient management include the interpretation of pulmonary function testing, physiology of single lung ventilation, considerations for reactive airway disease perioperative care for severe COPD, restritive lung disease, and mediastinal masses, minimally invasive lung resection, controversies in volume management, and considerations for induction chemotherapy.

CA-2 residents are expected to master the techniques available for lung separation as well as the technique of jet ventilation. In addition, they learn how to interpret ABG's in the context of real-time oxymetry and capnography in order to assess the adequacy of ventilation. They begin to perfect their skills in the technique of fiberoptic bronchoscopy.

The CA-3 resident is expected to demonstrate proficiency at all of the above, such that they can function independently. They are expected to perform fiberoptic bronchoscopy, manage chest tubes and fresh tracheostomies, and perform nerves blocks for management of postoperative pain.

For those residents wishing to pursue a CA-4 year, a fellowship year in thoracic anesthesia is offered through the Section. Fellows are expected to supervise residents, perform clinical care, educate residents, and participate in clinical research within the Section.

Vascular Anesthesia

Both CA-2 and CA-3 residents spend time with the Section of Vascular Anesthesia, typically in 3-6 week blocks. The cases include carotid endarterectomy, carotid artery stenting, lower extremity bypass, open and endovascular approach to repair of abdominal aortic aneurysm, angioplasty of the major vessels, saphenous vein stripping, arterial bypass of the mesenteric, renal and axillary arteries and toe amputations. The typical patient for vascular surgery has several coexisting diseases that warrant intraoperative monitoring beyond what is standard. As such, emphasis is placed on preoperative evaluation and appropriate intraoperative hemodynamic monitoring and maintenance. The goals of the rotation are to gain an in-depth knowledge of cardiovascular physiology and pathophysiology, achieve a level of confidence with indications for, placement of, and indications for invasive line placement such as arterial lines, PA catheters, provide clinical assessment and care of the critically ill patient, understand the use of vasoactive and anesthetic drugs in the geriatric patient with co-morbid disease, understand criteria for transfusion, understand the approach to a patient with a pacemaker and AICDs, and perfect interpretation of ACT and ABG values.

CRITICAL CARE

Neonatal and Pediatric ICU

The Peter & Mary Kalikow Pediatric Critical Care Center at The New York Presbyterian Hospital-Cornell Medical Center is a multidisciplinary environment providing specialized, state-of-the-art care to children with life-threatening medical and surgical conditions. Interns in the categorical program spend one-month in the Neonatal Intensive Care Unit, providing them a solid background in the care of healthy and sick premature infants and an additional month in the Pediatric Intensive Care Unit, providing them familiarity with the care of older babies and children who are critically ill. The experience is centered in a 20 bed multidisciplinary PICU. The Division of Pediatric Critical Care is responsible for children from 1 day to 21 years old with complex medical and surgical illness. The units are "closed" and the critical care staff is responsible for all aspects of the patient's care in collaboration with the referring services. Infants and children are recovered in the PICU following cardiothoracic and neurologic surgeries. The medical staff consists of six pediatric critical care attendings and six pediatric critical care fellows. Pediatric, Emergency Medicine, and Anesthesia residents, working under the direct supervision of the critical care fellow, support the critical care staff. There is a fellow in the PICU 24 hours a day.

Neurosciences ICU

The Neurosciences ICU was opened in the fall of 2003 in order to provide care for both neurologic and neurosurgical patients. It is a collaborative effort between the Departments of Neurology, Neurosurgery and Anesthesiology. Faculty and residents from each of these Departments participate in the daily management of these patients. One CA-1 resident is assigned to this ICU for every three-week rotation.

Memorial Sloan Kettering ICU

(coming soon)

Cardiothoracic Critical Care

The cardiac anesthesia division at New York Weill Cornell Center has the good fortune of having an excellent relationship with the cardiothoracic surgeons. Part of this relationship is enhanced by the presence of anesthesia personnel in the cardiothoracic intensive care unit (CTICU). The CTICU is a unit that is devoted to the care of patients who have had one of many cardiothoracic operations or who are awaiting surgery. The CTICU team is composed of an anesthesia critical care attending, two anesthesia residents, a surgical resident and a Pharm D. The team has work rounds every morning to review and discuss each patient's care. Along with the cardiothoracic attending surgeons and cardiothoracic surgery fellows, a comprehensive approach to patient care is provided. Residents are expected to learn how to manage inotropes with the use of a pulmonary artery catheter, evaluate hemodynamic arrangements, provide proper ventilation management, manage an external pacemaker and intraaortic balloon pumps. Residents are also instructed on how to present critical ill patients in discussions and how to assess each patient's medical problems. The CTICU rotation compliments the cardiac anesthesia rotation by following it, thereby allowing the resident to learn some cardiac pathophysiology prior to working in the CTICU.

Post Anesthesia Care Unit

The Post Anesthesia Care Unit (PACU), commonly called the recovery room, is a 36-bed unit that provides care for patients who have undergone any procedure which requires post-procedure monitoring. It is staffed by an excellent nursing staff and medically supervised by anesthesiologists. Typically, a CA-1 resident is assigned to staff the Ambulatory Center PACU and a CA-2 resident is assigned to staff the Greenberg Pavilion PACU. This resident is responsible for pain management, ventilation management and overall medical management in conjunction with the surgeons. Ongoing communication between the surgical and the anesthesia resident is important for patients care. Additionally, the Greenberg PACU serves as an "overflow" unit when other ICUs in the hospital are full. The CA-2 PACU Resident is also responsible for responding to "codes", off-the-floor intubations and other "off-the-floor" situations where the help of an anesthesiologist is requested. Electroconvulsive therapy is performed every Monday, Wednesday, and Friday in the PACU; both CA-1 and CA-2 residents administer anesthesia for these cases, which promote development of airway management skills. The CA-1 resident is assigned to the PACU during the day for a three-week period. The CA-2 resident stays in the PACU for a 24-hour period and gets the next day off. By the end of the rotation, the resident is expected to have learned appropriate hemodynamic, fluid, pain and ventilation management. The resident will have also learned how to perform emergency intubations and manage airways in the emergency setting, under the supervision of the Anesthesia Attending running the Operating Rooms on that given day.

Acute & Chronic Pain Management

The Section of Pain Management is comprised of four fellowship-trained physicians. There are anywhere from 3 to 4 Fellows in Pain Management each year through the Tri-Institutional Pain Management Program. These faculty staff both the Center for Pain Management and the Acute Pain Service. The resident pain rotation is structured for CA-1 and CA-3 residents as a three-week rotation. During those three weeks, residents are exposed to the principles of both inpatient and outpatient pain management. A member of the Department of Anesthesiology is available 24 hours per day, seven days per week to address the pain needs of patients at NYPH-WCMC. Common treatments used by the acute pain service include patient controlled analgesia (PCA), patient controlled epidural analgesia (PCEA), and peripheral nerve blocks. In addition, The Chronic Pain Service treats many conditions, including: cancer pain, low back pain, sciatica, RSD, post-herpetic neuralgia and myofascial pain syndromes. The clinical exposure is complemented by bi-weekly educational conferences that take the form of Visiting Professors, didactic lectures, Morbidity & Mortality conferences and Journal Clubs.

Orthopedic & Regional Anesthesia

The Section of Orthopedic and regional anesthesia offers the opportunity to explore and practice regional anesthetic technique. Epidural, spinal, combined spinal-epidural, axillary, ankle and interscalene blocks are commonly used. Both CA-1 and CA-2 residents are assigned to the orthopedic service at NYPH-WCMC. This regional experience is supplemented by rotations at the Hospital for Special Surgery.

Hospital for Special Surgery

Residents rotating through the Department of Anesthesiology at The Hospital for Special Surgery receive an exceptional experience in regional anesthesia. The Hospital for Special Surgery (HSS) is the nations' premier orthopedic subspecialty hospital. The Hospital for Special Surgery annually performs over 14,000 anesthetics of which nearly 85% utilize regional anesthetic techniques. CA-1 residents spend approximately 9 weeks and CA-3 residents spend 3-6 weeks at HSS.

The program for the anesthesia residents is designed to include a concentrated exposure to regional anesthesia and its broad based applications. Resident coverage is typically one to one with an attending in order to ensure maximal time for practical and didactic teaching in the operating rooms. Techniques that residents are expected to learn while rotating through HSS include spinals, epidurals, combined spinal and epidural techniques, ankle blocks, axillary blocks, interscalene blocks, femoral and popliteal nerve blocks as well as the placement and management of continuous indwelling catheter techniques. Additionally, residents are exposed to the practice of regional anesthesia in pediatric populations. The regional experience is complemented by general anesthesia exposure on the complex spine service. On call responsibilities for the anesthesia resident include management of the Acute Pain Service and of the Post-Anesthesia Care Unit, which functions as the Hospital's intensive care unit.

The Department of Anesthesiology has a prolific research and educational component. Morning conferences are held three times each week to foster an academic environment and a persistent dedication to learning. Weekly conferences include journal club, grand rounds and a morbidity and mortality conference each Friday morning, designed specifically for residents.

Memorial Sloan Kettering

As an intern, residents rotate through the intensive care unit, thoracic surgery, general surgery and participate in an internal medicine elective. The Intensive Care Unit is a 12-bed unit that provides care for both the surgical and medical services of the Hospital. Our PGY-1 residents work directly under the supervision of Critical Care Fellows and Attendings. The surgical experience is unique because the team structure comprises the intern, directly responsible to a fellow and attending, involved in both intraoperative and post-operative patient management. CA-1 residents spend three weeks per year in the operating rooms at Memorial Sloan Kettering Cancer Center. Their primary responsibilities involve the care of gynecologic oncology and general surgical oncology patients. CA-3 residents spend from 6 Ð 9 weeks at MSKCC. Their experience is centered on the intraoperative care of thoracic and pediatric oncology patients.

The Department of Anesthesiology of MSKCC actively participates in joint Grand Rounds with the Weill Cornell Department of Anesthesiology.