Residency > Rotations
Rotations
Cardiothoracic Anesthesia
Thomas Jefferson University Hospital has a busy cardiac surgery
service that has been ranked as one of the best in the nation.
Our residents spend a minimum of two months on the cardiac anesthesia
service. During this time they acquire the knowledge and technical
skills needed for the anesthetic management of complex cardiac
surgery patients. Our residents are exposed to a wide variety of
cardiac surgical procedures including minimally invasive techniques;
repair of simple congenital heart defects; and the use of biventricular
assist devices as a bridge to cardiac transplantation. The cardiac
rotation enables the resident to become familiar with cardiac pathopysiologic
conditions including severe left ventricular dysfunction, myocardial
ischemia, pulmonary hypertension, and cardiac dysrhythmias. Residents
have the opportunity to gain expertise in the placement of arterial
lines, central venous pressure lines, and pulmonary artery catheters.
Bispectral electroencephalographic analysis is used in many patients
and transesophageal echocardiography is used in most patients.
During the third year of anesthesia training residents can elect
to spend 3 to 6 months on the cardiac anesthesia service allowing
a more in-depth experience. Research is encouraged and supported
though not required. In past years, many residents in our program
have had the opportunity to publish and present their research
at national meetings. Fellowships are available for the individual
interested in preparing for a career as a cardiac anesthesiologist.
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Critical Care
Each resident will spend a minimum of two months in the Intensive
Care Units delevoping an understanding of the diagnosis and treatment
of complex critical illnesses. Residents develop the additional
skills required for the care of critically ill patients with multiorgan
system failure. The resident will have day to day experience in
airway management, mechanical ventilation techniques, intravenous
administration of potent and rapidly acting drugs, blood and fluid
administration, and both non-invasive and invasive monitoring of
vital organ function. Residents are "at the head of the bed" for
all critically injured trauma patients on arrival to the Emergency
Department, actively managing the initial resuscitation in the
trauma team setting. Residents will gain experience with the ethical
and legal considerations as well as cost effectiveness in the management
of patients in an Intensive Care Unit. During the CA-3 years, interested
residents may gain extra critical care training and participate
in research projects.
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Neurosurgical Anesthesia
The active Neurosurgery Department generates an operating room
schedule that requires the use of sophisticated anesthetic techniques.
While on this service, the resident learns about the complex interactions
between anesthetics and altered cerebral physiology. Specialized
monitoring techniques include Somatosensory Evoked Potentials and
Electro-encephalogram. Jefferson's designation as the Regional
Spinal Cord Injury Center of the Delaware Valley provides extensive
experience in dealing with problems of compromised airways, spinal
shock and neurologic deficits. Residents can obtain additional
exposure to neuroanesthesia during the CA-3 year.
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Obstetric Anesthesia
Thomas Jefferson University Hospital has an active obstetrics
service with over 2200 deliveries each year. As a high-risk referral
center, we routinely care for women with complicated obstetric
problems. Residents will learn how to furnish labor analgesia as
well as anesthesia for routine elective and emergency cesarean
section. They will develop the manual skills to perform epidural
and subarachnoid anesthetics reliably. In addition, residents work
in close consultation with obstetric residents in managing severely
ill parturients in the High Risk Obstetric Care Unit. In the CA-3
year, we offer further clinical and research training in obstetric
anesthesia. Interested residents will have ample opportunities
to develop and participate in clinical and laboratory research
projects.
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Outpatient Anesthesia
The realization that patients may safely undergo many surgical
procedures without overnight hospitalization has dramatically increased
the demands for outpatient surgical services. At Jefferson, we
provide anesthesia for outpatient surgery in our main hospital
complex and a freestanding ambulatory surgical center with four
operating rooms. In this setting, anesthesia is provided to patients
of all ages, some with significant medical problems. Residents
learn to provide an anesthetic, which allows rapid recovery in
preparation for discharge.
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Acute Pain Management
The Pain Management Section in the Department of Anesthesiology
is composed of two divisions: One division treats patients with
acute postoperative pain while the other deals with patients suffering
from chronic pain syndromes. The Acute Pain Management Service
(APMS) manages pain in the acute postoperative period. The census
is typically between 20 and 40 inpatients that are seen daily.
Pain management techniques include patient controlled analgesia,
infusions through epidural and intrathecal catheters, and continuous
peripheral nerve blocks. The use of adjunctive pain medications
is stressed as well. Didactic teaching occurs daily on rounds in
addition to a weekly conference.
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PACU
Residents learn to manage such problems as post operative nausea,
shivering, pain management, cardiovascular and respiratory problems
occuring following anesthesia and surgery during a rotation in
the post anesthesia care unit. Supervision is provided by the acute
pain management staff anesthesiologist.
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Chronic Pain Management
A separate medical group based at the Jefferson Pain Center manages
those patients suffering from chronic pain. The chronic pain team
manages patients suffering from a wide spectrum of diseases including
chronic low back pain, cancer pain and neuropathic pain. Jefferson
is a major referral center for patients with reflex sympathetic
dystrophy and other neuropathic conditions. Therapies include the
use of medication, nerve blocks, psychotherapy and/or physical
therapy. Appropriate referrals are made to other medical personnel
in the surrounding area for therapies such as biofeedback, hypnosis,
relaxation training and acupuncture. Weekly interdisciplinary meetings
take place where specific patients are discussed. These meetings
form the basis for cooperative efforts from the Departments of
Neurology, Neurosurgery, Vascular Surgery, Psychiatry and Pharmacy.
Residents in the CA-2 year will spend at least one month on the
service. The option exists for 3 to 12 months of advanced training
in the CA-3 year.
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Pediatric Anesthesia
Exposure to pediatric anesthesia occurs throughout the residency.
A Jefferson, the faculty includes several pediatric anesthesiologists
who provide the expertise to care for infants with severe medical
problems. In addition, each resident will spend two months during
their CA-2 year at the duPont Hospital for Children for their pediatric
anesthesia experience. DuPont Hospital is a 128 bed multidisciplinary
pediatric facility and is affiliated with the Jefferson Health
System. During the rotation the residents will have the opportunity
to participate in a wide array of pediatric surgical procedures,
ranging from neonatal emergencies to routine outpatient procedures.
Many surgical specialties are present and active at duPont, including
otorhinolaryngology, urology, general surgery, orthopedic surgery,
ophthalmology and neurosurgery. The fellowship-trained faculty
at duPont has clinical expertise in caring for high-risk neonates,
infants, and children. Residents may also return to duPont for
an elective rotation of 3-6 months during their Ca-3 year to further
develop their skills and knowledge of pediatric anesthesia.
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Preadmission Testing Center
Members of the anesthesia department in our preadmission testing
center evaluate virtually all patients who will undergo elective
surgery. Jefferson was one of the first medical centers in the
Delaware Valley to establish such a sophisticated preoperative
evaluation center. Anesthesiologists (including members of the
resident staff) decide on appropriate laboratory studies, consultations,
etc. in preparation for planned surgery. Studies from our own center
and others have shown that preadmission testing and evaluation
is a cost effective way to prepare patients for surgery. The Center
prepares patients psychologically for surgery and allows them to
discuss special anesthetic concern directly with an anesthesiologist.
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