SURGICAL ANESTHESIOLOGY-UCH
GOALS AND OBJECTIVES
CA 2 Level
DEFINITION
During the CA-2 year, residents rotate primarily through the specialty services, but will have a
variable number of months (1-3) in the CA-2 Advanced Surgical Anesthesiology rotation. Goals
are to provide anesthesia for several surgical specialties to include general, vascular, outpatient,
orthopedic, plastic, gynecologic, neurologic, otorhinolaryngologic, and urologic surgery. In
general, CA-2 residents will be given the higher acuity cases within the above services in concert
with the level of experience. This is expected to be a continuation of skills learned in the CA-1
year.
CURRICULUM/GOALS
Residents rotating through the general operating room in their CA-2 year are expected to build
on the basic fundamentals of anesthetic care of the patient undergoing surgery. This includes
advanced clinical expertise and cognitive management of the perioperative needs of the surgical
patient undergoing routine procedures found in community and tertiary care hospitals.
Advanced airway skills are further developed in this rotation, along with management of
increasingly complex patients. Specific skills sets that will be further developed include
anesthetic management of the vascular surgery patients with cardiac disease, use of a variety of
regional anesthesia techniques as appropriate, management of outpatient surgery patients and
appropriate pain management skills for patients expecting to be discharged that day. Skills in
invasive monitoring will be increasingly utilized during this rotation. Participation in human
stimulation scenarios, especially crisis management scenarios will be utilized.
MEDICAL KNOWLEDGE
The knowledge units described in the CA-1 general OR section will apply for this section.
Additional expectations for CA-2 residents include the following:
1. Advanced airway management including jet ventilation
2. LMA, Fast-trach intubations, and use of the CMAC or Glidescope with expectation of
independent ability to use each of these.
3. Awake and asleep fiberoptic intubations with the expectation of independent performance of
these techniques.
4. Use of regional anesthesia including neuraxial or peripheral nerve blockade in combination
with complex abdominal, orthopedic, or vascular cases.
5. Anesthesia for remote locations
o MRI, ECT, CT, Interventional Radiology, Electrophysiology suite etc.
6. Anesthesia techniques specific for ambulatory surgery including appropriate use of the
following:
o sevoflurane
o desflurane
o propofol infusion
o short acting opioid analgesics
o nonsteroidal anti-inflammatory drugs
7. Anatomy used for routine nerve blocks used in both ambulatory and inpatient surgery
including but not limited to:
o Brachial plexus blockade: supraclavicular, infraclavicular, interscalene, axillary
o Lower Extremity blockade: femoral, sciatic, lumbar plexus, peroneal, ankle
o IV regional blockade (Bier block)
o Blocks utilized for ophthalmologic procedures: complications associated and
treatment as needed
o Appropriate management of local anesthetic toxicity
8. Application of current AHA guidelines of care for patients with coexisting cardiac disease.
This includes management of patients with coronary stents, ongoing CAD, various levels of
valvular disease, and various arrhythmias.
PATIENT CARE
The patient care units described in the CA-1 General Surgical Anesthesia section apply here. The
focus is on further development of more complex skills in patient management and decision
making.
1. The preoperative evaluation (including history physical exam and special investigations) for
the patient undergoing elective surgery
2. The preoperative consultations for seriously ill patients undergoing surgery
3. The role of the medical consultant in the care of complex patients; interpret and use medical
specialty consultations in the care of complex patients
4. The nature of medical problems, their order of priority, and how they affect the anesthetic
plan Counsel and educate patient and families as to the risks and benefits of anesthesia care
5. The complexity of co-existing medical diseases; use information technology to support
patient care decisions
6. The issues surrounding airway management, insertion of peripheral and central lines, arterial
catheters, and spinal, epidural, regional, and peripheral nerve blocks
7. The efficacy and accuracy of monitoring techniques
8. The role of postoperative analgesia in patient care
9. Select, apply, and consider the efficacy and accuracy of monitoring techniques
10. Execute and manage the anesthetic plan in a facile, well-prepared, and skilled manner,
including induction, maintenance and emergence from anesthesia of medically simple and
complex cases undergoing simple and complex surgical procedures
11. Perform basic and more advanced procedures: including airway management, insertion of
peripheral and central lines, arterial catheters, and spinal, epidural, regional, and peripheral
nerve blocks
INTERPERSONAL AND COMMUNICATION SKILLS
The units listed under the CA-1 section also apply here. In addition, at the conclusion of the
rotation the CA-2 resident will:
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1. Demonstrate techniques for effective communication with patients concerning pre-operative
assessment
2. How to explain the processes of anesthesia and discuss the risks of general and regional
anesthesia
3. Demonstrate skills for making a rapid yet thorough preoperative assessment of each patient
4. Develop effective communication skills for explaining the process of anesthesia
5. Show effective communication with both patients and other members of the patient care team
6. Demonstrate behaviors that show commitment to effective communication with both patients
and other members of the surgical center team
7. Communicate pertinent data about the patient to their attending in a precise and efficient
manner
PROFESSIONALISM
The CA-2 resident will learn / demonstrate:
1. The basic definitions of professional conduct as it applies to the practice of inpatient and
ambulatory anesthesia, and basic ethical principles
2. How to balance speed and efficiency with appropriate patient care
3. Act in a way that shows commitment to professional practice in their interactions with
patients, colleagues and other members of the health care team
4. Be expected demonstrate rapid turn over their own operating rooms and contribute to the
smooth running of the operating room
5. Be expected to complete all pre, intraoperative and post operative documentation in
accordance with departmental requirements
6. Demonstrate commitment to professional practice in their interactions with patients;
colleagues and other members of the health care team
PRACTICE BASED LEARNING AND IMPROVEMENT
In addition to the skills outlined in the CA-1 section the CA-2 resident will gain an
understanding of the following:
1. The practice of reflection on their performance
2. How to learn from experience
3. Understand the principles of life-long learning and evidence-based medicine as it relates to
inpatient and ambulatory anesthesia
SYSTEMS BASED PRACTICE
The CA-2 resident will gain an understanding of the following regarding systems based practice:
1. Understand how patients flow through the inpatient and ambulatory surgical centers
2. Understand how their management impacts on this flow
3. Understand the differences between phase1 and phase 2 recovery
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4. Gain an understanding for cost effective practice of anesthesia
5. Take part in practices and initiatives such as quality improvement programs that interact with
other areas of the health care system
6. Be expected to function as a team member and work with nurses, surgeons and
administrative staff to improve the care they offer their patients and their own understanding
of the broader aspects of the health care system
7. Develop behaviors that show an appreciation for the impact of their practices in their work
environment to the whole health care system
Evaluation Tools:
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2.
3.
4.
5.
AKT-18 to evaluate medical knowledge of the CA-2 resident in training
ITE exam
Self – evaluation process
Direct observation by faculty with monthly written performance evaluations.
360° Evaluations by nursing / OR staff.
Rev. 7/2009
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