SURGICAL ANESTHESIOLOGY- UCH
GOALS AND OBJECTIVES
CA 1 Level
DEFINITION
This is a four month rotation for CA-1 residents, which includes anesthesia for several surgical
specialties to include general, orthopedic, plastic, gynecologic, neurologic, otorhinolaryngologic,
and urologic surgery. There is one month dedicated as the general OR advanced airway rotation.
CURRICULUM/GOALS
Residents rotating through the general operating room in their CA-1 year are expected to be
introduced to the basic fundamentals of anesthetic care of the patient undergoing surgery. This
includes clinical expertise and cognitive management of the perioperative needs of the surgical
patient undergoing routine procedures found in community and tertiary care hospitals.
Introduction to and competence in performing the basic functions of the anesthesiologist
including preoperative assessment, medical optimization, anesthetic selection, maintenance of
homeostasis, and postanesthetic care are expected for this rotation. Participation in human
stimulation scenarios, especially crisis management scenarios will be utilized.
MEDICAL KNOWLEDGE
At the conclusion of this rotation, the resident should be able to:
1. Assess the functional status of the patient’s health including a comprehensive review of
major organ systems.
2. Describe the physiologic effects and impact on anesthesia of medications used for acute and
chronic illness
3. List the American Society of Anesthesiologists (ASA) Physical Class categories and the key
features of each
4. Describe the Mallampatti classification of airway assessment and the implications of each
thereof
5. Discuss the major forms of anesthesia (general, regional, local) and know the common
complications associated with each and the relative risk
6. Describe the basic function and design of the anesthesia machine and other anesthesia
delivery systems including knowledge of inherent safeguards and the sequence of the
functional check-out procedure
7. Understand the composition and physiologic consequences of various intravenous fluids used
during surgery
8. Discuss the expected fluid needs of the patient as it relates to preoperative preparation/fasting
and intraoperative changes.
9. List the ASA guidelines for preoperative fasting as pertains to solids, liquids, and abnormal
gastric function
10. List those factors which predispose patients to postoperative nausea and vomiting, and the
possible solutions to this problem
11. Understand the pharmacodynamics and pharmacokinetics of the intravenous and volatile
agents used in surgery
12. Understand the pharmacodynamics and pharmacokinetics of sedative and anxiolytic
medications used in the preoperative period.
13. Discuss the pharmacodynamics and pharmacokinetics of opioid analgesics used in the
perioperative period
14. Have a basic understanding of the proper positioning of patients to prevent injury during
surgery
15. List the physiologic changes associated with anesthesia, surgery, and positioning.
16. List the indications for blood transfusions and the risks of blood products
17. Know the minimum alveolar concentration (MAC) of common volatile anesthetics
18. Understand the pharmacodynamics, pharmacokinetics, and physiology of neuromuscular
blocking agents and neuromuscular function
19. Discuss pulmonary physiology in respect to the maintenance of proper ventilation of the
patient and the appropriate timing of extubation
20. Discuss the various stages of anesthesia and anesthetic depth and the assessment thereof
PATIENT CARE
At the conclusion of this rotation, the resident should be able to:
1. Perform a comprehensive preanesthetic history and physical examination, and assess the
adequacy of preparation to include appropriate laboratory testing
2. Determine if the patient’s chronic medical conditions are stable and optimally managed
3. Assign an ASA Physical Classification number to the patient
4. Determine if the patient has met the criteria for preoperative fasting or will need a rapid
sequence induction
5. Prepare an operating room for a case to include proper selection of induction medications, set
up of intravenous fluids, and function check the anesthesia machine
6. Perform induction of anesthesia with minimal assistance for ASA Class I and II patients
7. Intubate the trachea using direct laryngoscopy after proper mask ventilation
8. Identify the patient with a potentially difficult airway
9. Properly select induction medications and maintenance agents based on the patient’s
comorbid conditions, type of surgical case, and anticipated length of surgery
10. Select and administer the proper type and amount of intravenous fluids based on the patient’s
needs due to comorbid conditions, preoperative volume status, and type and length of
surgical procedure
11. Properly manage neuromuscular blockade for a variety of patients and surgical procedures
12. Manage an anesthetic to permit and rapid and smooth emergence from anesthesia, and
correctly assess when a patient is ready for tracheal extubation
13. Properly perform intravenous and arterial cannulation including central venous access (with
assistance)
14. Assess the need for blood product administration and safely deliver the infusion, and
recognize complications associated with specific products
15. Properly (safely) position a patient for surgery in the supine, lateral decubitus, and prone
positions, and recognize potential injurious situations.
16. Make a rational choice of medications to use intraoperatively and postoperatively to provide
for adequate analgesia
17. Provide appropriate anesthesia for the wide variety of routine operations seen in the
community and tertiary care settings
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INTERPERSONAL AND COMMUNICATION SKILLS
At the conclusion of the rotation the CA-1 resident will:
1. Be able to form a rational plan, in consultation with the attending anesthesiologist, for
anesthesia for a routine surgical procedure, communicate that plan to the patient, and obtain
informed consent
2. Inform the attending anesthesiologist of any changes in patient condition, or progress of the
procedure which may affect patient condition, that occur during anesthesia care
3. Cooperate with the preoperative holding area nursing staff and surgeons to assure proper
preparation of the patient for the planned surgical procedure and coordination of preoperative
testing
4. Be able to interact effectively with the patient, family members, and nursing staff to insure
patient satisfaction with their care
PROFESSIONALISM
At the conclusion of the rotation the CA-1 resident must:
1. Demonstrate adherence to procedures designed to protect patient privacy
2. Demonstrate effective sensitivity to cultural, racial, and religious issues of importance to
their patient and the patient’s family
3. Be able to achieve a smooth and safe intraoperative anesthetic course for the surgical patient
4. Anticipate common intraoperative problems associated with routine surgical cases
5. Confirm the safety of their patient in the postanesthesia setting as well as adequate analgesia
and satisfaction with their care
6. Be prepared, in a timely fashion, to manage their cases
PRACTICE BASED LEARNING AND IMPROVEMENT
At the conclusion of the rotation the CA-1 resident will gain an understanding of the following:
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The role of evidence based medicine techniques and how they apply to anesthesiology
Statistical analysis
Randomized, controlled trial studies
Limitations of RCTs in regards to anesthesia practice
Cochrane database and other meta-analyses
The necessity of electronic based media and its utilization
The role of continuing medical education
The role of maintenance of certification processes
The role of life long learning and self-assessment and its implications regarding selfimprovement
SYSTEMS BASED PRACTICE
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The CA-1 resident will gain an understanding of the following regarding systems based practice:
1. The Institute of Medicine’s core competencies in regard to the delivery of health care,
namely that care is to be:
o safe
o timely
o effective
o efficient
o equitable
o patient-centered
2. Anesthesia billing and collection modules
3. Staffing and the implications of running an operating room
4. The role of physician extenders in anesthesiology such as
○ CRNA
○ anesthesia assistants
○ anesthesia technicians
5. Medicare teaching rules and regulations, especially in regards to supervision and billing
6. Malpractice and risk assessment
7. Quality improvement and the role of the Center for Clinical Effectiveness (CCE) at this
institution
8. Anesthetic costs, pharmaceutical and equipment
Evaluation Tools:
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AKT-1, AKT-2, AKT-6 to evaluate medical knowledge of the CA-1 resident in training
Self – evaluation process
Direct observation by faculty with monthly written performance evaluations.
360° Evaluations by nursing / OR staff.
“Mock” Oral Exams given by faculty
Mentoring system: Each resident will select a mentor during their first CA-1 year to help
direct training based on the results of the above evaluations.
Rev. 7/ 2009
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