The Section of Neurosurgical Anesthesia offers advanced subspecialty clinical training in an environment that promotes academic excellence. Members of the section care for patients undergoing a variety of neurosurgical procedures, including neurovascular procedures, craniotomy for tumor, posterior fossa surgery, and functional surgery in awake patients for conditions such as Parkinson’s disease and other movement disorders. Procedures take place in the regular operating room or in the interventional radiology suite. Training in neurosurgical anesthesia includes an introduction to perioperative problems such as spinal and cerebral head trauma, intracranial hypertension, acute stroke or cerebral hemorrhage, and neurologically associated endocrinopathy.

Residents spend two consecutive months at Comer Children’s Hospital during their CA-2 year, and occasionally their CA-1 year, for the required pediatric anesthesia experience. An advanced elective month in pediatric anesthesia is available during the CA-3 year. Comer Children’s Hospital is a free-standing, 172-bed acute-care facility for family-centered, comprehensive, state-of-the-art care. In this major tertiary academic referral center and pediatric Level I trauma center, Comer staff care for children of all ages, from premature neonates to older adolescents, with all types of medical problems, ranging from the common to the rare and complex. Comer Children’s Hospital is committed to serving the community by caring for Medicaid patients and those without insurance.

Residents gain clinical experience managing pediatric patients with a variety of pathologies for all types of surgeries and procedures. Included are routine surgical cases and pediatric subspecialties: neurosurgery, craniofacial, cardiac, otolaryngology, ophthalmology, orthopedic, urology, plastic, burn, trauma, and transplant surgery. Diagnostic and therapeutic medical procedures, such as endoscopy, interventional radiology, and CT/MRI, are performed outside the operating room. A dedicated pediatric anesthesia morning lecture series takes place two or three times a week. Rotating residents participate in mock oral boards and attend departmental Grand Rounds on other mornings. We also hold pediatric anesthesia morbidity and mortality conference and journal club sessions. Additionally, residents participate in pediatric-specific simulation sessions at the University of Chicago’s in-situ simulation center at Comer.

Under the direct supervision of the pain faculty, residents acquire the tools to understand chronic pain and suffering and to tackle it in an effective and compassionate way. Anesthesia residents rotate for 3 months in the University of Chicago Pain Medicine Center. The 3 months are not consecutive but are spread over the 3 years of anesthesia training, 1 month each year. Residents spend approximately half of the time in the Pain Clinic and half of the time on the Anesthesia Inpatient Pain Service. During the time in the Pain Clinic, residents develop procedural skills and learn to evaluate complex chronic pain syndromes.

In an environment conducive to learning and with attending supervision, anesthesia residents practice technical skills as early as the third month of anesthesia residency during the chronic pain rotation. Residents participate in daily lectures on various pain topics and in multidisciplinary conferences within the institution and the Chicagoland area. Each month of the rotation in the Pain Clinic, residents improve their knowledge of common and uncommon pain syndromes. At the end of the rotation, they are able to diagnose (through a differential diagnosis algorithm) many pain syndromes and formulate a complex treatment plan with attending supervision. The pain syndromes include lower back, radicular, facet arthropathy, neck, myofascial, inflammatory, sympathetically mediated, cancer, neuropathic, and facial pain, including trigeminal and occipital neuralgia. Residents perform lumbar epidural steroid injections, lumbar facet intra-articular injections, lumbar medial branch nerve block, sacroiliac joint injections, trigger point injections, and joint injections of shoulder, knees, and hips.

All procedures in the pain clinic are performed using image-guided techniques such as fluoroscopy and ultrasound. Residents also may choose a pain elective in the third year. At this level, residents function on par with pain fellows and participate in more complex cases. They help diagnose complex pain syndromes such as complex regional pain syndrome, central sensitization, failed back surgery syndrome, chronic post-surgical pain, and phantom limb pain. During the elective rotation or during the last required chronic pain rotation, residents may participate in complex pain and surgical procedures; kyphoplasties; spinal cord stimulators (trials and implants), intrathecal drug delivery systems (trials and implants), radiofrequency ablations (medial branch, trigeminal, splanchnic), sympathetic chain blocks (stellates, celiac, lumbar sympathetic, superior hypogastric, ganglion impar).

The acute pain service (APS) experience is a two-week rotation within the month-long pain medicine rotation, though residents can elect more than one month of pain medicine. While on the APS, trainees have the opportunity to prevent and treat acute and chronic pain. As a consulting service, the APS provides postsurgical care for some of the most challenging and in-need patients in the hospital. Of note, it is one of the most utilized consult services in the medical center.

The APS uses a modern, progressive approach to pain management. Faculty members are board certified in pain medicine and experts in regional anesthesia. The APS can be a transition to outpatient pain management. All APS faculty also care for outpatients. The APS serves complicated patients in the pediatric and adult hospitals including the intensive care units, the burn units, wound rounds, and the preoperative and intraoperative care for complicated pain patients having surgery.

At the heart of the APS experience is an education in pain science. The pathophysiology of acute and chronic pain is the starting point for assessment and therapeutic planning. Residents learn the neurobiology of pain and the molecular mechanisms of pain, and the treatment of refractory pain. Clinically, therapies are selected in a pathway-targeted fashion and based on primary literature and clinical data. Optimizing the doctor-patient relationship is another key didactic component of the rotation. Appropriate treatment can only be identified after an individualized assessment followed by patient education and continued reassessment. 

At the University of Chicago, the APS provides a myriad of therapies that have the potential to improve a patient’s comfort and postoperative function. Residents learn the selection criteria, risks, and alternatives as well as the technique and its analgesic mechanism of action. The APS team performs a multitude of bedside and procedure suite-based rescue therapies for acute pain. The team utilizes a procedure cart linked to the electronic health record (pictured). Patient monitoring and data captured at the mobile station give staff immediate access to critical resuscitation medications and equipment. Some common procedures include:

  • Bedside ultrasound-guided transversus abdominis plane (TAP) and/or rectus sheath block via single shot or catheter.
  • Ultrasound-guided paravertebral blockade via single shot or catheter
  • Bedside adductor canal block via single shot or catheter after total knee arthroplasty
  • Bedside upper and lower extremity blockade for acute surgical pain via continuous catheter and or single shot
  • Bedside sympathetic blockade via ultrasound-guided block for cardiovascular symptomatology or sympathetic pain syndromes
  • Various peripheral nerve blocks for facial pain and headache
  • Continuous infusion therapies
  • Low dose ketamine outside of the ICU
  • Lidocaine infusion (ICU and OR only)
  • Bedside epidural placement
  • Sympathetic blockade for acute on chronic abdominal pain and pelvic pain
  • Neurolytic blocks for cancer pain
  • Intrathecal catheter placement for continuous therapy
  • Continuous peripheral nerve blockade for aggressive physical therapy

The APS faculty members serve on national committees for the specialty and subspecialty and contribute to several high-impact textbooks and journals. Faculty active conduct prospective research on acute pain, rescue blocks, patient-centered care, continuous peripheral neural blockade, and epidural training simulation. The APS faculty lead several medical center initiatives and committees for patient safety and access to novel and developing pain therapies. When not lecturing outside of the institution, the APS faculty members lecture on pain management in other departments. Several surgical care pathways have been shaped by collaboration with the APS. The many academic and clinical activities conducted by the faculty are available for residents and fellows. Motivated residents have written book chapters or review articles, presented scientific posters, and conducted clinical research with the faculty. The department’s rotation is a unique educational experience within anesthesia training.

Critical care is a strong fundamental offering in the core anesthesiology residency. The department has a longstanding tradition of excellence in critical care, managing three separate intensive care units (ICUs) in the hospital- Cardiothoracic, Surgical, and Burn. Residents can expect an intense and fulfilling experience managing the sickest patients in the medical center, learning firsthand about principles of resuscitation, invasive monitoring with central lines and pulmonary artery catheters, and complex physiology. 

Our cardiac surgery population ensures an enriching experience in the cardiothoracic ICU, including the complex management of devices (left or right vetricular assist devices, extracorporeal membrane oxygenation, and total mechanical heart), transplant patients, and various forms of shock. Residents emerge from the rotation confident in their understanding of the principles of cardiovascular physiology and therapy. The surgical ICU experience encompasses a wide variety of cases and care (septic shock, acute respiratory distress syndrome, heparin-induced thrombocytopenia), demonstrating the full trajectory of operative illness and building on a true perioperative care model, most recently emphasized in the concept of the perioperative surgical home. Our burn ICU goes even further. Here residents see intake and triage of thermal injury, resuscitation and subsequent debridements and grafting, and are directly involved in care through and after discharge. Residents become skilled at central line, arterial line, and temporary catheter placement fo dialysis patient by participating in central line training simulation taught by our ICU faculty, and by frequent opportunities for line placement in our busy ICUs. 

Our ICU faculty take pride in their teaching, which includes bedside rounds and regular didactics during the week. For anyone who has enjoyed case-based teaching of physiology, these rotations are a great way to build valuable skills in the ICU and operating room. Residents can expect their responsibilities to increase in tandem with their knowledge. As they proceed in their residency, the expectations in the ICU change to a broader oversight strategy. Our ICUs are a unique opportunity to learn how to manage many patients and even an entire ward at the same time. These rotations demand a lot of effort, but offer a truly galvanizing experience.

Research is also highly emphasized in our ICU section. Residents are encouraged to partake in research projects that are already IRB-approved, or to ask clinical questions and create their own IRB proposals to study clinical queries. These projects and IRB submissions are mentored by our ICU faculty. With faculty leadership in the Society of Critical Care Anesthesia and as editors of Anesthesia and Analgesia, writing opportunities for academic advancement are abundant. Residents are frequently invited to co-author review articles and book chapters or and present scientific abstracts at regional and national meetings. When academic efforts strengthen a CV, the resident is competitive in a fellowship match.

First- and second-year anesthesiology residents rotate for 2 months on obstetric anesthesia, where they participate in the clinical care of both healthy and high-risk parturients. Residents become skillful at providing analgesia for labor and delivery and anesthesia for operative obstetric procedures; they also learn the critical role the anesthesiologist plays in maternal safety. Residents undergo simulation training for the administration of general anesthesia for emergency cesarean delivery. Didactic sessions are conducted daily, and journal club, weekly. Multidisciplinary care is stressed, and residents take part in daily multidisciplinary rounds and monthly multidisciplinary morbidity and mortality conferences. Most CA-3 residents elect to spend an additional 1-2 months on the service, where they assume a largely supervisory role and take part in a transthoracic echocardiography curriculum. 

Residents will spend at least two months (two one-month rotations) administering anesthesia to patients undergoing a variety of cardiac surgeries including valvular repairs and replacements, aortic repairs, coronary artery bypass grafts, transcatheter aortic valve replacement, left ventricular assist devices, and extracorporeal membrane oxygenation. We do more robotic cardiac surgeries than any hospital in Illinois and have one of the busiest heart and lung transplant programs in the region. Our patients are sick and their pathophysiology is complex. Attendings are often assigned to only one cardiac room and make a concerted effort to spend most of the time in the operating room teaching. Lecture topics covered include invasive monitoring, hemodynamic management, cardiopulmonary bypass, arrhythmias, coagulopathy, inotropes, extracorporeal membrane oxygenation, balloon pumps, acid-base management, and much more. There is ample opportunity for perfecting procedure skills as nearly every patient needs an arterial line, central line, pulmonary artery, and transesophageal echocardiography (TEE). Because TEE is an integral part of our cardiac practice, residents also have the opportunity of doing a three-week rotation focusing solely on TEE. All of the cardiac faculty have passed the advanced TEE exam, and many of the clinicians have presented or are presenting at national echocardiography conferences.

The evolution of preoperative evaluation and management challenges training programs to educate practitioners who can function both inside and outside the operating room. Optimal preoperative assessment depends on the skills of physical diagnosis and patient assessment, personnel and business management, and an understanding of outcome-based research in this area. It is unrealistic to expect the next generation of anesthesiologists to manage administrative and clinical functions in perioperative medicine without adequate experience during residency training. The University of Chicago was one of the first programs to offer an academic experience in preoperative medicine to trainees in anesthesiology and surgery and to medical students. We see between 6,000-8,000 patients a year. We see approximately 40% of non-hospitalized adults having surgery. Most of our patients belong to the American Society of Anesthesiologists physical status class 3 or 4, which means they have severe systemic disease or a disease that is life-threatning. Primarily our medically complex patients are same-day admissions. A small number are pediatric in-, hospital, or ambulatory surgery patients. 

During the three clinical anesthesia years at the University of Chicago, a minimum of one month is spent in the Anesthesia Perioperative Medicine Clinic (APMC). This rotation is divided into 2-week segments in the CA-2 and CA-3 years. Successive experiences reflect increased responsibility and learning opportunities. Residents also can elect additional days in the APMC. Program objectives include physical assessment of the patient, interpersonal skills, effective communication, and working in a team-based clinic with medical assistants and physician extenders. An attending anesthesiologist with an interest in perioperative medicine staffs the clinic daily. Faculty publications define preoperative medicine in peer-reviewed journals and major textbooks of anesthesiology. Clinic faculty also maintain busy operating room practices, and many are dual trained in internal medicine, critical care, or pain management. The APMC evaluates patients who are referred by surgeons once surgery is scheduled or even before a decision is made to proceed with surgery is finalized. Practitioners and trainees collaborate with surgeons, oncologists, cardiologists and anesthesiologists in planning the best management perioperatively. The APMC at the University of Chicago is focused on training the next generation of physician experts and leaders in perioperative care.

Anesthesiology residents have the opportunity to rotate at Evanston Hospital, which is part of our affiliate institution NorthShore University HealthSystem. This rotation offers a unique community-based experience for residents. Evanston Hospital is a mid-size hospital with a busy operating room treating all ages and acuity of patients with a variety of surgeries. Biweekly didactics are offered covering a variety of topics including (but not limited to) oral board preparation, practice management, critical care topics and financial well-being of the physician. Every other month the residents present Journal Club keeping the group abreast of the current hot topics of anesthesia. NorthShore has a 13,000 square foot state-of-the-art simulation lab, the Grainger Center for Simulation and Innovation. NorthShore is currently the only non-university hospital certified for maintenance of certification courses in anesthesia (MOCA). Residents participate in simulation cases during their NorthShore rotation focusing on rare critical events that are encountered in the operating room and how to treat them. 

CA-2 residents assigned to NorthShore spend two consecutive months there: one month focusing on OB anesthesia and one month focusing on neuroanesthesia. Residents participate in managing a busy OB service and gain experience with a diverse patient population from straightforward deliveries to high-risk complicated ones. Neurosurgical cases include both open and interventional intracerebral cases and a busy spine service. 

A CA-3 can choose NorthShore as an elective rotation. Case requests are encouraged at NorthShore. There is an opportunity to manage complex patients before launching a successful career.