A wide range of clinical experience in cardiothoracic anesthesia is offered at UNMC. Residents become skilled and knowledgeable in caring for patients undergoing coronary revascularization, valvular replacement, thoracic operations. Experience and expertise is gained in placement and interpretation of hemodynamic monitoring and Transesophageal ECHO. UNMC provides the majority of adult caseload experience. UNMC performs 400-500 heart operations per year. The Veterans Affairs Medical Center offers further training in major vascular and thoracic anesthesia. Children's Hospital performs more than 125 Pediatric open heart cases a year, allowing residents to care for critically ill pediatric patients with complex congenital heart lesions.
UNMC is one of the world's foremost organ transplant centers, where liver, lung, pancreas, kidney, bowel and bone marrow transplants are performed. The liver transplant program started in July 1985 and has since become one of the nation's top ten transplant programs. UNMC performs approximately 100-120 liver transplants a year, totaling more than 2,000 since the program began. One-fourth of these are pediatric liver transplants, including living-related. UNMC also performs living-related kidney transplants. Clinical and lab research in this area is available. UNMC performs 100 kidney, pancreas and/or kidney-pancreas transplants per year. The residents' exposure to these cases significantly enhances their training and management of critically ill patients.
The department supports a skull base surgery team for the care of acoustic neuromas, skull based tumors, intracranial to extracranial mass lesions, interventional neuroradiology cerebral aneurysm clipping, and seizure foci ablation. At the completion of their training, residents are comfortable with the management of high risk neurosurgical procedures.
The obstetric anesthesia subspecialty rotation emphasizes the management of high risk and normal pregnancies. Residents are taught an understanding of the physiologic changes during pregnancy, providing a basis for the care of these patients. During the two month rotation, both the academic and practical aspects of centroneuraxis anesthesia for labor and delivery are emphasized. The Clarkson and University Obstetrical services are merged for Anesthesia coverage which has greatly increased our volume of procedures.
The division of Pain Medicine of the Department of Anesthesia encompasses four components: the Chronic Pain Clinic, the Pain Management Center, the Acute Pain Service and the Cancer Pain Service. The Pain Service stresses a multidisciplinary approach to pain management and has on staff two clinical psychologists, two physical therapists and three full-time nurses. The invasive approach to treatment is a major component of this rotation and includes placement of a variety of nerve blocks.
Acute Pain Service
The primary goal of this service is quality management of peri-operative pain with an emphasis on neuraxial and regional techniques. After surgery, patients are closely followed by the APS team who round on patients daily. Anesthesiology residents learn to diagnose and manage peri-operative pain in all types of surgical and non-surgical patients. They also learn to identify patients who will benefit from neuraxial and peripheral nerve blocks and receive intensive training in regional techniques. The Acute Pain Service also provides education to physicians, nursing staff, patients and their families on pain physiology and pain control.
Approximately 20% of surgical cases done at University Hospital are pediatric. A wide spectrum of experience and knowledge is gained in caring for a diverse pediatric population that ranges from healthy ambulatory cases to the critically ill transplant recipients. With a 34-bed neonatal intensive care unit, numerous surgical procedures are done each year on premature infants. Residents receive an additional two months of pediatric training at Children's Memorial Hospital.
Critical Care Medicine
Critical care medicine exposure at UNMC is comprised of rotations in the adult, neonatal and pediatric intensive care units. Anesthesiology residents gain extensive experience in the primary care of critically ill patients, under the guidance of the adult pulmonary team that runs the Intensive Care Unit. Residents benefit from daily teaching rounds and conferences held two to four times a week.
The Department of Anesthesia at UNMC is a regional referral center for malignant hyperthermia. James Chapin, MD is a MHAUS (Malignant Hyperthermia Association of the United States) Hotline Consultant who volunteers four weeks a year to staff the nationwide 24-hour hotline.