The cardiothoracic anesthesia rotation exposes residents to anesthetic management of a variety of cardiac surgeries including coronary bypass surgeries, valvular repairs and replacements, aortic repairs, vascular surgeries, and intra-thoracic cases.  Residents develop a solid understanding of cardiac anesthesia and the steps to go on/off cardiopulmonary bypass.  However, given our complex patient population, residents not only learn the basics of cardiac anesthesia but also how to manage the myriad of other conditions during bypass.  Our cardiac attendings are assigned to one cardiac room per day which allows for direct resident teaching every day.  Residents learn how to place arterial lines, central lines, pulmonary artery catheters, and perform intraoperative transesophageal (TEE) for each patient.

Residents also participate in thoracic cases involve wedge resections, lobectomies, pneumonectomies which are either preformed open, thoracoscopic or robotic. During these cases the resident will learn placement and management of double lumen tubes, one lung ventilation, and invasive monitoring. Major vascular cases include carotid endarterectomies, major aortic surgery (AAA) and all different kind of vascular bypass surgeries.

Transesophageal Echocardiography

TEE is an integral part of our cardiac practice and is an invaluable tool for the general anesthesiologist when patients are decompensating intra-operatively.  Residents are assigned to a two week TEE rotation prior to the cardio-thoracic anesthesia rotation.  During this block, residents complete an online course with several didactic lecture and learning modules.  Additionally, they can practice obtaining various images on the TEE simulator with a dedicated echo attending.  During this rotation, residents are an integral part of the cardiac team and participate in all intra-operative TEE and any hospital based inpatient TEE/TTEs with our hospital cardiologists.

Residents also participate in several off-site cardiac services:

1. TAVR Thursday: In addition to the open heart cases we perform multiple transcatheter aortic valve replacement (TAVARs), balloon valvuloplasties and left atrial appendage occlusion devices (watchman procedure) every Thursday in our hybrid OR. We also participate in laser lead extractions in the hybrid OR for removal of infected or broken defibrillator and pacemaker leads which require a general anesthetic with invasive monitors including placement and interpretation of TEE.
2. Cardiac Catheritization Lab: We have a very active electrophysiology program and there are ample opportunities to take care of patients undergoing cardiac ablation procedures for supraventricular and ventricular arrhythmias in the cath lab. We also participate in laser lead extractions.  It is critical for our residents to gain experience in these areas of care as general anesthesiologists routinely manage these patients throughout their career.
3. Loyola: After completing the echo rotation, one month cardio-thoracic rotation, and one month of liver anesthesia, our residents rotate through Loyola Medical Center CV Anesthesia for one month of operating room anesthesia and one month of cardiovascular ICU.  Loyola performs some of the most complex CV cases in Chicago.  We are fortunate to draw on the strengths of Loyola and expose our residents to their expertise in CV care.  Our residents are well versed in cardiovascular care and get to develop their skills further in this complex environment.

Didactics:

1. Daily Intra-operative teaching.
2. Monday/Tuesday Subspecialty Cardio-Thoracic Conference. Residents on this rotation have specialized lectures from the CV faculty on topics including: invasive monitoring, hemodynamic management, cardiopulmonary bypass, coagulopathy, inotropes, extracorporeal membrane oxygenation, balloon pumps, ventricular assist devices, and much more.

The University of Illinois at Chicago’s transplant program was established in 1968 and has performed more than 2,000 transplant surgeries of the kidney, liver, kidney-pancreas, pancreas, and small bowel. Our transplant program has achieved the highest rates of patient and graft survival in 2009 for kidney, kidney/pancreas, and liver transplant in Illinois despite a very challenging case mix as documented by the latest official release from UNOS. The University of Illinois Medical Center’s one-year adult patient survival rates were 100 percent for kidney-pancreas transplantation, 98 percent for kidney transplantation, and 89 percent for liver transplantation. The one-year graft survival rates were 100 percent for kidney-pancreas transplantation, 96 percent for kidney transplantation, and 85 percent for liver transplantation. These successful results can be attributed to many factors, and the anesthetic and perioperative management has an important role.

During the four week rotation, teaching will be one-on-one by anesthesiologists from the liver team. An orientation regarding the OR set-up and overview of anesthesia for liver transplantation will be done before the rotation. A manual containing the most pertinent articles regarding liver transplantation is distributed by the first day of each rotation. Residents are required to finish reading it–and understand it—by the end of the rotation.

Upon completing this rotation, CA-2 residents should have a basic understanding of a liver transplant patient starting from preoperative evaluation until the postoperative period. The resident should be able to conduct anesthesia for a straight forward liver transplantation, hepatic resection, portal-caval shunt, and bile duct reconstruction.

Residents will place invasive monitoring on patients with end-stage liver disease and will manage massive blood loss using different modes of transfusion, such as the rapid infusion pump and cell saver. The resident will manage coagulation changes with blood products as well as using pharmacological intervention as needed. Residents will be able to use preventive measures for hypothermia in patients undergoing prolonged surgeries and will manage acid/base and electrolyte abnormalities. The resident will safely transport the patient and transfer care to the ICU team.

During the liver rotation, residents will:

1. discuss the pros and cons of use of veno-veno bypass, and gain knowledge of alternate techniques when bypass is not used;
2. discuss and describe post-reperfusion injury;
3. discuss the special medical issues related to patients with end stage liver disease and the impact of liver disease on hemostasis;
4. discuss indications for and uses of various inhalation and intravenous anesthetics in transplantation patients.

All the preoperative evaluations and transplant cases done are discussed in detail with the residents. Residents have the option to come to the Liver Transplant meeting and observe the process of listing the patients on the transplant list. The resident will have the opportunity to read and prepare a short topic related to anesthesia for liver transplantation. All residents are encouraged to take another month of the liver transplant anesthesia rotation during the CA-3 year. Residents taking a CA-3 elective in this area will be required to operate with more independence than in the CA-2 year, and will provide care in more difficult or complex anesthesia procedures, and care for more seriously ill patients

Liver anesthesia team faculty:

Katharina Beckmann, MD
Marina Gitman, MD
Hokuto Nishioka, MD
Nikki Wilkinson, MD

Our residents are immersed in the ICU experience in several arenas. Our aim is to have our residents experience a variety of patient pathologies while preparing them for acquiring knowledge for anesthesia practice, critical care medicine, and future exams. We are committed to following ACGME standards to assure that our residents have involvement in the care of critically-ill patients.

Our residents start during their intern year on the Medical ICU service where they are part of a multi-disciplinary team that rounds on some of the sickest patients in the hospital. Further experience is gained in the CA-1 year with rotations in the Surgical ICU, where the resident experiences taking care of a wide range of post-surgical patients and related complications. To complement our experience with cardiac anesthesiology at Loyola University Medical Center, our senior residents spend one month in the Cardiothoracic ICU taking care of post-surgical cardiac, thoracic, and vascular patients. Overall, they gain knowledge and skills in medicine, surgery, professional acumen, system-based learning, and team dynamics.

Patient care involves pathologies in sepsis, acute respiratory failure, COVID-19 illness, acute kidney injury, liver failure, vasculopathies, opportunistic infections in immunocompromised, oncology, leukemia, sickle cell disease, stroke, post-kidney transplant, post-liver transplant, post-LVAD, post-heart transplant, post-lung transplant, and ECMO.

Residents work with other residents from Medicine, Surgery, and Emergency Medicine. They also work with other attendings from other specialties such as Pulmonary, Surgery, and other off-site anesthesia departments. There is future consideration for a rotation in Neuroscience ICU to complement our experience in neuroanesthesia.

Our intensivists are board certified and fellowship trained from institutions such as University of Chicago, Northwestern University, and University of California San Francisco.

he Pediatric Anesthesia experience at UIC includes a rich and diverse exposure to two very different pediatric hospital environments: UIC Children’s Hospital within a Hospital and Shriners Hospital for Children Chicago.

At UIC hospital, residents participate in the full spectrum of pediatric surgical care, from 1kg NICU babies with patent ductus arteriosus or necrotizing enterocolitis to infants with Pierre Robin requiring mandibular distraction, spanning all the way up to obese adolescents with obstructive sleep apnea and tonsillar hypertrophy. With abundant occasions to anesthetize children needing both routine and complex orthopedic, ophthalmologic, otolaryngologic, craniofacial, dental, general surgical, and urologic care, residents learn to fine-tune their manual dexterity and procedural skillset, with placement of small IV and arterial lines, management of challenging airways, and performance of caudal epidural blocks.

At Shriners Hospital for Children Chicago the experience is vastly different but certainly no less stimulating. Shriners is an internationally renowned children’s plastics and orthopedic surgical hospital. It remains one of the world’s greatest medical philanthropic organizations, of which we at UIC are enormously privileged to be a part. Residents rotating at Shriners will have the unique opportunity to care for pediatric patients possessing rare and complex pathology such as neuromuscular scoliosis, arthrogryposis, muscular dystrophy, cleft lip and palate, cerebral palsy, osteogenesis imperfecta, myelomeningocele, spinal cord injuries, and a multitude of craniofacial syndromes resulting in extremely difficult airways. The anesthetic planning for these involved procedures is complex and richly nuanced, often incorporating residents’ growing familiarity with advanced airway equipment and use of ultrasound for regional anesthesia techniques and vascular access.

A committed division of ten fellowship trained and subspecialty board certified pediatric anesthesiologists enthusiastically guide residents through the rotation, with a dedicated morning lectures series 2-3 times a week as well as defined intraoperative topics discussed throughout the day. Our pediatric faculty encourage rotating residents to engage in quality improvement projects and enjoy serving as mentors for abstracts and posters on interesting pediatric cases at national pediatric anesthesia conferences. Several members of our division also participate in international mission trips and facilitate inclusion of interested residents when openings arise.

The Division of Obstetric Anesthesia is responsible for the anesthetic services in the Labor and Delivery suite and the pre-anesthetic evaluations for pregnant patients undergoing both obstetric and non-obstetric procedures at the University of Illinois.

Our labor and Delivery suite provides abundant learning opportunities. The busy labor suite includes eight delivery rooms and two operating rooms. There are approximately 3,000 deliveries per year and a diverse patient population, ranging from the uncomplicated laboring women to the critical care of high–risk parturients. In the past year, we have been involved in the care of women with severe pre-eclampsia, HELLP syndrome, thrombocytopenia, ARDS, Swine flu, severe cardiomyopathy and left ventricular dysfunction, abnormal placental implantations including placenta percreta, amniotic fluid embolism, post partum hemorrhage, achondroplasia, vaginal births after cesarean delivery, conjoined twins, triplets, quadruplets, and the super morbidly obese, just to name a few of the more challenging medical conditions. Despite this, our Cesarean Section rate remains below 30% and our labor epidural rate exceeds 60%.

During the four-week rotation, residents spend two weeks on a day float schedule learning the basics of labor analgesia and surgical obstetric anesthesia, most often working one on one with an anesthesiology attending. The last two weeks of the rotation is a night float because as we know the laboring patient never sleeps. Residents become proficient in performing neuraxial techniques including spinals, epidurals, and combined spinal-epidurals, far exceeding ACGME requirements for those procedures.

By being mindful and present in Labor and Delivery, we have built a great relationship with the Obstetrics/Gynecology department, which promotes a collegial relationship between all members of the Labor and Delivery team. We attend morning board report. Here we can discuss complicated patients, formulate treatment plans, and learn and offer the best care for our patients. In addition, OB anesthesia-related journal club and focused lectures help residents develop a solid foundation of knowledge. We also participate in the Illinois Department of Public Aid Maternal Hemorrhage project which requires each member of the anesthesiology department to attend lectures, undergo simulation training, and complete competency testing on the management of maternal hemorrhage. Upon completion of their rotation, residents are confident with all forms of neuraxial anesthesia and perioperative care of parturients.