The University of Colorado Chronic Pain Clinic serves outpatients with chronic pain in a multi-specialty environment. The service also provides consultations on complex inpatients and closely collaborates with the Acute Pain Service in the care of such patients. There is a formal weekly didactic lecture as well as daily bedside teaching. Residents spend a 1-month rotation in the clinic with the opportunity for additional rotations based upon interest and availability. Our Pain Medicine Clinic sees over 100 new patients per month and performs approximately 3,500 procedures annually. Residents will work side-by-side with Pain Medicine fellows and have ample opportunities for hands-on learning of diagnostic and therapeutic procedures including nerve blocks, musculoskeletal injections, neurolytic procedures, spinal cord stimulation and other analgesic techniques.

Children's Hospital Colorado in Aurora, CO is a standalone all pediatric facility. It is highly ranked nationally in 9 pediatric specialties. Children's Hospital Colorado is a 486-bed children's general facility with 17,547 admissions in 2016, and performed 6,372 annual inpatient and 11,289 outpatient surgeries. It is a level I pediatric trauma center with a full range of pediatric surgical specialists. Children’s Hospital Colorado also includes pediatric cardiac surgery and fetal surgery programs. Our state of the art hospital features award winning neonatal and pediatric intensive care units, as well as a maternal-fetal center.

The pediatric anesthesia specialty rotation takes place at the Children’s Hospital Colorado during the CA2 year where residents have a very wide range of exposure to different case types. Residents have frequent exposure to surgical procedures which include neonatal cases, high-risk spine fusion cases, neurosurgery, general surgery, radiology, urology, and otolaryngology. Residents will care for a diverse population of pediatric patients, ranging from medically complex to healthy children undergoing outpatient procedures. Case numbers for pediatric anesthesia cases are consistently above the national average. There are also additional opportunities to be exposed to pediatric cardiac surgery, critical care transport, acute and chronic pain management. 

University of Colorado Anesthesiology Residents will rotate on the Obstetric Anesthesia service for at least 2 months, usually as CA-2 and CA-3 residents. There are approximately 3800-4000 deliveries annually at University of Colorado Hospital, of which a significant percent are “high risk” and over 75% receive some form of labor analgesia. The cesarean delivery rate is approximately 28% of which over 95% are performed under neuraxial anesthesia. Residents rotating on labor and delivery will gain experience and competence in assessment of both low and high-risk parturients, methods of non-neuraxial labor analgesia, neuraxial analgesia and anesthesia techniques such as combined spinal-epidurals, and strategies for effective maintenance of labor analgesia. On a typical rotation, residents participate in multidisciplinary team meetings, high-risk patient consultations and simulations of obstetric emergencies. The core faculty of 5 fellowship-trained obstetric anesthesiologists oversee the daily educational activities as well as the clinical service management. There is also significant exposure to the expertise of a small group of advance practice providers that spend a majority of their clinical time providing obstetric anesthesia.

 

The Cardiothoracic Anesthesia rotation takes place at The University of Colorado Hospital where residents learn how to provide anesthesia for cardiac and thoracic operations. Residents will be exposed to the following: 

• Management of patients requiring CPB, mechanical circulatory assistance, and ECMO
• Anesthesia for heart transplantation
• Major thoracic aortic operations
• Endovascular aortic repair (TEVAR and EVAR)
• Complex thoracoabdominal aortic surgery
• Transcatheter aortic valve replacement (TAVR)
• CPB with circulatory arrest
• Operations for arrhythmias 
• Invasive monitoring - PA catheterization, TEE
• Anesthesia for single and double lung transplantation
• Bronchoscopy 
• Techniques of lung isolation utilizing double lumen endotracheal tubes and bronchial blockers
• Management of single lung ventilation in patients with significant pulmonary pathology and limited pulmonary reserve 
• Perioperative management of thoracic patients undergoing open thoracotomies and VATS procedures including pulmonary resections, esophagectomies and mediastinal operations
• Complex tracheal reconstructive surgeries, including tracheal resection and tracheoplasty
• Pain management techniques including thoracic epidurals, and paravertebral blocks 
• Management of interventional pulmonary procedures needing fiberoptic and rigid bronchoscopy 

Critical care education includes rotations in both the University of Colorado Hospital Cardiothoracic Intensivist Care Unit (CTICU) and Surgical Trauma Intensive Care Unit (STICU). The CTICU is a 24-bed unit that admits patients from cardiac, thoracic, and vascular surgical services. Common diagnoses include patients undergoing CABG, valvular and aortic repair, mechanical circulatory device placement, VV and VA ECMO, thoracotomy, esophagectomy, and open vascular procedures. The STICU is a 24-bed unit admitting patients from all other surgical services and obstetrics. Common diagnoses include trauma, pancreaticohepatobililary and acute care surgery, and liver transplantation. Both units are led by Medical Directors from the Department of Anesthesiology. Daily multidisciplinary rounds includes medical students, residents, fellows, respiratory therapists, dieticians, pharmacists and faculty intensivists. Resident education includes daily lectures and a comprehensive online curriculum. 

The rotation with the Acute Pain Service and University of Colorado Hospital exposes residents to a variety of analgesic procedures, multimodal medications and daily management of the perioperative patient. There will be a heavy exposure to thoracic epidural and ultrasound guided nerve blocks. Interdisciplinary communication, medication management, opioid sparing, and catheter management will be emphasized. The rotation will also impart pharmaceutical and procedural safety, contraindications and complications. Residents will gain considerable confidence in regional procedures such as:

•  Neuraxial analgesia

- Thoracic Epidural, Intrathecal opioid 

•  Upper Extremity/Brachial Plexus

- Interscalene

- Supraclavicular

- Infraclavicular

•  Lower Extremity

- Femoral – Inguinal Crease, Adductor Canal

- Sciatic – Infragluteal, Popliteal

•  Truncal

-  PECs, TAP/QLs and Paravertebral

The residents are supervised and instructed by faculty members with expertise in regional anesthesia. There will also be significant exposure to the knowledge of Regional/Acute Pain Fellows, NPs and PAs.

In the typical rotation, there will be 2-3 residents. One resident covers the Pain Rounding Service with a dedicated attending; the remaining residents cover the Regional Service with the APS attending. This will alternate to create equal exposure. In addition, several didactic lectures, a chance to experience the cadaver lab and attend the monthly journal club will be part of the Acute Pain Service rotation.

 

The neuroanesthesiology rotation includes at least two months of exposure to a variety of neurosurgical and spine procedures. Rotations take place at the University of Colorado Hospital, a high complexity referral center. The neurosurgery and spine services at the University of Colorado hospital take care of over 2700 cases a year, providing the residents with the unique opportunity of gaining experience in a wide-variety of neurosurgical and spine procedures. Residents become skilled in performing preoperative assessments of patients with neurological, neurosurgical diseases, and spine pathology; developing and executing appropriate anesthetic plans including monitoring techniques and provide perioperative management for these patients. The residents are supervised and instructed by neuroanesthesiology faculty members. 

Procedures include:

1. Craniotomy for supratentorial masses including awake craniotomy
2. Posterior fossa craniotomy
3. Stereotactic surgery 
4. Complex cerebrovascular procedures
5. Functional neurosurgery including epilepsy and movement disorders
6. Neuroendocrine procedures
7. Head trauma
8. CSF shunting procedures
9. Spinal cord and spinal column surgeries including injury
10. Intraoperative electrophysiologic neuromonitoring

The Non-OR Anesthesia rotation (NORA) is an advanced CA-3 year rotation that focuses on gaining consultant level knowledge, and becoming familiar with the unique limitations present in providing safe and optimal patient care in a geographically remote site. More and more minimally invasive procedures are being performed outside of the OR on individuals that are deemed too risky for open procedures, and therefore the demand for our expertise as anesthesia providers in these locations is on the rise. Residents will apply core competencies of preoperative assessment, medical optimization, anesthetic selection, intraoperative management, crisis management, post-anesthetic care, and interdisciplinary communication all within the remote setting from central anesthesia services.

During this two-week rotation, residents will spend time in each of the following areas with supervision from both general and cardiac anesthesiologists:

• EP suite/Interventional cardiology: TEE/cardioversion, pacemaker placement/testing, EP studies, EP ablations, mitral valve clippings, LAAO/watchman, etc
• Endoscopy suite: Luminal (EGD, colonoscopy, EMR), High-tech (ERCP, EUS, SBE), etc
• Interventional radiology/Neuroradiology: TIPS, PTBD, neuroembolizations, AVM therapies, PE lysis, etc
• CT and MRI: standard imaging, MSK ablations, cryoablations, etc
• Interventional pulmonology: therapeutic and diagnostic bronchoscopies​

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The resident Transplant rotation at the University of Colorado Hospital is a dynamic experience. Work hours, caseload and number of procedures is highly variable. However, residents will gain significant knowledge in the management of patients with end stage liver and kidney disease, with an opportunity for a generous amount of invasive monitoring placement. Residents will gain experience in massive transfusion, coagulation management, intra-operative hemodialysis and trans-esophageal echocardiography.

The rotation is staffed with 1-2 residents per rotation. The cases consist primarily of liver and kidney transplants and major liver resections. Pancreas transplants are rare at our institution, but we make every effort to include our residents when the case is available. Attending faculty presence is high on this service and we are very actively involved in your education.​