Clinical Sections

Perioperative and Adult Anesthesia

Orthopedic & Regional Anesthesia

There is perhaps no other subspecialty of anesthesia requiring a greater variety of anesthetic techniques than orthopedic anesthesia. As an alternative to a general anesthetic, many procedures in orthopedic patients may be better managed with regional anesthesia or with combined regional/general anesthetic techniques.

While providing care to patients undergoing orthopedic surgery, anesthesia residents deal with an elderly population suffering from severe co-existing cardiovascular or pulmonary diseases. In addition to requiring familiarity with a number of regional anesthetic procedures (i.e., spinal, epidural, and major nerve blocks), orthopedic anesthesia is demanding. It requires a high degree of technical skills and familiarity with other anesthetic techniques, such as fiberoptic intubation for complex airway problems or patient positioning to avoid intraoperative nerve injury. Also, residents on this service learn how to manage induced hypotensive anesthesia, isovolemic hemodilution and cell saver techniques, all of which serve to reduce perioperative blood loss and decrease the need for perioperative blood transfusion.

In addition to general anesthesia, residents dealing with orthopedic surgical procedures will have a wealth of opportunities to learn various regional anesthetic techniques such as central neuraxial (spinal and epidural) anesthesia; upper extremity blocks (axillary, supraclavicular or interscalene approaches to the brachial plexus); lower extremity blocks (femoral/sciatic, popliteal ankle); and peripheral nerve blocks (median, ulnar, radial, peroneal). As a complement to the vast clinical exposure, residents are also encouraged to develop their own clinical investigations, or to participate in ongoing clinical or laboratory studies.