Rotations
The Anesthesia Residency Program at Boston Medical Center – Brighton (BMC Brighton), offered by the Department of Anesthesiology, Critical Care, and Pain Medicine, provides an excellent educational and clinical environment to facilitate the learning, critical thinking, clinical knowledge, and procedural skills expected of a consultant in anesthesia that translate to the operating room, critical care unit, pain management center, medical subspecialty procedural unit, and emergency room.
Specialized one-month rotations include cardiac, major vascular, thoracic, and vascular anesthesia; obstetric anesthesia; pain management; critical care; orthopedic and neuroanesthesia; post-anesthetic care; pediatric anesthesia; and ENT and offsite anesthesia.
Cardiac Anesthesia
The Cardiac Anesthesia Service at BMC Brighton provides intraoperative care to 700 to 800 patients annually. Our service, with two dedicated operating rooms, specializes in adult cardiac surgical procedures. We have a challenging case mix, including coronary bypass, valve repair and replacements, and emergent reoperative procedures. Our patients are primarily high-risk with multisystem disease.
Our cardiac case mix includes multiple arterial bypass grafts, combined bypass-valve procedures, off-pump coronary artery bypass procedures (OPCAB) and mini-thoracotomy bypass (MIDCAB).
In conjunction with our interventional cardiology colleagues, we have a robust minimally invasive percutaneous aortic valve replacement program which includes transfemoral, transapical, and transaxillary approaches.
Our structural heart program includes MitraClip and Watchman atrial appendage exclusion devices. We utilize invasive monitors, including pulmonary artery catheters and intraoperative transesophageal electrocardiography (TEE) on almost all cardiac procedures.
Staff anesthesiologists are assigned one-on-one to residents for each cardiac surgical procedure. The junior residents (CA-1 and CA-2) have a two-month rotation in cardiac anesthesia. They are expected to evaluate all assigned cases and discuss them preoperatively with staff members.
At the end of this rotation, the resident should be facile with the insertion and use of pulmonary artery catheters and comfortable with the principles of hemodynamic management of cardiac surgical patients.
CA-3 residents demonstrating a keen interest in cardiovascular anesthesia have an opportunity to select additional clinical time in cardiac anesthesia. All residents are expected to be well versed in cardiac physiology and pharmacology, the management of CPB, and understand the principles of myocardial preservation. Residents can expect to develop a basic understanding of intraoperative tracheoesophageal echocardiography.
Obstetric Anesthesia
BMC Brighton’s Division of Obstetrics (historically, St. Margaret’s Center for Women and Infants) treats about 900 routine and high-risk parturient patients from eastern Massachusetts. Residents are exposed to many patients with pregnancy-induced hypertension, multiple gestation, prematurity, diabetes, and other medical and obstetrical comorbidities.
BMC Brighton provides full training in obstetric anesthesia. New residents are taught the physiologic and pharmacologic characteristics of parturient patients.
CA-1 residents are assigned to the obstetric suite for a one-month rotation during which they administer all the anesthetics requested. Lectures and case conferences on obstetric anesthesia take place throughout the year. All residents have additional experience in administering obstetric anesthetics as part of their on-call responsibilities during their tenure at BMC Brighton.
Most cesarean sections are performed with the patient under spinal anesthesia, whereas most of the vaginal deliveries in which anesthesia is used involve an epidural block.
Pain Management
BMC Brighton’s Center for Pain Management is a comprehensive pain center providing services for patients with acute, chronic, non-malignant and malignant pain. Residents and fellows have the opportunity to treat chronic pain patients through the use of multiple interventional modalities with a goal of minimizing chronic narcotic use. Residents and fellows become familiar with applying the appropriate modalities to reduce and control the pain associated with their underlying conditions.
Training in chronic pain management in the outpatient center includes the expertise from specialties of anesthesiology, Physical Medicine & Rehabilitation (PM&R), neurology, and psychiatry. Patients are provided with an individualized pain management treatment plan after a comprehensive review has been completed.
Our services and treatments include:
- Comprehensive assessments for determination of treatments that focus on attaining positive long-term outcomes.
- Emphasis on interventional pain therapies with minimal systemic narcotic use.
- State-of-the-art fluoroscopic- and ultrasound-guided spinal, peripheral nerves, and joint injections for diagnostic and therapeutic applications.
- Spinal cord stimulation trials and implants to treat failed back surgery syndrome and complex regional pain syndrome.
- Peripheral nerve stimulation trials and implants to treat various neuropathies.
- Minimally Invasive Lumbar Decompression (Mild®) procedures used for patients who have significant lumbar spinal stenosis due to thickening of the ligamentum flavum, or ligaments of the spine.
- Platelet-Rich Plasma (PRP) injections for degenerative disc disease, facet joint pain, and low back pain, as well as for painful muscles, shoulders, and knees.
Critical Care/Intensive Care
Residents are scheduled for two one-month rotations during the second year, with an additional month in the third year if desired. One month is located at BMC Brighton and one at the Beth Israel Lahey Hospital and Medical Center (“Lahey Clinic”), located approximately in Burlington, Massachusetts, approximately 15 miles from BMC Brighton.
These ICU experiences offer a stimulating educational environment for fellows, residents, medical students, nurses, and paramedical personnel. The anesthesiology resident rotation is specifically designed to provide a broad clinical experience in the care of the critically ill surgical and injured patients. The educational program consists of daily bedside teaching with an emphasis on POCUS skills, organized didactic lectures, and directed study, utilizing recommended texts and an assigned reading list.
On completion of the rotations, the resident will have acquired the fundamental knowledge and technical skills necessary to diagnose and manage acute life-threatening single-organ dysfunction, as well as complex multisystem failure.
Neuroanesthesia
During their second year of training, residents acquire two months of neuroanesthesia training: one month at Lahey and one month at either Massachusetts General Hospital or Merrimack Health Methuen Hospital (previously Holy Family Hospital).
Ample experience is offered in providing anesthesia for intracranial tumors, aneurysms, shunts, and other neurosurgical procedures. In addition, the resident will gain experience caring for interventional neurovascular radiology procedures such as catheter-based treatments for intracranial aneurysms and arteriovenous malformations.
Residents will also care for patients having complex spine surgery, including scoliosis repairs and multilevel hardware instrumentation using somatosensory-evoked potential (SSEP) and motor-evoked potential (MEP) monitoring.
Post-Anesthesia Care
A structured one-month post-anesthesia care experience combines direct patient care in the post-anesthesia care unit, ambulatory surgical unit, and intensive care units with responsibilities for management of acute postsurgical pain, postoperative nausea and vomiting, hemodynamic compromise, and emergencies related to the post-anesthesia care patient.
Pediatric Care
Anesthesia residents rotate to Boston Children’s Hospital for two one-month rotations.
Residents work with pediatric anesthesiologists and fellows on cases that range from simple outpatient ENT and urologic procedures to complex repairs for congenital heart disease to neonatal congenital emergencies.
Additional months are available to residents who seek further pediatric experience.
Ear, Nose, and Throat (ENT) Care
A one-month elective is offered at Massachusetts Eye and Ear. Residents work closely with highly specialized staff on complex ear, nose, and throat (ENT) surgeries as well as eye surgeries.
Additional pediatric experience is also a large component of this rotation.