Academic Prospectus

The fellow should acquire a basic fund of knowledge in the following areas by the end of the fellowship.

  1. Maternal physiologic changes during pregnancy
    1. Cardiovascular system
    2. Respiratory system
    3. Acid-base balance
    4. Gastrointestinal system
    5. Hepatic system
    6. Neurologic system
    7. Renal system
    8. Hematologic system
  2. Uterine blood flow
    1. Changes during pregnancy
    2. Effects of local/general anesthesia
    3. Effects of vasopressors/antihypertensives
  3. Maternal uptake/distribution, placental drug transfer, and perinatal effects (including neurobehavioral effects and transfer of drugs into breast milk) of:
    1. Volatile anesthetics, barbiturates, ketamine, muscle relaxants, narcotics, sedatives, tranquilizers, and scopolamine and their effects depending on the route of administration (i.e. intravenous, intramuscular, etc.)
    2. Local anesthetics
    3. Antihypertensives
    4. Anticoagulants
    5. Tocolytics
    6. Hypoglycemics/glucose administration
  4. Physiology of labor
    1. Stages of labor
    2. Effects of analgesia and anesthesia on labor
    3. Suppression of preterm labor. Describe mechanism(s) of action and the anesthetic considerations of:
      1. B-sympathomimetics
      2. Magnesium channel blockers
      3. Calcium channel blockers
      4. Prostaglandin synthetic inhibitors
      5. Ethanol
      6. Progestational agents
    4. Dystocia
      1. Fetal
      2. Maternal
      3. Diagnosis/management
    5. Induction/augmentation of labor
      1. Amniotomy and its anesthetic considerations
      2. Oxytocin and its anesthetic considerations
      3. Prostaglandins and their anesthetic considerations
      4. Ergot derivatives and their anesthetic considerations
  5. Local anesthetics
    1. Basic structure, properties, and mode of action of:
      1. Lidocaine with/without epinephrine
      2. Bupivacaine
      3. Mepivacaine
      4. Choloroprocaine
      5. Tetracaine
      6. Ropivacaine
    2. Maternal absorption and placental transfer, including prevention and treatment of central nervous and cardiovascular system toxicities.
  6. Inhaled anesthetics and ketamine
    1. Uptake and distribution during pregnancy
    2. Inhalational analgesia/anesthesia and its maternal and perinatal effects
    3. Ketamine maternal and perinatal effects
  7. Use of paracervical, pudendal, and perineal infiltrative blocks
    1. Anatomic landmarks
    2. Commonly used drugs
    3. Associated maternal and fetal complications
  8. Basic concepts of major regional anesthesia in obstetrics
    1. Vertebral column anatomy
    2. Regional blocks
      1. Cardiovascular effects
      2. Respiratory effects
      3. Spinal dermatomes
      4. Pain pathways
    3. Indications and contraindications, including:
      1. Coagulopathy
      2. Neurologic diseases
      3. Hypovolemia
      4. Drug allergy
      5. Fever
      6. Backache
      7. Scoliosis
      8. Discuss why the above may be considered absolute/relative contraindications
    4. Complications due to regional anesthesia. Be able to discuss the incidences depending on the technique chosen (i.e. spinal vs. epidural), and be able to formulate a treatment plan for each of the following:
      1. Cardiovascular
      2. Headache
      3. Backache
      4. Bladder dysfunction
      5. Neurologic sequelae
      6. Infection
  9. Subarachnoid anesthesia
    1. Techniques (preparations, landmarks, procedures)
    2. Local anesthetics and administration
    3. Subarachnoid opioids; mechanism of action, drugs used, systemic effects, and associated complications.
  10. Lumbar epidural anesthesia
    1. Techniques (preparations, landmarks, procedures)
    2. Local anesthetics and administration
    3. Epidural opioids: mechanism of action, drugs used, systemic effects, and associated complications.
    4. Use of continuous epidural infusions, including patient controlled epidural analgesia (PCEA).
  11. Caudal anesthesia
    1. Techniques (preparations, landmarks, procedures)
    2. Local anesthetics and administration
    3. Complications
  12. Cesarean delivery
    1. Indications for cesarean delivery, including:
      1. Failure to progress
      2. Breech presentation
      3. Cephalopelvic disproportion
      4. Previous cesarean delivery
      5. Fetal distress
    2. Selection of anesthetic. Be able to discuss why certain techniques are chosen over others.
    3. General anesthesia
      1. Management of induction, intraoperative anesthesia, and emergence
      2. Significance of delivery intervals and concentrations of volatile agents
      3. Pros and cons of nitrous oxide
      4. Complications of general anesthesia, including diagnosis and management of aspiration and failed intubation
    4. Regional anesthesia
      1. Significance of delivery intervals
      2. Maternal and neonatal effects of anesthetic induced hypotension
  13. Emergency delivery
    1. Vaginal delivery
    2. Cesarean delivery
    3. Discuss why certain anesthetic techniques are chosen over others
  14. The high risk parturient: Be able to discuss why the following maternal health complications pose problems for an obstetric anesthesiologist and the anesthetic management of these patients during labor and delivery.
    1. Cardiac disease, including:
      1. Congenital heart disease
      2. Valvular lesions
      3. Associated pulmonary hypertension
      4. Cardiomyopathy (Obstructive and Restrictive)
    2. Respiratory disease
      1. Restrictive
      2. Obstructive
    3. Diabetes
      1. Classifications (ACOG, Modified White)
      2. Management
      3. Associated maternal/neonatal complications
    4. Morbid obesity
    5. Difficult airway, airway abnormality
    6. Miscellaneous: thyroid disease, malignant hyperthermia, coagulopathy, and neuromuscular disease
  15. Obstetric complications: Be able to discuss the diagnosis, obstetric management, and anesthetic considerations/management for each of the following:
    1. Abnormal presentation
      1. Breech, Face, Brow, and Compound presentations
      2. Transverse lie
      3. Prolapsed cord
      4. Multiple gestation
    2. Pregnancy induced hypertension
      1. Classification
      2. Diagnosis
    3. Premature rupture of membranes
    4. Hemorrhage
      1. Placenta previa
      2. Abruptio placentae
      3. Uterine rupture
      4. Postpartum hemorrhage (uterine atony, retained placenta, birth trauma, uterine inversion, placenta accreta, disseminated intravascular coagulation)
      5. Embolism: amniotic fluid, air, thrombus
  16. Anesthesia for surgery during pregnancy
    1. General surgery
      1. Preoperative evaluation and management
      2. Intraoperative management
      3. Use of tocolytics
      4. Perioperative fetal monitoring
      5. Anesthetic considerations including teratogenic effects and other problems
    2. Cerclage placement
      1. Anesthetic management
  17. The fetus and neonate
    1. Physiology of the fetus and newborn
    2. Antepartum fetal assessment
      1. Electronic fetal heart rate monitoring
      2. Fetal pH monitoring
      3. Non-stress test
      4. Oxytocin challenge testing
      5. Biophysical profile
      6. Fetal lung maturity testing
    3. Diagnosis and management of peripartum fetal asphyxia
    4. Evaluation of the neonate
    5. Resuscitation of the neonate
    6. Specific neonatal disorders and their management
      1. Meconium aspiration
      2. Diaphragmatic hernia
      3. Tracheoesophageal fistula
      4. Sepsis
      5. Respiratory distress syndrome