A Day in the Life of a Duke Anesthesiology Resident

Juliann Hobbs, MD, CA-2 Resident

Ambulatory Surgery Center (ASC) Rotation

The Ambulatory Surgery Center (ASC) rotation is one of the most anticipated rotations among Duke Anesthesiology residents. We spend several weeks at the ASC during the CA-2 and CA-3 years. A typical day begins at 6:00 AM when we arrive and set up the block carts. By 6:30 AM we begin seeing patients in the pre-op area, reviewing the history and physical, conducting a focused physical exam, completing the anesthesia consent, and discussing the plan for the patient’s anesthetic. Many of the patients will have a regional anesthetic. After discussing the plan with the attending, we begin giving the patient sedation and perform the regional anesthetic. During the rotation, we have the opportunity to practice a wide variety of single injection peripheral nerve blocks of the upper and lower extremity, including interscalene, supraclavicular, infraclavicular, axillary, Bier blocks, lumbar plexus, sciatic, femoral, popliteal, and ankle blocks, as well as intra-articular injections of the knee. Residents are encouraged to practice both nerve stimulator and ultrasound-guided techniques. We also have the opportunity to practice placing continuous regional anesthetic catheters for select patients. After completing the block and confirming its onset, we help the nurse anesthetist transport the patient to the operating room. Then it’s time to return to pre-op holding and begin evaluating the next patient. Between evaluating and blocking patients, we check on our previous patients in the operating room and in the post-anesthesia care unit. The ASC rotation is a great opportunity not only to learn and practice regional anesthesia, but also to learn about ambulatory anesthesia and the unique challenges it presents, such as management of postoperative pain and nausea/vomiting, as well as the more rapid turnover time expected in ambulatory surgery. The day ends between 3:00 and 4:00 PM when all of the patients have gone into the operating rooms and any issues with post-operative patients have been addressed.

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