General Anesthesia Section Chief
James Mayfield, MD
The general anesthesia rotation at AU Health is one with diverse pathology and abundant learning potential. The general rotation exposes residents to several cases and nearly every subspecialty including thoracic, orthopedic, ENT/airway, vascular, neuro, and acute care surgery.
The defining feature of the general operating suite is the degree and extent of surgical pathology complemented by the anesthetic management expertise of our highly qualified attending anesthesiologists. Staffed with board certified and subspecialty trained anesthesiologists, the general operating suite is one of the primary areas of education for our residents during their first year of clinical anesthesia at the Medical College of Georgia at Augusta University. The advanced subspecialty training each attending brings to the cases enforces a sophisticated and deeper level of planning and foresight into the potential complications and course of each case. We are a Level I trauma center which provides service to a large swath of eastern Georgia and western South Carolina.
The general anesthesia rotation at AU Health is divided into junior- and senior-level rotations. Junior level (CA-1) residents will generally spend 6-8 months rotating on general anesthesia at AU. This is where our CA-1s learn the bread and butter of anesthesia. They are involved in a wide variety of cases: general surgery, urology, ENT, gynecology, surgical oncology, ophthalmology, orthopedics, and plastic surgery. Because AU is a busy Level 1 trauma center, call nights can involve exploratory laparotomies for gunshot wounds, motor vehicle accidents, neck explorations for stab wounds, open orthopedic fractures, ruptured globes as well as laparascopic appendectomies and abscess I&Ds. As their basic skill set expands, many of our CA-1s find themselves in cases such as pheochromocytomas, large abdominal or pelvic tumor debulkings and exenteration, radical neck dissections for laryngeal cancer, and kidney transplants. There are also thoracic cases performed as part of the main OR rotation which are generally staffed by senior residents.
Junior residents will take call with a senior level resident and an attending while on the general OR rotation. Overnight call at AU is a great opportunity to learn from each attending as well as upper level anesthesia residents. It also gives residents the chance to develop some autonomy. Call is either on a Saturday or Friday/Sunday basis. CA-1s will generally average 3-4 calls per month, and rarely more than 4. Saturday calls are 24 hours. The Friday/Sunday coverage is usually about 12-20 hours. With CRNAs present overnight on the weekends, one CA-1 will usually be sent home on either of the nights. Post call days are off.
Senior residents (CA-2 or 3) on the general anesthesia service take on the responsibility of "junior faculty" with close supervision from the attending on call. This is how senior residents learn the attributes that will help them transition to their future practice. Call in the main OR is from Friday through Sunday, and the week is covered by a senior night float system. The night float-general OR rotation is typically done once during each of the CA-2 and CA-3 years. Night float starts on Sunday night and extends through Thursday night. These are the only 2 weeks during the year that are dedicated to covering the main OR. Call is either Saturday or Friday/Sunday and covered by services that are eligible for main OR call. Only the Saturday call is 24 hours long. There is CRNA cross-coverage overnight on the weekends, and during the weeknights. Call days require senior residents to manage the emergent and urgent surgeries on deck after hours, ensuring pre-ops are completed appropriately and managing the staffing of cases. They work one-on-one with their junior co-residents in the OR in a “pre-attending” role. Additionally, they are responsible for any emergent airways in the hospital, gaining valuable experience in the ICU, on the floor, and in the emergency department learning to intubate in out-of-OR conditions that are often urgent or emergent.
AU has a pre-operative (pre-op) anesthesia clinic that patients attend prior to surgery to be assessed and optimized by an anesthesiologist. The adult pre-op is on the second floor of the hospital (BI-2403). This is an excellent opportunity for residents to develop focused pre-op assessment skills, learning to decide who is medically optimized for surgery and when surgery needs to be delayed for further work-up. There are specific preop/post-anesthesia care unit (PACU) rotations that are staffed by CA-2 residents, and later in the year are staffed by some CA-1 residents. There are intermittent opportunities to rotate through these areas while on the general OR rotation; this helps to expand the scope of the general OR rotation to further the development of the perioperative anesthesia experience.
Anesthesiology residents graduating from Augusta University are well suited to handle any pathology, surgical case or trauma they encounter.