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Anesthesia for vascular surgery provides many opportunities to manage patients with major medical problems. Patients requiring anesthesia for this type of surgery characteristically have co-existing diseases including coronary artery disease, hypertension, diabetes mellitus, pulmonary disease and other vascular problems. The goal of the vascular surgeon is the relief of some critical obstruction or lesion in the vascular tree. However, arteriosclerosis is a generalized disease. Changes during anesthesia and surgery may result in previously non-critical lesions becoming significant problems. Some patients will require anesthesia for surgery for salvage of limb or relief of pain despite the severity of their coronary artery disease. In aortic surgery, wide hemodynamic disturbances accompany clamping and unclamping of the aorta which the anesthesia team need to minimize for the optimal management of the patient. In carotid artery stenosis, cerebral blood flow may be marginal and could be compromised further by intra-operative and post-operative events. Anesthetic management of these patients includes general anesthesia with conventional anesthetic agents, high dose narcotic techniques with post-operative ventilation, and regional techniques including epidural, spinal and regional blocks. Intra-operative management also involves invasive monitoring of the circulation and EEG and transcranial Doppler monitoring for carotid surgery. In addition, many patients will need thoracic epidural analgesia, fiberoptic bronchoscopy or double lumen endotracheal intubation. Several clinical research projects are in progress. Currently, the effect of epidural fentanyl on post-operative pain relief and the effect of combining regional anesthesia with general anesthesia in patients undergoing carotid surgery is being evaluated. In planning are studies on the effects of aortic crossclamping on renal function and other ischemic changes, with clarification of the factors which may modify these responses. The trainee is welcome to participate in any ongoing project or to originate a research project. Because of the time required to set up any new project the proposal will need to be discussed well in advance, in order to obtain Human Studies Committee approval. The residents and fellows take night and weekend call in the general operating room pool with other residents, an opportunity to keep other anesthesia skills current. Stanley Lee Son, MD Director of Vascular Anesthesia