From Volatile Agents to Ventilators: Benefits of an ICU Rotation for the Future Anesthesiologist

by Ratna Ramaraju

“If you’re not overwhelmed on the first day of your ICU rotation, you’re not doing it right.”

These words, spoken by my preceptor after my first time rounding in the ICU had never been more accurate. When I badged into the unit earlier that morning, I had no idea what to expect. It was only my second rotation of third year, and I had no clue what specialty I wanted to do. So, it was no surprise that after I was greeted by the cacophony of monitors beeping and ventilators humming, I immediately felt out of place and in over my head. Little did I know that over the course of the next month, those same beeps and hums would soon become part of my daily rhythm while fostering a desire to pursue critical care medicine and, ultimately, anesthesiology. 

Personally, I completed a critical care rotation prior to an anesthesia rotation and felt that it greatly benefited me due to overlapping pharmacology, physiology, and patient management. However, the order in which the two rotations are completed has no significant impact as they are mutually beneficial. A good example of this includes the use of benzodiazepines, propofol, and alpha-2 adrenoreceptor agonists for sedation in the ICU as well as sedation in the OR.1 The same goes for analgesics such as fentanyl, morphine, and ketamine, as they are useful for pain management in both settings.2 Learning about the indications, pharmacology, and adverse effects behind each of these agents during my ICU rotation allowed me to gain a deeper understanding and clinically reason through anesthetic considerations for each patient in the OR, thus enriching my rotation experience even further.

Additionally, ventilator physiology is a major aspect of both anesthesiology and critical care medicine. While rotating in the ICU, my preceptor made it a point to quiz me about the ventilator mode and settings for each patient so that I could easily identify and explain each parameter on the monitors. This proved to be helpful when discussing how to interpret the monitors in the OR, since the same physiological principles applied. More importantly, it gave me the foundation to anticipate any changes needed in the ventilator settings during various points of the surgery, such as optimizing ventilator settings once a patient was placed in Trendelenburg position or increasing a patient’s respiratory rate if I noticed their EtCO2 was getting high. Through this, I was able to develop the skill of integrating real-time physiology with my understanding of ventilator settings, a skill that is essential to anesthesiologists.

Furthermore, many of the procedures done as an intensivist are also done as an anesthesiologist. One procedure both specialties do is intubation, albeit for different reasons. In the OR, anesthesiologists intubate for surgery, and in the ICU, intensivists intubate for respiratory failure. However, learning to intubate in either setting is extremely helpful as airway management is a core principle of anesthesiology.3 Additional procedures performed by both specialties include arterial line placement, central line placement, and point of care ultrasound. In fact, recognizing the importance of critical care medicine for anesthesiology trainees, the ACGME released a set of program requirements stating that every accredited anesthesiology residency program must include a minimum of four one-month rotations in critical care medicine.4  Exposure to critical care medicine applies to non-physician anesthesiology providers too, specifically certified registered nurse anesthetists (CRNAs) who are required to have a minimum of one year full-time critical care experience, or its part-time equivalent, as a registered nurse in a critical care setting prior to applying for CRNA school.5

So yes, while I may have been extremely overwhelmed my first day in the ICU, the rotation pushed me to be a better student and equipped me with skills applicable to multiple aspects of anesthesiology. It also molded me into someone who does their best to reassure every patient and their loved ones during extremely vulnerable moments, a trait that is necessary not only in anesthesiology and critical care medicine, but other specialties as well. Of course, doing an ICU rotation may not be for everyone – and that’s more than okay! But if you’re someone who plans to apply for anesthesiology residency, I strongly encourage you to consider doing one and hope that it helps you grow personally and professionally, just as it did for me. 

References
1. De Bels D, Bousbiat I, Perriens E, Blackman S, Honoré PM. Sedation for adult ICU patients: A narrative review including a retrospective study of our own data. Saudi J Anaesth. 2023;17(2):223-235. doi:10.4103/sja.sja_905_22

2. Gommers D, Bakker J. Medications for analgesia and sedation in the intensive care unit: an overview. Crit Care. 2008;12 Suppl 3(Suppl 3):S4. doi:10.1186/cc6150

3. American Society of Anesthesiologists. Statement on Practice Recommendations for Anesthesiology. American Society of Anesthesiologists. Updated October 2023. Accessed May 3, 2026. https://www.asahq.org/standards-and-practice-parameters

4. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Anesthesiology. Accreditation Council for Graduate Medical Education; 2026. Accessed May 3, 2026. https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/040_anesthesiology_2026.pdf

5. American Association of Nurse Anesthesiology. Become a CRNA. American Association of Nurse Anesthesiology. Accessed May 3, 2026. https://www.aana.com/about-us/about-crnas/become-a-crna/