Anesthesiology case minimums, explained.

All 16 at a glance

Twelve categories, four of them with a minimum inside the minimum (a sub-minimum). Every number below is ACGME’s, from Section 4.4 of the Program Requirements.

Numbers and sections: ACGME’s Program Requirements for Graduate Medical Education in Anesthesiology, effective September 3, 2025, pages 21 to 23. The kinds of cases under each line (high-risk deliveries, combined spinal-epidurals, acute pain consults and so on) are the subcategories ACGME’s own Minimums report lists.

How the numbers fit together

Sub-minimums sit inside their category. The 20 children younger than 3 are part of the 100 pediatric patients, and the 5 younger than 3 months are part of those 20. The 10 bypass cases are part of the 20 cardiac cases. The open-cranium cases are part of the 20 intracerebral cases.

One case can count toward more than one minimum. A minimum describes the patient or the anesthetic, so a single case can satisfy several:

• A cesarean section under spinal anesthesia counts toward cesarean sections and toward spinals, because the spinal minimum includes cesarean sections (§4.4.c.9).
• A combined spinal-epidural counts toward epidurals and toward spinals: ACGME’s Minimums report lists it under both.
• A coronary bypass on pump counts toward cardiac surgery and toward cardiac with bypass.
• A hernia repair in a 2-year-old counts toward pediatric and toward younger than 3 years: the patient’s age decides it, not the procedure.
• A total knee with a regional block counts toward peripheral nerve blocks whether the block was the anesthetic or the pain plan (§4.4.c.10).

What trips people up

Vascular access doesn’t count as a major vessel

The major-vessel minimum excludes “surgery for vascular access or repair of vascular access” (§4.4.c.4), so an arteriovenous fistula for dialysis, or its revision, won’t move this number. Open or endovascular work on the major vessels themselves does.

Intracerebral needs mostly open cases

Endovascular intracerebral cases count toward the 20, but “the majority” must involve an open cranium (§4.4.c.6.a). ACGME’s own Minimums report tracks the open cases, vascular and nonvascular, as a separate line, “Total Intracerebral Open”, with a minimum of 11.

Pain counts new patients only

The pain minimum is for patients “presenting for initial evaluation of pain” (§4.4.b.2.a), so follow-up visits don’t add to the 20. New consults do, and not only in a pain clinic: ACGME’s Minimums report counts acute, cancer and chronic pain consults toward this line.

Some requirements have no number at all

Section 4.4 also requires competence in acute post-operative pain management, airway management, central venous and pulmonary artery catheters, transesophageal echocardiography and evoked potentials, and ultrasound and echocardiography outside the operating room (§4.4.c.11 to 4.4.c.13). None of these has a case count, so you won’t find them among the 16: they’re competencies, not tallies.

How programs use your case log

• Your program director must review residents’ case logs regularly and verify they’re accurate and complete when they go to ACGME (§4.11.n).
• Logs are submitted to ACGME’s Review Committee every year, in the format and by the date it sets (§4.11.n.1).
• Your program director also watches how cases are spread across residents (§4.11.p).
• Case logs, with the Milestones, are among the tools used to judge that you’re ready for autonomous practice when you finish (§5.2.a).

The Program Requirements don’t set out how an individual case is credited: who logs a shared case, what “personally performed” means, or how soon a case must be logged. For that, see ACGME’s anesthesiology FAQ and Case Log resources, and ask your program how it applies them. Our guide to logging cases in ACGME collects ACGME’s answers to the common questions.