Cardiac Anesthesia

We all are eager to teach you as much as possible but there is no substitute for READING, reading and more reading and asking, asking and more asking. If you do not know something ASK your attending. Nurses, circulators, perfusionists have been around for a long time and would be happy to see you participating and asking questions. Be proactive; participate in the case, read (again) so you know what is next. KNOW your patient inside out. Frequently, someone else would have seen your patient for the day. Find and read the pre-op note; clarify any questions that YOU think have not been addressed in the pre-op note. Make sure there are no significant changes in status since the patient was seen. Among our group there are slight individual differences on how we do things. Do not get confused by this, so always ask when you don’t know and actively discuss the case with your attending before the start of the case.

Come early in the morning and start the basic setup in one of the cardiac rooms. Unfortunately, at this time, we cannot guarantee you that assignments would have been made before 6:00 am. There will be made very soon thereafter but since the basic setup of the room is standard, having it done ahead of time would save time and frustration for everyone.

Be prepared to take the patient into the OR immediately after patient has been checked by the circulating nurse. We are in house by that time and the anesthesia techs are standing by, so there is no reason for delaying. We do not ask you to be in at a certain time but you should be in early enough so you can setup the room, familiarize yourself with the patient and be ready to take the patient back after having been checked and interviewed by nursing. The ideal situation would be if you are ready to have the patient positioned on the table by 7:00 AM.

At the end of the day please remember not to leave without checking with your attending AND the attending on call.

If there is a third case on the schedule and you are assigned to it, please keep communication open with the attending covering the case and with Nora. Try to determine starting time and have the desk (Nora) to page you when patient is sent for. Keep yourself informed and involved at all times. All of the above will make your life easier, your rotation more meaningful and you more successful. We all want you to have fun while learning.

The Handbook contains all the information you need on everything you need to prepare and setup for a typical cardiac case.

You should anticipate that the rotation is going to be intense (the cases usually are) and multitasking is not only desirable but also necessary.

Clinical anesthetic management of patients for this rotation will primarily involve adult patients undergoing coronary artery bypass surgery, valvular heart surgery, heart transplantation and placement / removal of mechanical assist devices. In addition, you may be involved in cases where alternative surgical techniques will be used, with or without the use of cardiopulmonary bypass.

During the rotation you are expected to:

• Provide patient care that is compassionate, efficient and specifically tailored to the circumstances surrounding the cardiac surgical setting.
• Improve understanding of the physiology of normal and pathologic cardiovascular system.
• Improve your knowledge of the pharmacology of anesthetic agents and their effects on the cardiovascular system, drugs commonly used in the treatment of heart disease, and their interaction with anesthetic drugs.
• Perform proper preoperative patient evaluation.
• Formulate the anesthetic plan based on the patient’s medical history and the planned surgical procedure.
• Acquire experience with placement of invasive monitoring lines (arterial, central and pulmonary artery), and be able to interpret the information.
• Become familiar with cardiopulmonary bypass and its anesthetic implications.
• To learn the pathogenesis, diagnosis and treatment of cardiac dysrhythmias.
• Understanding the hemostatic changes that occur with cardiopulmonary bypass and the blood products and drugs used to improve coagulation.
• Learn the basics of transesophageal echocardiography
• Induce, manage, and transfer care of the patient to the ICU.
• Work as a member of a complex team to provide safe and effective care.

We recommended the following cardiac anesthesia textbook:

"Practical Approach to Cardiac Anesthesia" by Joseph P. Ashton, Donald E. Martin, Glenn P. Gravlee (Copies of this book are in the library. However, it is recommended that you buy a copy for yourself.) ISBN: 0781734444

"The Cardiac Anesthesia Section in Clinical Anesthesiology" by Morgan and Mikhail is also very helpful.

We all hope you will enjoy this rotation.

Michael England, MD

Bhawana Dave, MD

Tammam Farhat, MD

Emil Bogdanov, MD

Stefan Ianchulev, MD