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Cardiac Anesthesiology


Attendings: Dr. Graber, Dr. Nakai, Dr. Abdalla, Dr. Gamaleldin, Dr. Miller, Dr. Alcodray, Dr. Jordan, Dr. Asher, Dr. Joy
Location: OR 18 - 21
On the first day of the rotation: CA-1 should text senior resident (TEE) before Monday and discuss the plan regarding setting up the room. Recommended arrival time for the first day is 0500-0530 to allow yourself ample time to set up the OR.

The Ultimate Resident Guide - Cardiac Jr. Section
The Ultimate Resident Guide - Cardiac Sr. (TEE) Section
The Ultimate Resident Guide - Thoracic Section

Rotation Information

Welcome to Cardiac Anesthesia! During this rotation you will learn how to manage common cardiac cases including CABG, valve repair/replacement, as well as more complex mechanical support cases including ECMO, Impella, and VADs.

  • Cardiac Junior Goals & Objectives

    • Develop proficiency with preoperative evaluation of the cardiac surgical patient.

    • Continue to refine arterial and central line placement technique.

    • Understand complex cardiovascular pathophysiology and how to manage it during anesthesia.

    • Learn about cardiac bypass and the interplay between surgeon, anesthesia, and perfusionist.

    • Carry the knowledge you obtain from this month to future cases, both cardiac and non-cardiac.

  • Recommended Pre-Reading:

    • Rotation Goals and Objectives - start here!

      • Also has lots of great resources that will be useful during intraoperative management.

    • Barash Chapter 39: Anesthesia for Cardiac Surgery

    • Stoelting Coexisting Disease: Chapters 5, 6, 8, 9, 10

    • M&M Chapter 20

    • Hensley’s Cardiothoracic Anesthesia: DENSE! Use as a reference.

  • Videos

Cardiac Set Up Video

Helpful Hints

  • Intimidating but the only real tough part is the hours

  • Don’t be afraid to ask your senior ANYTHING. There are no stupid questions to keep pt safe and things flow well

  • You WILL do hearts on call/late duty so it’s good to get comfortable early. (sometimes attending will have 2 cardiac rooms and you will be on your own)

  • Sometimes you will get an emergency heart add-on to your room without expecting it

    1. Senior should be there to help, but try to set up as much as possible, as quickly as possible, but priority will be getting patient to room so try to at least have the basic necessities ready 

  • ECMO

    1. Simply a glorified central line placement in a super sick patient

    2. ECMO placement is typically emergent so patient is usually lined up and on a million gtts  

    3. Once the line goes in, have cleviprex or nitroglycerin bolus ready b/c there will be a large bolus of fluid from ECMO prime when ECMO is started and so will be VERY hypertensive 

    4. Decannulation is planned-- still will have lines and possibly pressors/inotropes, but check what they are on/be prepared to give additional support if necessary

  • iEPO

    1. Used for RHF/pulm HTN 

    2. Usually decide if its needed when coming off pump

    3. ICU RT will bring ICU vent bc it must be administered nebulized through vent

    4. Will need to switch to TIVA bc cannot give gas through ICU vent

    5. Attending must order epo

    6. Need extra insert for CO2 monitoring (ask workroom or look for in other cardiac ORs)

  • Patient may need perfusionist for transport to OR if LVAD, impella, ECMO or IABP is present 

  • Redo-sternotomy

    1. Have level one v. belmont available and set up

    2. 6 u PRBCs should be on hold, instead of the typical 4 uPRBCs 

    3. Surgeons will typically cannulate for bypass before sternotomy

Learning Modules - Cardiac Reading

 

UH is proud to announce that we now have a Cardiothoracic Fellowship! Visit the Fellowship Page for more information!

 

Considering a Career in Cardiac Anesthesia? Visit the link below for more information!

https://www.scahq.org/Fellowships-Career-Development/ACGME-Accredited-Fellowship-Programs