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Cardiothoracic Anesthesiology

Department Chief: Dr. Fitzsimons
Attendings: Dr. Abdallah, Dr. Mohapatra, Dr. Gamaleldin, Dr. Graber, Dr. Asher, Dr. Singh, Dr. Wyler
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. Intern should arrive early enough (usually 0430 to 500) to set up the room for 0715 start. At the beginning it takes some time around 1-1.5hrs to set up the room. Please learn how to set up the room before the first day.  

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

Expectations and Objectives

  • Cardiac Junior Goals & Objectives <download>

    • Cardiac junior resident is expected to set up their cardiac room in the morning for 0715 start. Also discuss the case with attending the night before. Cardiac junior resident’s focus should be learning to frontline cardiac cases including induction, line placements, going on CBP and coming off of CBP.

  • Cardiothoracic Senior (TEE/thoracic) Goals & Objectives <download>

    • Cardiac Sr (TEE): Cardiac senior resident is expected to assist in starting the cardiac junior’s case in the morning including line placements. Then the cardiac senior will learn performing TEE with the attending. Cardiac senior is also responsible for giving breaks and lunches for the cardiac junior resident and if possible, cardiothoracic senior resident. Cardiac senior resident’s main focus should be learning to perform and read basic TEE views. Please also see the TEE Elective page for more TEE Information!

    • Cardiac Sr (Thoracic): Cardiothoracic senior rotation is the thoracic rotation. Thoracic surgeries usually take place in OR 20. The resident is responsible for setting up the OR and frontlining the cases. This rotation focuses on learning to place double lumen tube, perform bronchoscopy, and manage thoracic surgery patients.

Helpful Hints/Tips.

  • 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

OR Resources - Cardiac Jr

  • Cardiac Anesthesia Protocols & Guidelines <link>

  • Cardiac Junior Rotation Manual <link>

  • Concomitant mitral valve procedures <link>

  • Eighth annual INTERMACS report <link>

  • History and Use of del Nido Cardioplegia Solution <link>

  • Microplegia during coronary artery bypass grafting <link>

  • Seventh INTERMACS annual report <link>

  • Use of del Nido Cardioplegia for adult cardiac surgery <link>

  • VAD Anesthesia Management Guideline <link>

OR Resources - TEE

  • Guidelines for performing a comprehensive TEE <link>

  • TEE images <link>

  • TEE manual <link>

  • TEE standard views <link>

OR Resources - Thoracic

  • Bronchoscopy site <link>

 

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