Cardiothoracic Anesthesia Service

The number of patients presenting to Tisch and Bellevue Hospitals for cardiac and thoracic surgery provide our residents and fellows an abundance of opportunities to learn the anesthetic management of critically ill patients. Clinical teaching of residents is an integral part of our responsibility. While residents are on the 8 week rotation, they learn how to monitor and care for patients during cardiac surgery. For thoracic surgery cases, they learn how to manage patients during one lung ventilation, the different types of devices used for lung isolation and different methods of neuraxial pain relief. In addition to learning the more challenging and complex adult cardiothoracic cases, our fellows will learn how to manage congenital cardiac cases. Clinical teaching includes educating the residents in pre, intra, and post-op management and TEE training. Methods of clinical research are introduced, and our residents and fellows are encouraged to participate in the ongoing clinical research.

Didactic education occurs during weekly cardiac conferences, as well as in the operating room. The conferences are often lectures given by the cardiothoracic anesthesia attendings, on topics ranging from preoperative assessment of cardiac patients to intraoperative management of patients with intra-aortic balloon pumps. There are also discussions of journal articles on pertinent topics.

Pre-operative patient assessment including evaluation of myocardial function interpretation of cardiac catheterization and echocardiographic data, and other pre-operative diagnostic tests are stressed. Strong emphasis is placed on complete pre-operative evaluation and the preparation and development of sophisticated anesthetic plans to deal with the intra-operative or post-operative problems. There is close collaboration with the angiographers and echocardiographers, as well as the cardiac surgeons.

Intra-operative care including TEE and all major types of hemodynamic monitoring is taught. Daily contact with a clinical echocardiographer augments the training in echocardiography. There is also emphasis on the peri-operative management including vaso-active infusions, pacemakers, defibrillators, intra-aortic balloon pumps, and ventricular assist devices.

Most of the time, there is one to one attending to resident coverage, which allows maximal interaction and education for our residents so the clinical experience is optimized. This allows time throughout the day to discuss management strategies and techniques, as well as evaluation and feedback of resident performance so that improvements can be made in a timely manner.