Cardiothoracic Anesthesia - Fellowship Rotations

Our fellows train in the cardiac operating rooms for six months. During this time, they demonstrate patient care that is compassionate, appropriate and effective for the treatment and anesthetic management of cardiothoracic surgical patients. 

Objectives include:

• Conduct accurate and comprehensive preoperative evaluation of adult cardiothoracic surgical patients
• Prepare evidence-based anesthetic plans and effectively communicate plans in a comprehensive and concise manner to supervising faculty demonstrating progressive understanding of anesthetic management and patient pathophysiology
• Maintain homeostatic patient status with appropriate anticipation and timely interventions in the adult cardiothoracic surgical patient and appropriate recognition of the necessity of faculty consultation
• Demonstration of appropriate technical prowess in performing procedures including organization of workspace, observance of universal precautions, sterile technique (when indicated) for placement of invasive hemodynamic monitors, postoperative pain procedures, perioperative echocardiographic procedures, lung isolation and ventilation and other procedures necessary for the care of the adult cardiothoracic surgical patient

The CVICU rotation for Fellows in the Anesthesia Critical Care Training Program is a two-four week rotation under the supervision of the intensivist physicians. The educational goals and objectives are to gain knowledge, technical skills and decision-making capabilities required to manage critically ill patients, with special emphasis on the management of patients after major cardiovascular surgery. This includes gaining additional training in airway and ventilator management, in invasive and noninvasive hemodynamic monitoring and in the use of intra- aortic balloon pumps, ventricular assist devices, Impellas and extracorporeal membrane oxygenators. Fellows are responsible for participating in rounds, for facilitating triaging and transfers to the floor, for aiding communication with the surgical and consulting teams and for assisting with the day’s clinical work and documentation. Fellows should pre-round to determine any urgent issues that need to be addressed with the attending, such as:

• Change in neurologic status
• Hemodynamic instability, increasing pressor requirements, or evidence of hypoperfusion or support device malfunction
• Unstable cardiac rhythm
• Increasing oxygen requirements or worsening ventilator status
• Concerns for developing infection
• Concerns for bleeding

By the end of the rotation, the fellow should be able to assess, present and manage the unit’s patients with attending supervision. The fellow may participate in a variety of procedures during the rotation. The attending should be notified of any pending procedures, so that appropriate supervision can be provided. Over the course of each rotation the fellow is responsible for providing the staff with one 30 minute didactic lecture.

The congenital cardiac anesthesia rotation for fellows in the Cardiac Anesthesia Program is a four-week rotation under the supervision of Peter Dalton, DO, Cynthia Keene, MD, Walter Rose, DO, Ryan Swain, MD. PhD and Nadine VanWyk, MD. The educational goal of this rotation is to familiarize fellows with the perioperative care of patients with both straightforward and complex forms of congenital heart disease. Due to the multitude and diversity of congenital cardiac lesions, fellows are not expected to independently provide complex pediatric cardiac anesthesia care at the end of their four-week rotation. Such competence requires many more months of special training in pediatric cardiac anesthesia.

The Point-of-care Ultrasound (POCUS) rotation for Fellows in the Adult Cardiothoracic Anesthesia fellowship is a four week rotation under the supervision of Marcus Stoddard MD and Robert Whitford MD. The educational goals and objectives are to gain knowledge, technical skills and decision-making capabilities required to perform POCUS and to help diagnose cardiovascular pathology in healthy and critically ill patients. Fellows are expected to:

• Identify appropriate candidates and use of rescue POCUS
• Perform and interpret preoperative, intraoperative and postoperative, transthoracic echocardiograms and lung ultrasound on patients with a targeted clinical question
• Perform bedside focused cardiac ultrasound on healthy preoperative patients
• Formally interpret TTE studies, to be logged into fellow’s case log

1 month - research, perfusion or additional TTE/structural heart option

Fellows will gain education and experience in all area of the cardiac catheterization laboratory including interventional cardiology, structural heart and electrophysiology cardiology. Fellows will be involved in anesthetic management, echocardiography and interventional techniques in addition to preoperative assessment and postoperative management.

To provide experience and basic knowledge of perfusion related principles and equipment, including but not limited to the components of the extracorporeal circuit; operation of the heart and lung machine; operation of ancillary perfusion equipment; physiological monitoring, analysis and intervention during cardiopulmonary bypass; myocardial protection; management of mechanical support devices; as well as the basic principles of other perfusion modalities. Level of mastery and competence achieved will depend on time spent on the rotation, as well as level of training.