MetroHealthAnesthesia Case Western Reserve University
MetroHealth Medical Center Department of Anesthesiology
Anesthesiology Resident Cardiothoracic Anesthesia Rotation

Goals and Objectives for Cardiothoracic Anesthesia

Goals and Objectives for Anesthesia for CA-1 and 2 Residents in Cardiothoracic Surgery

I. Define the Rotation
Anesthesia for cardiothoracic is a two month rotation. The first month occurs during the CA-1 year, and the second during the CA-2 year.

II. Primary Area of Knowledge and Goals
The overall goal of this rotation is to provide an introduction and a broad understanding for the sub-specialty of anesthesia for cardiothoracic surgery. The areas of knowledge to be covered will include:
  1. an introduction to the preoperative assessment, intraoperative management and postoperative management of patients presenting for cardiac, aortic and/or thoracic surgery.
  2. an introduction to one lung ventilation and fiberoptic bronchoscopy.
  3. an introduction to invasive monitoring including arterial, central venous and pulmonary artery catheters

III. Cognitive Objectives The resident will be able to:
  1. describe the normal anatomy and physiology of the heart.
  2. discuss pharmacology pertinent to the cardiovascular system.
  3. describe coronary artery and valvular heart disease.
  4. explain anesthesia implications of these diseases.
  5. discuss and explain the rationale of induction and maintenance of anesthesia techniques for cardiothoracic surgery.
  6. discuss the mechanism and anesthesia implications of cardiopulmonary bypass.
  7. describe the pathophysiology and the anesthesia implications of anesthesia for aortic surgery.
  8. describe the pathophysiology , and discuss the anesthesia implications of pulmonary surgery.
  9. explain the sequential steps in cardiopulmonary resuscitation.
  10. list the indications, and potential complications of :
      a. arterial catherization
      b. central venous catherization
      c. pulmonary artery catherization
      d. bronchoscopy
      e. double lumen tube placement
      f. epidural catheters
  11. describe the expected postoperative recovery of the uncomplicated cardiac surgery patient.
  12. list common problems and their treatments of this uncomplicated surgery patient.
  13. describe the expected postoperative recovery of the uncomplicated thoracic surgery patient.
  14. list common problems and their treatment of this uncomplicated surgery patient.
  15. describe the management of ventilation of the uncomplicated cardiac/thoracic surgery patients.

IV. Skill Objectives: The resident will be able to:
  1. insert, manage, and interpret the results of arterial catherization, central venous catherization, and pulmonary artery catherization with minimal staff assistance.
  2. perform fiberoptic bronchosopy with minimal staff assistance.
  3. insert and manage double lumen endotracheal tubes with minimal staff assistance.
  4. place and manage epidural catheters for patients having thoracic surgery.

V. Conference and Literature Assignments
The CA-1 or 2 rotating resident will attend the weekly conferences held by the Department of Anesthesiology. The annual curriculum is expected to fully cover the subject for cardiothoracic surgery, and include such specialty items such as journal club, and quality assurance issues. Reading and active participation is expected of these residents.

Goals and Objectives for Anesthesia for CA-3 Residents in Cardiothoracic Surgery

I. Definition
Rotations for CA-3 residents in anesthesia for cardiothoracic surgery are provided for a duration of 1 to 6 months.

II. Goals and Primary Area of Knowledge
The overall goals to be attained will relate directly to the duration of training elected in this subspecialty by the CA-3 resident, but in general is intended to provide advanced training in anesthesia for cardiothoracic surgery.
The area of knowledge includes a preoperative assessment, and the intraoperative and postoperative management of patients presented for cardiac, aortic, and/or thoracic surgery. Also included will be training in one lung ventilation, fiberoptic bronchoscopy, invasive monitoring, and introduction to transesophageal echocardiography. Some of these areas such as transesophageal echocardiography will be intended for those residents spending at least 6 months training in the subspecialty.

III. Cognitive Objectives: The resident will be able to:
  1. demonstrate mastery of all cognitive objectives expected of the CA-1 and 2 resident.
  2. describe anesthesia implications of transesophageal echocardiographic monitoring.
  3. describe the anatomy and pathophysiology of congenital heart abnormalities.

IV. Skill Objectives: The resident will be able to:
  1. demonstrate mastery of all skill objectives expected of a CA-1 and 2 resident with essentially no staff supervision.
  2. Demonstrate the basic use and interpretation of transesophageal echocardiography.

V. Conference and Literature Assignments
The CA-3 rotating resident will attend the conferences held by the Department of Anesthesiology. The annual curriculum is expected to fully cover the subject for cardiothoracic surgery, and include such specialty items such as echocardiography, journal club and quality assurance issues. Reading and active participation is expected of these residents. There will be greater expectation of the CA-3 resident in reading, participation, and presentations at these sessions.



Send Comments to Greg Gordon MD, gjg@po.cwru.edu
Department of Anesthesiology
The MetroHealth System
2500 MetroHealth Drive
Cleveland, Ohio 44109-1998
Phone: (216) 778-4801
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