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Cardiothoracic anaesthesia is considered Key Unit of Training in which SpR 1/2 trainees should spend the equivalent of at least one month of training and, normally, not more than 3 months.
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Training Objectives
- By gaining experience in cardiothoracic anaesthesia, the trainee should also develop competency in the management of cardiovascular and pulmonary problems arising in non-cardiac surgical patients.
- The trainee should develop the ability to assess the circulation and have experience in the use of inotropes and vasoactive agents to support the circulation in patients with cardiac disease. They should also develop an understanding of the problems of extracorporeal circulation.
- The trainee should understand the problems of one-lung anaesthesia and develop experience in the placement of double-lumen tubes.
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Attitudes and Behaviour
- To communicate effectively with surgical colleagues / other members of the theatre team.
- To be able to summarize a case to critical care staff.
- Understand how to communicate with the intubated patient in intensive care.
- To be able to recognize the need for senior help when appropriate.
- Maintain accurate clinical records.
- Presentation of material to departmental meetings and participation in clinical audit.
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Knowledge - Cardiac Anaesthesia
- Preoperative assessment and perioperative care of patients with cardiac disease.
- Induction and maintenance of anaesthesia for high risk cardiac procedures, including valve replacement.
- Antibiotic prophylaxis against subacute bacterial endocarditis.
- Problems of cardiopulmonary bypass.
- Postoperative cardiac critical care, including analgesia, sedation and ventilatory management.
- Significance of cardiac tamponade.
- Interpretation of ECG and CXR.
- Interpretation of invasive and non-invasive cardiovascular monitoring.
- Temperature control and patient rewarming methods.
- Coagulopathy.
- Cardiac pacing modes.
- Intra-aortic balloon counter pulsation.
- A working knowledge of stress testing.
- A working knowledge of cardiac catheterization.
- A working knowledge of transthoracic and transoesophageal echocardiography.
- A working knowledge of radionuclide scans.
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Knowledge - Thoracic Anaesthesia
- Preoperative pulmonary function tests.
- Local and general anaesthesia for bronchoscopy including techniques of ventilation.
- Understanding of fibreoptic bronchoscopic techniques for airway management.
- Principles of one-lung anaesthesia.
- Management of a pneumothorax.
- Principles of underwater seals on chest drains.
- Postoperative care and analgesia after thoracic surgery.
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Skills - Generic
- Internal jugular and subclavian venous cannulation.
- Arterial cannulation.
- Invasive pressure monitoring, including pulmonary artery catheters and interpretation of derived indices.
- Postoperative analgesia by appropriate methods including local techniques.
- Cardiopulmonary resuscitation and appropriate use of defibrillators.
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Skills - Cardiac Anaesthesia
- Preoperative assessment of patients with valvular and ischaemic heart disease.
- Induction and maintenance of anaesthesia for elective coronary bypass.
- Management of the patient during cardiopulmonary bypass.
- Use of inotropes and vasodilators.
- Anaesthesia for procedures in intensive care including emergency resternotomy, reintubation, tracheostomy or cardioversion.
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Skills - Thoracic Anaesthesia
- Preoperative assessment, preparation of patients with pulmonary disease.
- Preoperative assessment, preparation of patients for thopracic surgery.
- Induction and maintenance of anaesthesia for minor thoracic procedures in particular, bronchoscopy and the use of the Sanders injector.
- Use of single and double lumen endobronchial intubation.
- Fibreoptic endoscopic confirmation of tube placement.
- Induction and maintenance of anaetshesia for major thoracic procedures.
- One lung ventilation.
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