Cardiac Anesthesia - what do you wish you had known?

[Propofool123]

Hey all,

Question for the cardiac fellows and attendings out there. What do you wish you had known about being a cardiac fellow or cardiac attending when you were a resident?

Sorry, I’m sure this has been discussed extensively elsewhere in the forum but was trying to get an idea of what life is like as a cardiac anesthesia attending out in private practice and also what it’s like to be a fellow.

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[T-burglar]

I didn’t feel like there were any surprise except maybe just how many dead bodies on ECMO I’d be taxiing back and forth to the OR in a year.

Gets old real fast

 

[dchz]

Coming from a place without mechanical circulatory support. I wish I had extensive experience as a resident with it. Such a game changer.

Also, people in the NorthEast are dinguses.

 

[Radar26]

There are so many details in cardiac cases that go over most resident’s heads because you are just focused on the basics. The fellowship year is a must IMO if you want to feel confident in the breath of what can occur in the cardiac room. I think one of those details is not only ECMO transport/management but also getting a better understanding of other assist devices- VADs, Impella, IABP, tandem heart- it’s expected that you are comfortable in the management of these and residents don’t get much experience with these.

Also-fellowship year does not equal echo year. You spend a lot of time on echo but it is only a tool. If you don’t understand cardiac anatomy/pathophysiology and how to adjust your anesthetic accordingly, then the tool becomes much less helpful. Echo is a big part of the year, but there is way more to it than just echo.

fellow life is better than resident life (though this experience varies)

 

[sethco]

Also, people in the NorthEast are dinguses.

This. I went to residency at a Northeast program and thought all Cardiac surgeons acted like arrogant, self-righteous pricks. Fortunately, they did not deter me from applying as I enjoyed doing these cases the most during residency. Our residency program had an optional 2 month cardiac rotation in Palermo, Italy. I signed up and dragged my family with me. I was blown away by how different the surgeons were over there, in speed, skill, and attitude. This Regional difference was confirmed when I did my fellowship in TX. Skill was just ok among some of the surgeons but you can tell there was a definite team environment and the surgeons treated the rest of the staff with respect. I stayed in the area for practice and the same team environment persisted, except the skill has gone up tremendously among the surgeons I now work with

 

[CUBR]

How to deal with cardiac surgeons is a learned skill that you develop during fellowship.

 

[T-burglar]

Thought of some more:

Surgeons won’t respect you if you just ask them what to do. You’re supposed to know and be able to provide insight.

Along those lines, in cardiac you can’t fake it till you make it. It’s not like the general OR where you can be very ignorant of many of the surgical details and still get to the end of the case safely. I would argue that it’s mandatory to read a SURGICAL textbook so you can look at the dissection at any point and know what the surgeon is doing and where they can cause problems. Knowing what the surgeon is doing makes it much more likely you won’t miss an issue on the post echo or in general.

You should also plan to read a thick textbook on CPB so you understand that machine backward and forward. A fellowship that sends you to a local perfusion school to do a crash course with the pefusiinists is great imo

 

[Beeftenderloin]

Thought of some more:

Surgeons won’t respect you if you just ask them what to do. You’re supposed to know and be able to provide insight.

Along those lines, in cardiac you can’t fake it till you make it. It’s not like the general OR where you can be very ignorant of many of the surgical details and still get to the end of the case safely. I would argue that it’s mandatory to read a SURGICAL textbook so you can look at the dissection at any point and know what the surgeon is doing and where they can cause problems. Knowing what the surgeon is doing makes it much more likely you won’t miss an issue on the post echo or in general.

You should also plan to read a thick textbook on CPB so you understand that machine backward and forward. A fellowship that sends you to a local perfusion school to do a crash course with the pefusiinists is great imo

Just applying, so please correct me if I’m wrong, but dont most programs have you spend at least a couple weeks with the perfusion team?

 

[CUBR]

This. I went to residency at a Northeast program and thought all Cardiac surgeons acted like arrogant, self-righteous pricks. Fortunately, they did not deter me from applying as I enjoyed doing these cases the most during residency. Our residency program had an optional 2 month cardiac rotation in Palermo, Italy. I signed up and dragged my family with me. I was blown away by how different the surgeons were over there, in speed, skill, and attitude. This Regional difference was confirmed when I did my fellowship in TX. Skill was just ok among some of the surgeons but you can tell there was a definite team environment and the surgeons treated the rest of the staff with respect. I stayed in the area for practice and the same team environment persisted, except the skill has gone up tremendously among the surgeons I now work with

I think this is a little generational. Our more senior surgeons are grumps with personality disorders, but the newer ones are collaborative and nicer to work with.

 

[T-burglar]

Just applying, so please correct me if I’m wrong, but dont most programs have you spend at least a couple weeks with the perfusion team?

Sure but those exeperiences are often an afterthought to the perfusion team, it’s a bit of shadowing before and during the case. I got to go to a perfusion school and build a pump from the ground up including being tested on tubing diameter selection for various pathologies and BSAs, loading and testing the raceways, intelligently placing and removing clamps, knowing pros and cons of filter and safety mechanism placements. The list goes on, and I feel like I can truly oversee the use of the machine, not just regard it as a semi black box that the technician knows more about than I do.