Cardiac Anesthesiology

[cfdavid]

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While cardiac cases (bypass, valvular repair etc.) seem to present unique challenges as well as requiring a special skillset (could include a fellowship), is there a surplus in anesthesiologists with cardiac fellowship training (therefore, tending to specialize in cardiac)???

I ask this because, it seems that due to newer, less invasive technologies, cardio-thoracic surgeons are the only surgical subspecialty with a surplus. Does this apply to their specialized anesthesia colleagues??

 

[Stillwater45]

According to a 4th year resident I know who is about to start his fellowship in Cardiac.... A lot of the Bariatric cases will potentially start leaning towards cardiac boarded anesthesioligist. But from what I understand fellowships are not required, especially in private practice. My take on cardiac fellowships is that they are most useful for folks who are going into academics.

 

[militarymd]

According to a 4th year resident I know who is about to start his fellowship in Cardiac.... A lot of the Bariatric cases will potentially start leaning towards cardiac boarded anesthesioligist. But from what I understand fellowships are not required, especially in private practice. My take on cardiac fellowships is that they are most useful for folks who are going into academics.

There is no such thing as a cardiac boarded anesthesiologist.

 

[UTSouthwestern]

Fellowship in cardiac anesthesiology does not include board certification. There is no board certification for cardiac anesthesiology. The fellowship year is probably best suited for those residents who gained only minimal experience with cardiac cases and who desire to gain more experience as well as become proficient with TEE.

 

[Stillwater45]

I stand corrected. I guess what I meant was an anesthesiologist with cardiac fellowship experience.

 

[jwk]

According to a 4th year resident I know who is about to start his fellowship in Cardiac.... A lot of the Bariatric cases will potentially start leaning towards cardiac boarded anesthesioligist. But from what I understand fellowships are not required, especially in private practice. My take on cardiac fellowships is that they are most useful for folks who are going into academics.

Why would you need a cardiac anesthesiologist for bariatrics? Granted, I don't do many 800 pounders, but our "normal" 300-500 pound laparascopic bypasses that take a little over an hour just don't need that expertise.

 

[Stillwater45]

Why would you need a cardiac anesthesiologist for bariatrics? Granted, I don't do many 800 pounders, but our "normal" 300-500 pound laparascopic bypasses that take a little over an hour just don't need that expertise.

My take on it (as a lowly med student) is that obesity is incredibly taxing on the cardiovascular system and therefore the majority of the patients undergoing bariatric surgery would be at a higher risk for cardio complications.


Also another thought is....More than any other surgery, the media has talked up the risks of anesthesia associated with bariatric procedures. I can remember watching a number of "Dateline" or "20/20" type programs that documented these patients as they underwent these life changing procedures and emphasized the "high risk of mortality" associated with undergoing a gastric bypass. (Although I think it was a less than 3% mortality rate, but don't quote me on that) It may make the procedure more "marketable" if a cardiac anesthesioligist was on the case.

But once again, I have no grounds to speak to any of this, so my 2 cents is worth just that ;-).

 

[militarymd]

My take on it (as a lowly med student) is that obesity is incredibly taxing on the cardiovascular system and therefore the majority of the patients undergoing bariatric surgery would be at a higher risk for cardio complications.


Also another thought is....More than any other surgery, the media has talked up the risks of anesthesia associated with bariatric procedures. I can remember watching a number of "Dateline" or "20/20" type programs that documented these patients as they underwent these life changing procedures and emphasized the "high risk of mortality" associated with undergoing a gastric bypass. (Although I think it was a less than 3% mortality rate, but don't quote me on that) It may make the procedure more "marketable" if a cardiac anesthesioligist was on the case.

But once again, I have no grounds to speak to any of this, so my 2 cents is worth just that ;-).

BS....and ...actually only worth 1 and a half cent.

 

[jwk]

My take on it (as a lowly med student) is that obesity is incredibly taxing on the cardiovascular system and therefore the majority of the patients undergoing bariatric surgery would be at a higher risk for cardio complications.


Also another thought is....More than any other surgery, the media has talked up the risks of anesthesia associated with bariatric procedures. I can remember watching a number of "Dateline" or "20/20" type programs that documented these patients as they underwent these life changing procedures and emphasized the "high risk of mortality" associated with undergoing a gastric bypass. (Although I think it was a less than 3% mortality rate, but don't quote me on that) It may make the procedure more "marketable" if a cardiac anesthesioligist was on the case.

But once again, I have no grounds to speak to any of this, so my 2 cents is worth just that ;-).

The media talks up the risk of the PROCEDURE overall, NOT ANESTHESIA problems associated with it. These patients do very well in most cases from our standpoint. The majority, surprisingly, aren't that difficult to intubate with proper positioning, and the procedure is often done in a reverse Trendelenburg position (easier to ventilate as opposed to the head-down position of most laparoscopic procedures). In experienced hands, it's often done in an hour or so, and patients often leave the hospital a couple of days after surgery. Laparoscopic bariatric procedures are a huge improvement over open procedures of just a few years ago - huge incision, lots of complications.

Most of the risk comes from post op problems, either from their pre-existing pulmonary conditions, or from poor surgical technique by relatively inexperienced surgeons. Anastomotic leaks in these patients can be a huge problem, BUT they're not anesthesia complications!! This is not a good small-town hospital procedure - better that they're done in a facility that does a lot of them.

The other risks come from those who tend to ignore their dietary restrictions, often eating too much too soon. They also run the risk of blowing out their anastomosis or simply stretching out their pouch so it's just like a normal stomach. Taken a look at Randy Jackson lately (American Idol) ? He looks like he's put a lot of his weight back on, which is not unusual in this patient population. They bypass really only creates an artificial condition that gives patients a chance to lose weight - if they never change their eating habits, they're doomed to failure.

 

[mysophobe]

Man, the guys that do them here make them look like hernias as far as danger goes. I dunno where these news reporters are going where the surgery is "life-threatening".

 

[bubalus]

FWIW, adult cardiothoracic anesthesiology is well on its way to becoming an ACGME-recognized fellowship like CCM, Pain, Peds.

ACGME program requirements for cardiothoracic anesthesiology fellowship

Does that mean the fellowship is worth it? That's up to the individual.