Vascular-Thoracic:
Residency Educational Objectives

KNOWLEDGE /SKILLS / PERFORMANCE

Thoracotomy/Thoroscopy/Mediastinoscopy

• Placement and pharmacokinetics of neuraxial opioids.
• Physiology/ramifications of lateral positioning.
• Function, structure and use of standard double-lumen tubes: include techniques of placement and confirmation by auscultation and/or FOB.
• Management and physiology of single-lung ventilation.
• Placement, dosing, and management of thoracic epidural.
• Function, structure and use of bronchial blockers and univent tubes.

Abdominal aortic aneurysms

• Management via PIRAT protocol.
• Alternatives to PIRAT protocol management
• Anesthetic complications of cross-clamping aorta: both "high" and "low" crossclamps and then unclamping (wash-out, hemodynamic changes, hypotension, etc.).

Peripheral vascular disease surgery - major.

• Comfort with epidural management in long cases

Peripheral Vascular Disease - Minor (AV fistula, femoral artery, pseudoaneurysm, etc.)

Carotid endarterectomy

• Comfort and efficiency in mixing/using vasoactive drips.
• Understanding of the morbidity/mortality issues.

Liver resections/large GI (abdominal) cases

• Placement of large-bore IV's, 8.5 Fr. sheaths, etc.
• Use of adjunctive epidural opioids
• Anesthetic implications of argon-beam surgery
• Implications of blood transfusions (medium-size)

Thoraco-Abdominal Aneurysms

• As above for large liver cases
• Management of rapid transfuser set-up
• Placement of lumbar drain and antecubital cordis
• Management of partial bypass and coming off bypass
• Implications of massive transfusions.
• Placement of double lumen tubes and implications of changing over to a single lumen tube.

General Skills

• Complete room set-up for early AM start
• Ability to work confidently and efficiently in early AM before attending arrives
• Mastering of arterial cannulation, central line placement and PA catheter insertion
• Comfort with hemodynamic manipulation correlated to PA catheter measurements

Airway

• Management of patients with anticipated complex airway pathophysiology.
• Technical expertise with fiberoptic, lightwand, LMA, rigid bronchoscopy, jet ventilation management techniques.
• Expertise with emergency/unanticipated difficult airway in the OR suites, units, and wards - for intubation and extubation.
• Consultation perioperatively on patients with anticipated/unanticipated difficult airway.