Residency Educational Objectives

KNOWLEDGE

• Pre-operative assessment of cardiac disease (including interpretation of data from ECG, echo, cardiac catheterization, exercise testing).
• Pathophysiology of cardiac diseases (including coronary artery disease, valvular heart disease, cardiomyopathy, congenital heart disease).
• Indication for and complications of invasive hemodynamic monitors.
• Pharmacology, doses and side effects of inotropes, pressors and vasodilators (e.g. nitroglycerin, nitroprusside, dopamine, epinephrine, norepinephrine, amrinone, isoproterenol, phenylephrine).
• Cardiovascular side effects of anesthetic agents.
• Issues in cardiopulmonary bypass (placement of cannulas, anticoagulation, bypass circuit, side effects of bypass, potential disasters).
• Management of intraoperative arrhythmias.
• Familiarity with mechanical assist devices.
• Issues in the management of heart and lung transplantation.
• Management of anticoagulation and coagulopathy with heparin, protamine or blood products.

SKILLS

• Set-up for cardiac cases (including mixing vasoactive drips, use of IMED pumps, bolus dosing of vasoactive drugs); placement of radial arterial, central venous and pulmonary lines.
• Additional skills for the second month: Set-up for pediatric cardiac cases; placement of TEE probe; very basic interpretation of TEE studies.

PERFORMANCE

• Formulation of an anesthetic management plan for heart surgery, taking into account commonly encountered coexisting disease (COPD, diabetes, hypertension, cerebrovascular disease, peripheral vascular disease, obesity etc.).
• Use of hemodynamic monitors intraoperatively to guide the management of anesthesia.
• Fluid and electrolyte management.
• Airway management in the cardiovascularly compromised patient.
• Management of acute hemodynamic instability.
• Preparation of the patient to separate from cardiopulmonary bypass.
• Analysis and management of failure to come off bypass.
• Anesthetic management for AICD placement.