Albany Medical Center is a tertiary care center. We also take care of patients with severe cardiac dysfunction - acquired and congenital. At present we are involved in the care of about 700 patients requiring cardiac surgery. Cardiovascular disease is the leading cause of death among Americans.
Thomson Reuters ranks Albany Medical Center among the top hospitals in the nation for cardiovascular care. We have led the way in heart care for decades, performing many of the region’s first heart procedures—including the first heart transplant and the first open heart surgery on an infant.
There are six dedicated cardiac anesthesiologists involved in the care of patients undergoing cardiac surgery. All the cardiac anesthesiologists are fellowship trained in cardiac anesthesia and most are also board certified in Transesophageal echocardiography (TEE). The cardiac anesthesiologists also share call with the cardiologists to provide in house coverage for patients requiring TEE exams. We work in close cooperation with a group of excellent cardiac surgeons, perfusionists and highly skilled nurses. The working relationship is very collegial and is we are known for working well as a team.
In the cardiac operating rooms we have the latest in monitoring devices and all the heart rooms have dedicated TEE machines, including a 3-D TEE to help in the care of patients undergoing valve repairs.
We also provide one to one coverage for the residents and there is an active didactic program that involves ECHO rounds, Morbiditiy and Mortality conferences and clinical presentations. The Division of Cardiac Anesthesia is also active in making presentations at national meetings.
A typical day of a Cardiac Anesthesia Resident
It’s in your hands
On the cardiac rotation, the seminal part of each day, weaning off cardiopulmonary bypass is often introduced as the surgeon turns to the anesthesiologist and says, “It’s in your hands.”
Despite hours of intense surgical repair, the delicate transition from mechanical bypass to the revitalized native organs is up to the anesthesiologist. It is in our hands to determine whether that critical heart was sufficiently repaired; if it wasn’t, it is in our hands to make a split-second life-prolonging decision about further interventions.
During the cardiac months, the patients are in our hands, in a very real and literal sense. Dexterity is honed through repeated and intricate procedures. Every day, and sometimes multiple times per day, one will place a myriad of invasive lines and monitors. Each routine cardiac patient receives an arterial line, a central line, a pulmonary artery catheter, and a transesophageal echocardiogram. Beginning on the second day, each resident will not only participate in, but will be expected to perform each of these skills masterfully.
The physiologic understanding of the patients' varied pathology is also in our hands, and is correlated with concurrent use of echocardiography. The resident is expected not only to understand the pathological implications of various disease processes, but to make clinical judgments and prescribe treatment plans based on the images and measurements obtained.
It's our responsibility to teach junior residents and medical students. We show them the proper techniques for line placement and echo interpretation. It’s also in our hands to be active learners - and the teaching on the cardiac rotations is second to none. Residents regularly discuss articles with attendings, and each case in the OR is an opportunity for discussion of pathology, physiology, pressors, and postoperative concerns.
Ultimately, the cardiac experience is a time of intense growth and learning, with manual procedures and intellectual knowledge. Upon completion of the program, the resident will have seen and had experience treating all kinds of cardiac pathology. He or she will have mastered lines and echocardiography. He or she will also have mastered the knowledge and skills necessary to initiate, and come off of life-sustaining cardiac bypass. By the end of one’s residency, when the surgeon tells you that “it’s in your hands,” you’ll be able to believe it... and you’ll know what to do.
Rushton Jones, MD.