No one expects detailed knowledge of cardiac anaesthesia from residents but to make the maximum of you limited exposure it is a great idea to meet your patients and review the notes pre-operatively. Consultants should be called by mobile before the list to discuss the cases and premeds. Numbers are easily available on CLWrota.
We understand that whilst most do, not all residents are able to see patients the day before surgery. It is the same with consultants! With good communication and teamwork we can always sort something out. Patients will always need to be seen the day before surgery by someone.
Unlike many sub-specialties cardiac still uses sedative premeds. Patients are admitted to the ward the day before surgery usually on wards E2, E3, E4 or CHDU for adult and E1/PICU for paediatrics.
As well as the routine things you might discuss with any patient having an anaesthetic the pink cardiac anaesthetic chart will provide an aide memoir for cardiac specific data you need to know. Echo report, Angio report, CXR, PFTs, X match and antibody screen, Hb, plt count, Na/K and creatinine. A mock chart is included below:
Premeds help to minimise circulating catecholamines, decrease myocardial stress (afterload) and add another layer of hypnosis. Mostly we use a benzodiazepine such as temazepam (10-20mg PO) or lorazepam (1-2mg PO) +/- an opiate such as PO or IM morphine (10-20mg). Please contact your consultant to discuss this until you are confident.
Sometimes patients are brought in to be assessed by a specialist nurse in the ‘heart failure room’ on the E level corridor. Surgeons & anaesthetists have to see these patients before 5pm at which time they are discharged home. They are denoted on the operating list as FT or fast-track. Watch this space as the trust aims to reintroduce day of surgery admission for heart surgery in 2025…
A lot of data is now available through CHARTS & Digirounds on UHS computers making life a lot easier than it used to be. Specifically: angiograms, CXRs, PFTs, echo reports, bloods and transfusion data.
Our lists are published by email at 16:00 the day before surgery by the cardiac case managers (ext 8686). Their offices are on D-level out the back of the CICU & past the coffee room. Lists may well be available before this time however. You can ask to be added to this distribution list during your attachment if you would like by calling ext 8686. The morning of your list please attend theatre at 07:45 to prepare drugs and check the anaesthetic machines. See the shopping list. If in doubt ask the ODPs, they usually know the consultants preference.
Southampton Cardiac Anaesthesia 