Cardiac Anesthesiology

Cardiac Anesthesiology at the University of Ottawa Heart Institute is a multi-faceted division dedicated to perioperative cardiovascular care, education and research. Established under the early leadership of North American cardiac anesthesia pioneer J. Earl Wynands, MD, Cardiac Anesthesiology has established a model that is unique in Canada. The division encompasses:

  • Pre-operative assessment and preparation of all patients prior to surgery
  • Intra-operative anesthesia services
  • Intra-operative echocardiography imaging
  • Post-surgical intensive care management
  • All other respiratory care

Approximately 1,500 open-heart procedures per year require anesthesia. These procedures include coronary artery bypass, valve replacement , heart transplant, pulmonary thromboendarterectomy, and mechanical circulatory assist devices (artificial heart and left ventricular assist device). Clinical anesthesia is also provided for a growing number and variety of pacemaker and implantable cardioverter-defibrillator (ICD), percutaneous aortic valve and arrhythmia procedures.

Multi-disciplinary intensive care for cardiac surgery patients is provided in the Cardiac Surgical Intensive Care Unit. This unit is administered by a dedicated group of intensive care Cardiac Anesthesiology physicians. Respiratory care support is also provided to the Coronary Care Unit.

A team of anesthesia technologists, under the guidance of the Division Head, Cardiac Anesthesiology, assists the staff anesthesiologists with a variety of clinical duties.

Educational participation includes residency rotations for the University of Ottawa Department of Anesthesiology Residency Program, Fellowship rotation of the University of Ottawa Critical Care Program and a Cardiac Anesthesiology Post-Graduate Fellowship Program.

Programs & Units 

Cardiac Surgical Intensive Care Unit

Medical Director, Bernard McDonald, MD

The Cardiac Surgery Intensive Care Unit (CSICU) is a comprehensive care, multi-disciplinary, Level 1 (CCCS) Intensive Care Unit (alternatively called Level 3 by MOH) which provides care for cardiac surgical patients ranging from routine to the most advanced, complex life support methods available. The CSICU is comprised of a total of nineteen dedicated critical care beds located in three different modules.

All levels of care are provided for cardiac surgical patients recovering from surgery with acute postoperative management needs or with post-operative complications. Five attending critical care medicine physicians from the Division of Cardiac Anesthesia lead our multi-disciplinary team which includes over 100 critical care nurses, respiratory physiotherapists, registered dieticians, physiotherapists, speech-language pathologists, and a pharmacist, all dedicated to the CSICU.

This team structure enables the CSICU staff to expertly deliver all aspects of patient management such as advanced hemodynamic monitoring (including transesophageal echocardiography), advanced hemodynamic support (including intra-aortic balloon pump and temporary and long-term ventricular assist devices), advanced ventilatory support (including high frequency oscillation and extra-corporeal membrane oxygenation) sedation, nutrition and renal replacement therapies. Care is provided in close collaboration with our colleagues from the Division of Cardiac Surgery and with a full range of supporting medical and surgical services readily available for consultation.

CSICU physicians have an active teaching profile within the University of Ottawa’s Critical Care Medicine and University of Ottawa Anesthesiology programs, and the CSICU is a core rotation for critical care medicine fellows and anesthesiology residents. As well the CSICU hosts resident physicians and post-specialty fellows from a variety of post-graduate specialty educational programs including cardiac anesthesiology, cardiology, cardiac surgery, and thoracic surgery. The CSICU also hosts clinical rotations for trainees from all of the health professions working within our team.

Clinical Anesthesiology

Division Head, Jean-Yves Dupuis, MD
The clinical arm of Cardiac Anesthesiology provides all aspects of peri-operative care to cardiac surgical patients. This care is provided by cardiac anesthesiologists who have specialized in anesthesiology and critical care medicine for heart patients.

Anesthesia care starts with pre-operative consultation either as an out-patient in the Pre-Admission Unit (PAU) or as an in-patient in the hospital. Anesthesiology consultation is also available for surgical or medical inpatients.

Intra-operative Anesthesiology Care (the anesthetic itself) is provided for a variety of procedures and in a variety of clinical situations:

  • Cardiac surgical procedures
  • Electrophysiology ablation procedures to treat arrhythmias
  • Implantable cardiac defibrillator (ICD) insertions
  • Elective or emergency cardioversion
  • Peri-operative pain management, including nerve block procedures
  • Transesophageal echocardiography for cardiac surgery and critical care

Complete, comprehensive Critical Care Medicine services are provided by Cardiac Anesthesiology for post-operative cardiac care, and for any additional intensive care needs of the surgical patient. This takes place in the CSICU where all aspects of life support care are administered until patients are ready for mobilization and transfer back to the ward.

Respiratory support and consultative services are also offered to the Coronary Care Unit for critically ill non-surgical patients, especially those requiring ventilatory support.

Technical aspects of monitoring patients for cardiac surgical procedures are tailored to the needs of the patient. They include extensive state-of-the-art hemodynamic monitoring, transesophageal echocardiography, neurophysiological monitoring including electroencephalography and transcranial Doppler, respiratory and anesthesia monitoring, and computerized anesthesia record keeping.

A team of anesthesia technologists also assists in the cardiac operating rooms.

Pre-Admission Unit

Prior to elective surgery, many patients are assessed as out-patients in the Pre-Admission Unit (PAU). Patients meet an anesthesiologist and are provided with information concerning preparation for surgery, the anesthetic itself, and post-operative care.

The visit is a comprehensive one. Additional nursing assessment is done, and educational material regarding the surgical procedure and the entire hospital stay is provided in written and audio/visual formats. Instructions are provided for preparation for admission and timing and location of the admission itself, which will often occur the morning of the scheduled surgery.

Any additional pre-operative tests and consultations that are necessary are also arranged while in the PAU.

Research 

Current Director: Diem Tran, MD

The medical staff, within Cardiac Anesthesiology, are committed to providing the best available treatments for heart disease as well as developing new and better methods of care. We do this by comparing current treatments with new ones that we believe will give better results. In the context of approved clinical trials, new treatments can be compared to conventional treatment.

History

We have a long-standing history of research. The first chairman of the formal Division of Cardiac Anesthesiology was one of the founding fathers of cardiac anesthesia, J. Earl Wynands, MD. The research tradition continued with Dr. Howard Nathan whose research included extensive studies on brain protection during cardiac surgery.

Towards Improved Patient Care

Current themes extend from the Cardiac Surgical Suite through to the Cardiac Surgery Intensive Care Unit (CSICU), where patients initially recover from surgery. Research in our division encompasses a formal team of investigators, including medical and basic science researchers, research managers and coordinators. Both “peer-funded” studies (Heart Institute-centred and multi-centre studies) as well as internally directed research projects are undertaken.

Education 

Supervisor, Post-Graduate Education, Christopher Hudson, MD
Supervisor, Undergraduate and Fellowship Education, Sean Dickie, MD

Medical educational activities within Cardiac Anesthesiology take place at the undergraduate and post-graduate levels.

Post-Graduate Education

Educational participation includes residency rotations for the University of Ottawa  Department of Anesthesiology Residency Program and Fellowship rotation of the University's Critical Care Program. Dedicated Cardiac Anesthesia rotations, which are usually coordinated with other rotations in both the Cardiac Surgical Intensive Care Unit and the Coronary Care Unit, offer a unique, full spectrum educational experience in cardiac care. In addition, our dedicated Cardiovascular Core Program is provided as one of the major teaching components of the University Residency Program.

Undergraduate Education

Division members participate in formal undergraduate teaching at the University of Ottawa Medical School in the pre-clinical stages. In addition, we offer clinical rotations to undergraduate medical students who are interested in having exposure to cardiac anesthesia.

Post-Graduate Fellowship

The Cardiac Anesthesiology Post-Graduate Fellowship Program provides qualified anesthesiologists an opportunity to learn all aspects of cardiac anesthesiology, including advanced training in perioperative transesophageal echocardiography , critical care medicine and anesthesia for evolving non-invasive cardiac interventions.

For more information, please see Cardiac Anesthesiology Educational Programs.

Team 

Dr. Stéphane Lambert, Division Head

Several former members of Cardiac Anesthesiology remain in the hearts of Division members and other Heart Institute staff:

  • Dr. J. Earl Wynands
  • Dr. John Atkinson
  • Dr. John Cowan
  • Dr. Gilles de la Salle
  • Dr. Jeff Hertig
  • Dr. Ruaraidh McIntyre
  • Dr. Barry Wilson
  • Dr. John Wrazej

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