A Day in the Life of a Duke Anesthesiology Resident

David Martin, MD, CA-2 Resident

Cardiothoracic Anesthesia

My cardiothoracic anesthesia rotation marked a significant turning point in my education process. At the end of even a single month-long rotation I was profoundly more comfortable with both complicated procedures and difficult cases. The case selection at Duke is often high-level and complicated. Depending on the number of cases scheduled in the resident’s room that day, the day begins at approx 5 a.m. We arrive, gather our medications for the case from the pharmacy, and proceed to the O.R. Starting with a machine check and medication preparation, we begin setting up the OR. After setting up our pumps we head to the pre-operative area. We meet the patient at approximately 5:50 and start moving them back to an induction room by 6 a.m. In the induction room we place an arterial catheter, a large gauge IV and a central venous line under ultrasound guidance. Once lines are placed we are in the O.R. by approximately 7 a.m. After induction we place the pulmonary artery catheter if not in place and assist the fellow on echo that month with the TEE and its interpretation while managing the hemodynamics of the patient until it is time for bypass. Throughout the pre-bypass and post-bypass periods we closely communicate in an open two-way dialogue with the surgeons; it is truly a teamwork effort throughout. After the bypass period with the help of the attending we manage the sometimes difficult process of separating the patient from cardiopulmonary bypass. Once the patient is off bypass we interpret lab values on a real time basis, decide transfusion goals and strategies, and continue to manage the necessary vasopressors required by the patient. We transport the patient to the I.C.U. with surgery team at the conclusion of the case and stay immediately available until the patient is stable in intensive care. The day ends after the next day’s pre-operative evaluations are completed.

Cardiac anesthesia stands out among our rotations for many reasons: the faculty are entirely outstanding in teaching and intra-operative support, the research opportunities are numerous, the case-load is complex including a variety of transplants and assist devices, and the relationship between surgery and anesthesia is very good.

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