Syllabus for Cardiac Anaesthesia (MUHS)

(Academic Council Res. No. 14/2012 dtd. 27/02/2012, applicable from Academic year 2012-13)

1. Preamble

DM Cardiac Anaesthesia course is designed to train candidates in the principles and practice of Cardiac
anesthesia and intensive care and also to function as faculty/consultant in Cardiac anesthesia along with
perioperative, intensive care and pain management.


2. Admission Requirement
For admission to DM Cardiac Anaesthesia candidate is required to have MD or an equivalent qualification in
anesthesia of an institute/university recognized by the Medical Council of India.


3. Duration of Course
Three academic years

4. Aims and Objectives of the Course
The aim of the course is to impart thorough and comprehensive training to the candidate in the various
aspects of this specialty to enable him/her:
(a) To function as a member of faculty/consultant in the specialty
(b) To carry out and to help in conducting applied research in the field of cardiac anesthesia
(c) To plan and to set-up independent cardiac anaesthesia unit catering to cardiothoracic vascular
surgery and intensive cardiac care and Cath Lab.

5. Method of Selection
The selection of candidates for admission of DM in Cardiac Anesthesia is as per State Govt. rules & regulations.

6. Teaching Methods
During the period of training candidates follow in-service rotation residency programme. He/She works as senior resident
and is given gradually increasing responsibility of independently managing simple cardiac operations, decision making in
intensive care management, Cath Lab investigative procedures and various intensive monitoring. The day-to-day work of
the trainees will be supervised by the consultant of the department of cardiac anesthesiology. The posting is so designed
that the trainee gets posted in various areas of the department, including operation theatre, postoperative ICU, Intensive
coronary care unit, Cath. Lab, echo room, and cardiothoracic surgery department. Purpose of rotation in Cardiac Surgery
is to understand overall patient management and to develop and improve perspective on Cardiac Anaesthesia Services.
He or she will be learning invasive cardiovascular diagnostic and therapeutic procedures done in Cath Lab and
emergency services from viewpoint of Cardiac Anaesthesia. The Trainee will participate in regular Joint preoperative
Meetings and discussions with Cardiac Surgeons, Cardiologists, Pediatricians, Physiotherapists, Nurses and Physicians
for better patient management. Besides this a programme for invasive monitoring demonstrations, seminars, workshops,
journal club will also be organized. In addition, soft skills: working in team, communication skills, leadership skills,
ethics, techniques of documentation and knowledge of medico legal aspects will also be required to develop.


7. Teaching Programme
The following teaching programme is prescribed for the course:
Operation Theatre duty
Intensive care unit duty
DM seminar
Journal Club
Cardio-thoracic Surgery
Cath Lab
Teaching duty for MD Anesthesia students by the DM student is part of the training.

Duration of Course 3 academic years,


Research Projects Research projects As per Academic Council Resolution No. 228/2009 dated 19/12/2009 vide
Notification No. 11/2010 dated 13/04/2010.
Basic Qualification for admission M.D. or Equivalent qualification in Anaesthesiology from a University
recognized by MCI
Number of Candidates
Depending on Teacher Student ratio prescribed by MCI norms & as per the amendment if any in the MCI regulations
from time to time.

Curriculum for DM Cardiac Anaesthesia.

The trainee shall maintain a Log Book of the work assigned to them.

Curriculum is as follows :-

BASIC CURRICULUM
Basic sciences include applied Anatomy, Physiology, Pharmacology, Physics, Biochemistry, microbiology, Coagulation
studies.
Monitoring.
Cardio Vascular diagnostic and therapeutic techniques
Special consideration Cardio pulmonary bypass
Drugs related to anaesthesia of CPB, Pharmacokinetics during CPB
Pulmonary life-Support Advanced cardiac life support
Infection Control
Team work, Communication skills, Ethics, Medico legal Aspects of Cardio Thoracic and Vascular Anaesthesia and
Documentation.

Operative Observations
Operative DIRECT CARE (Conduct of anaesthesia)
Post-operative care and pain relief
Research Projects/Exchange Programme with other Centers :
Examinations Basic Sciences
(Theory and Practical) Clinical Practice of Anaesthesia ,Allied
Sciences &Recent advances


GENERAL
_ History of Anaesthesia for cardiothoracic & vascular surgery
_ Natural History of Cardiac & Pulmonary diseases
_ Demography Diagnosis, Pre-Op. evaluation & Preparation for surgery

Detailed Syllabus
I. BASIC SCIENCES
ANATOMY
Heart: Embryology, development of heart, pulmonary and vascular anatomy,
coronary artery anatomy

PHYSIOLOGY
Cardiac: Cellular Physiology, Haemodynamics, Role of Autonomic nervous system on Cardiovascular Function,
Cardiac functions, Action Potential
Cardiac rhythm
Blood Physiology, Coagulation
Acid Base and Electrolyte Balance
Pulmonary, Open & Closed chest ventilation. Ventilation / perfusion mismatch.
Pulmonary airway mechanics, one lung ventilation.
Thoracotomy and pulmonary physiology.
Renal, Hepatic, CNS, Endocrine System, etc.


Metabolic effects of surgery.
Endocrine response to anaesthesia and surgery
PATHOPHYSIOLOGY :
Shock, Heart &Hemodynamic failure, Congenital defects, COPD, Cardiopulmonary reserves,
acquired cardiac & pulmonary diseases. Vascular pathology..
Immunological and metabolic response during CPB.
Total Circulatory Arrest.
Altered Lung function, infection prevention,, diagnosis and management.
PHARMACOLOGY :
Total circulatory arrest, Pharmacokinetics & Pharmacodynamics
of Anaesthetic and Vasoactive drugs. Biochemical reactions and applied
concepts. Drugs related to anaesthesia practice, Cardiovascular drugs.
Antibiotics for ICU use Bronchodilator. Antiarrhythmic drugs,
nitric oxide.
PHYSICS :
Basic principles ,Analysing, measuring & monitoring devices and its role in interpretation of the results.
Electronics, computing of patients data. Laser in cardiac surgery,
robotic technique.
Equipment: Computer application, maintenance, Monitoring, use of Electronics in Documentation & analysis of data,
Equipment in OT, Equipment for transport of patients,
ICU equipment

II. CLINICAL SCIENCES
Anaesthesia for Cardio-thoracic & Vascular Surgery:
Anaesthesia for diagnostic procedures in adults & Paediatric age groups.
Anaesthesia for - Cardiac Surgery : For closed & Open heart surgery.
Anaesthesia Vascular Surgery : Aortic surgery, carotid artery surgery.
Anaesthesia for Thoracic procedures.


PAEDIATRIC :
Basic haemodynamics, palliative procedures, Pre-op. preparations &
special care in monitoring, Fluid balance & airway management
- Anaesthesia for neonatal simple & complex cardiac surgery
- Anaesthesia management for re-surgery
- Paediatric diagnostic procedures in Cath Lab & echocardiography
- Invasive therapeutic techniques like ASD devices, stent in major
vessels, coil embolization
-Paediatric lung surgery.
ADULT :
Anaesthesia for ischemic heart disease, valvular heart disease,
vascular disease, adult congenital heart surgery
- Electrophysiological & Arrhythmia surgery. Heart transplant, heart
lung transplant, ventricular assist devices
- Anaesthetic techniques for pulmonary surgery: Diagnostic & elective.
Emergency procedures for lung surgery. One - Lung anaesthesia and
Ventilation, Physiology (gas exchange & airway dynamics)
- Anaesthesia during emergency surgery and cases directly emerging from
Cath Lab after Cath Lab complication
- Anaesthesia in patients for diagnostic & palliative procedures in
Cardiology, Radiology, Cath Lab (outside operative rooms). Invasive
cardiology procedure
- Anaesthesia management of re-surgery
- Management for Post Op. ventilation care, prolonged ventilation,
weaning, Control of Pain - its techniques & agents. Postoperative
pain management during ventilation care.
- PAC, Intra op. monitoring, Cardiac output and coagulation monitoring



CARDIOPULMONARY BYPASS
_ Perfusion technology (principles, equipment, oxygenators, haemofiltration)
_ Hypothermia, techniques & protocols
_ Myocardial Protection
_ Haemodilution
_ Anticoagulation, Pharmacology, Monitoring methods
_ Side-effects, complications & management of CPB.
_ Vital organ system care cerebral, cerebral protection ,cerebral monitoring,
renal, hepatic protection,.

Total circulatory arrest, left heart bypass
Anaesthesia management during CPB
Pharmacokinetics & pharmacodynamics of drugs during CPB

INTENSIVE CARE MANAGEMENT
_ Protocols for sub-system care, cerebral, Renal, Hepatic & others
_ Ventilatory Care, weaning of Ventilatory support. Parenteral Nutrition, control of infection
_ Renal failure, bedside dialysis techniques
_ Postoperative management of single ventricular repair
_ Hepatic failure
_ ICU monitoring technique in postoperative pain management
_ ICU Management, especially after neonatal surgery ventilatory support in neonates, ECMO
programme for neonates and children
_ Intensive coronary care
_ Cerebral monitoring
III ALLIED SCIENCES
Relevant to practice of safe quality Cardiac Anaesthesia
Cardiac Surgery : Surgical technique, curative surgery, Palliative procedures Risk
evaluation, Prognosis, Robotic surgery.
Cardiology: Pre-op. evaluation, patho-physiology, Electrophysiology, Diagnostic
Radiology Procedures-ECG, x-ray Angiography, Cardiac Cath. Echo-Cardiography, Nuclear studies , their interpretations
& management
Special procedures : Pacing, Cardioversion, PTCA, etc.
Automated cardioverters, invasive procedures for arrhythmia i.e. ablation
of abnormal pathway.
Biotechnology : Various mechanical & electronic equip. Animal experiments, materials
used for CPB techniques, VAD. IABP, Laser for TMR, ECMO
Statistics : Bio Statistics
Research Methodology
Hospital Administration : Sterilization/Gas supply, equipment maintenance, ambient air control and infection control
techniques in OT
Microbiology
Infection control, prevention, diagnosis and management.


Monitoring in Anaesthesia
Invasive & Non-Invasive monitoring techniques for Peri -operative period
_ Understanding of basic concepts of monitoring
_ Indications, cost effectiveness, complications
_ Equipment usage & knowledge of accessories and their management
Knowledge of the following monitoring
Cardiac functions : ECG, ABP, Ventricular Pressures, Calculation of cardiac output, Vascular resistance,
Flow, Echo, Dopplers & (CAT, PET, NMR)
Pulmonary functions : PFT which includes Blood gases, Acid-base and Pulmonary Airway mechanics.
Coagulation Profile, Temperature, renal, B. Sugar and other biochemical monitoring
Neuromuscular blockade : Recent advances in monitoring. BIS cerebral oximetry, Evoked
potential monitoring, CNS monitoring during CPB.



RECENT ADVANCES
Knowledge of recent developments in field of Cardio thoracic & Vascular surgery
_ Cardiology - PTCA, Balloon embolectomy etc.
_ Heart - lung transplant - physiology, pharmacology (Anaesthetic consideration) - Donor - recipient
Selection, Immunosuppression etc.
_ Cardiac assist devices - Artificial heart, IABP, LHAD
_ Advances Pulm. support - ECMO, High frequency Ventilation
_ Blood substitutes
_ Current advances and concepts in drugs, equipments, and monitoring methods
Recent advances in Radiology, Cardio Thoracic Surgery, Cardiology, Cardio Pulmonary Bypass in relation to
Perioperative care of the patient in Cardio Thoracic and Vascular Anaesthesia.

Intensive Coronary Care Unit
During their posting in CCU for one month, the candidate is required to attend the CCU rounds
and to learn for himself the coronary intensive care in addition to the ventilatory care.


Pediatric Cardiology Intensive Care
For their one month posting in pediatric intensive care unit, trainees will be participating in the ward rounds and their
teaching programme in cardiology Cath Labs and echo room.

Cardiac Radiology
During their posting in Cardiology, trainees are required to participate in cardio, radiology meet,
teaching programme and echo room training.
The trainee is made conversant with the technique of various invasive cardiac therapeutic and
diagnostic procedures in adults, children and neonates, as well as CT scan and MRI scan under the
guidance of cardiac radiologist for one month. Cardiac radiological investigations are conducted everyday and a special
posting will be made for getting conversant with these produces.


Cath Lab
There will be a special posting for Cath Lab for handling the neonates and children undergoing investigative and
therapeutic procedure and also for insertion of implants/pacemaker in adult patient. They will be learning recent advances
in imaging cardiology during their posting in Cath Lab.

Period of Posting in Various Units
The trainee will be posted in different specialties and postings will be as follows :
Cardiac anaesthesia 2 years
CTVS 3 months
Cath Lab 2 months
Echo lab 1 month
ICCU 1 month
Paediatric ICU 1 month
Research experience 1 month (optional)
Elective posting 3 months to learn recent techniques (to go to other centers, national or international)

ASSESSMENT
There will be regular annual internal assessments in both theory and clinical practice for every candidate. In addition,
Internal assessment will be done in the course of day-to-day work of the trainee, which involves patient care, teaching,
anesthesia management in the operation room, emergency services, bedside presentation and research.

RESEARCH
The trainee is required to undertake research and write papers under the guidance of a consultant as per the PG
Academic Notification No. 11/2010 dtd. 13/04/2010 as follows;


1. A Superspeciality student should get training in Research Methodology, hence he/she has to undergo a
course in Research Methodology which should be mandatory.
2. At Superspeciality level Dissertation is not required. However Research is an important component hence
research project is necessary. The evaluation of the research can be done by following the procedure as
mentioned below.
(i) A student has to write a paper based on the research done by him/her.
(ii) The paper will be reviewed by three members who will constitute an Institutional Academic
Committee/Internal Research committee/ an equivalent Institutional committee having one member
as the subject expert.
(iii) The research paper will be sent to the examiners for the purpose of evaluation.
The assessment will be done as a separate head during the viva.
3. The research paper should be submitted by the student within six months before the final examination to the
committee mentioned above i.e.2 (ii) and three months before the final examination to the University.


FINAL EXAMINATION
Eligibility
Candidate will be allowed to appear after three years of training and after completion of his / her Research Project and as
per University rules.

Board of Examiners
Cardiac anesthesiologists with a minimum of 10 years of teaching experience with 5 years experience in the specialty.


(As per letter No. MUHS/XPG/X1/64/08/222/2012 dtd. 31/07/2012 received from Examination Section)

Theory Papers

04 Paper (Paper I to Paper IV, 100 Marks each. ) This system is followed in other subjects of D.M. Courses


Internal Assessment

Not applicable


Passing Criteria:-
As per existing system of passing criteria, it is mandatory for the candidate to obtain minimum 40% of passing
marks in each Theory Paper and 50% of marks in overall aggregate in all papers. For Clinical practical & viva
minimum 50% of marks in overall aggregate are required.