The second annual Thoracic Anesthesia Symposium sponsored by the Society of Cardiovascular Anesthesiologists (SCA) was held April 5-6, 2013 in Miami, Florida. The SCA developed this one-and-a-half day program to meet the increasing demand for continuing medical education in anesthesia for non-cardiac thoracic surgery, as this is an expanding area in both the number and types of procedures.
There have been many recent advances in anesthesia for non-cardiac thoracic surgery, including, but not limited to, lung isolation techniques in patients with difficult airways, prevention of hypoxemia during one-lung ventilation, and management of minimally invasive and robotic lung surgery. Discussions with attendees at recent anesthesia meetings and a survey of course evaluations have identified these particular areas as professional practice gaps. The symposium program of continuing education was designed to address the knowledge and performance deficiencies in these areas.
Anesthesia for thoracic surgery is not a separate subspecialty, but is commonly included within the subspecialty of cardio-vascular anesthesia. However, many clinicians who provide anesthesia for thoracic surgery do not provide cardiac anesthesia, and a large proportion of thoracic surgery is performed in hospitals that do not have cardiac surgery services. No adequate forum at national specialty or subspecialty anesthesia meetings has been available to facilitate keeping pace with the advances in thoracic anesthesia. This program was designed to be an update and review of thoracic anesthesia for both anesthesiologists who practice cardiac anesthesia and those without a cardiac practice, as well as for anesthesia fellows and residents interested in thoracic anesthesia.
Judging by the attendance and evaluations, the course was a success in meeting these goals. The program was sold out, with 160 attendees from many countries, and 46 faculty. The high ratio of faculty-to-registrants was designed to maximize interactivity with the use of panels, case discussions, workshops, Problem-Based Learning Discussions (PBLDs) and debates. Panel topics included pulmonary hypertension in thoracic surgery and new trends in intraoperative monitoring. The “Cancel the Case?” session was an interactive discussion of three cases: preoperative hypotension; new onset atrial fibrillation; and mediastinal mass.
During the pro/con debates, the audience considered two propositions: Thoracic Epidural is the optimal analagesia for VATS lobectomy and A bronchial blocker is the preferred airway device for lung isolation with a difficult airway.
Attendees rotated through six workshops: Bronchial Blockers; DLT Placement with a Difficult Airway; Paravertebral Blocks; Lung Ultrasound; Airway Surgery; and Simulator One-Lung Ventilation. Perhaps the most enthusiasm among the attendees was generated by the small-group PBLDs. All attendees rotated through three PBLDs chosen from a list of 13 topics. Included in the PBLD topics were lung transplantation, robotic thoracic surgery, the opioid-tolerant patient, sleeve resection, and cardiomyopathy in a patient undergoing pulmonary resection.
Twenty posters related to thoracic anesthesia were accepted for display at the meeting. Awards were presented for the best poster in three categories:
Best Clinical Pearl:
“Pulmonary Separation and Differential Lung Ventilation in Management of Severe Intraoperative Reexpansion Pulmonary Edema,” Jessica Brodt, et al.,University of Miami Hospital, Jackson Memorial Hospital
“Impact Of Transesophageal Echocardiography on Surgical Decision-Making During Lung Transplant,” Wilfredo Puentes Baltran, et al., University of Toronto, Toronto General Hospital
Best Case Series:
“Incidence of Hypothermia in Thoracic Surgery Despite Forced Air Warming,” David Bronheim, et al., Mount Sinai Medical Center, New York
The SCA will sponsor the 3rd Annual Thoracic Anesthesia Symposium next year in New Orleans on Friday, March 28 and Saturday, March 29, 2014, prior to the SCA Annual Meeting. The registration will remain limited and the program will evolve with new topics for panels, PBLDs, workshops and debates. Anesthesiologists, fellows and residents interested in thoracic anesthesia should watch the SCA website (www.scahq.org) for the announcement of the opening of registration for 2014 and the poster submission deadline.