Cardiothoracic Anaesthesia and Critical Care
Trainees in the West of Scotland programme rotate to the Golden Jubilee National Hospital to complete a two month essential unit of training during intermediate level and a further two month essential unit of training during Higher level training.
Trainees in the West of Scotland programme rotate to the Golden Jubilee National Hospital to complete a 3-month essential unit during their Stage 2 training.Dr Andrew Nath
Consultant anaesthetist / Cardiothoracic College Tutor
Golden Jubilee National Hospital
Glasgow G81 4DY
Tel: 0141 951 5602 (via secretary)
(in conjunction with the College Tutor at the base hospital)
Golden Jubilee National Hospital
Training in cardiothoracic is carried out at the Golden Jubilee National Hospital, Clydebank. The Cardiothoracic Anaesthetic department has 20 Consultants. The cardiac work is a mixture of coronary artery grafting, valve surgery, valve+graft surgery, adult congenital cardiac surgery, cardiac transplantation and surgery for mechanical support (VAD and ECMO). Due to the increasing number of children surviving to adulthood with complex congenital heart disease, we also are involved with the management of some obstetric cases as well as patients for non-cardiac surgery. There are 2 Intensive Care units with 22 beds and 2 High Dependency Units with 16 beds
Cardiothoracic Anaesthesia Advanced/Specialist Interest Area (SIA) Training Post
This post forms part of the West of Scotland Training Programme in Anaesthesia, has training approval from the Royal College of Anaesthetists and will conform to the formal training guidelines laid out in the Royal College documents. The post will be based at the GJNH, Glasgow. During the 12 month period, the Fellow will gain experience and confidence in the perioperative management of cardiothoracic surgical patients. There will be considerable exposure to transoeseophageal and transthoracic echocardiography and it is generally expected that the Fellow will gain accreditation and certification in echocardiography.
- Duration of post: 12 months
- Selection process: competitive entry
- Work involved: day time work and on-call
- Further details: Dr Andrew Nath, College Tutor
Anaesthesia for Thoracic Surgery Specialist Interest Area training post
The Thoracic surgery department at the Golden Jubilee National Hospital is one of the largest thoracic centres in the UK. It provides care for 1200 patients undergoing thoracic surgery per year, the majority of which are undergoing lung resection for cancer. This includes video-assisted, robotic assisted and open surgery, as well as bronchoscopic and airway surgery, often in conjunction with ENT specialists. There are currently 2 thoracic theatres running 5 days per week.
From the anaesthetic perspective, we offer the following services:
A pre-assessment pathway for thoracic surgery with consultant review available for all patients.
The full range of thoracic anaesthesia:
- lung isolation via several techniques which includes the core skill of flexible bronchoscopy
- shared airway anaesthesia including THRIVE and jet ventilation
- management of the difficult airway using video laryngoscopy and the use of awake fibre-optic intubation
- perioperative care of co-morbid frail patients undergoing high risk surgery
- regional anaesthesia including a newly established erector spinae plane block pathway that involves catheter placement and intermittent boluses for post op pain; as well as thoracic epidural and paravertebral analgesia.
- Post-op acute pain rounds to optimise pain management after thoracic surgery including ongoing care of epidural, paravertebral and ESP catheters.
Expected scope of the 3 month SIA Thoracic Anaesthesia block:
- 2 Thoracic theatre lists per week, 10 hours each
- Full shift on call in the cardiothoracic ICU along-side other trainees from the West of Scotland rotating on their stage 2 blocks. This would be expected to be 4-5 shifts total per month (days and nights).
- The remaining contracted hours made up from elective theatre lists. This would be provisionally in Cardiac theatres, though can be trainee preference led, with flexibility to include sessions in pre-operative assessment clinic, joining the acute pain round, or general/orthopaedic theatre lists.
- Work within cardiac theatres would allow familiarisation with transoesophageal echocardiography basic views, providing transferable knowledge and skills to trainees with an interest in focused intensive care echocardiography (FICE). There are several FICE mentors in the department who can sign off transthoracic echo studies from intensive care during the rotation, to assist with logbook completion for those in the process of FICE accreditation.
Expected work of the anaesthetist in training:
By the end of the three-month rotation, it would be expected that the trainee would be able to undertake a ‘standard’ thoracic theatre list independently with minimal input from the supervising consultant. This would usually be a list with 1-2 VATS or open lobectomies, and 1-2 smaller cases, e.g. mediastinoscopy or rigid bronchoscopy, which would involve:
- pre-operative assessment of elective and urgent patients on the thoracic ward and high dependency areas
- performance of erector spinae plane blocks and high thoracic epidural catheter insertion for post-operative analgesia
- induction and management of anaesthesia in a high risk patient population
- appropriate lung isolation technique to facilitate surgery, and management of airway for shared airway surgery including tumour de-bulking or stent insertion
- provide care in the recovery area following major thoracic surgery, and post-operative follow up/ assessment in the ward/HDU area
These outcomes are in line with key capabilities laid out by the Royal College of Anaesthetists for the special interest area curriculum for thoracic anaesthesia.
Evidence of attainment of these capabilities can be obtained from the following (not exclusive):
- logbook of theatre cases
- attendance at the pre-operative assessment clinic for thoracic surgical patients
- Supervised Learning Events. It would be expected to complete at least three of these (ACEX, CBD and DOPS)
- attendance at a national meeting on thoracic anaesthesia (these run twice a year)
- involvement in a quality improvement project/ guideline development during their time in the department
- completion of satisfactory consultant feedback at the end of the rotation.
For further information please email Andrew Nath