Minimally invasive mitral valve surgery from an anesthesiologist’s perspective. #cardiac #mitral #tee #minimallyinvasive #robot #anesthesia #meded

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Surgically, more and more cases are performed through tiny incisions for minimal scarring.  Don’t let that underestimate the size of the procedure.  For example, mitral valve surgery is still a common procedure that involves a sternotomy (“cracking the chest”) and stopping the heart — it’s a big procedure.  However, surgeons have become adept at making smaller incisions while still undergoing the big procedure.

Innovations; 2011: Vol 6, No. 2.  Minimally invasive vs. Conventional open mitral valve surgery: A meta-analysis and systematic review.

Robotic mitral valve repair: anatomic considerations

Journal of Heart Valve Disease: August 2006. 2D Echo measurements alone do not provide accurate non-invasive selection of annuloplasty band size for robotic mitral valve repair

Annals of Cardiothoracic Surgery: 2013;2(6): 796-802. Value of TEE guidance in minimally invasive mitral valve surgery.

Multimedia-Manual of Cardiothoracic Surgery: Vol 2009; Issue 0122. Minimally invasive mitral valve surgery via right minithoracotomy

Cardiac Anesthesia: Principles and Clinical Practice; Chapter 25: Anesthesia for minimally invasive cardiac surgery.

Mitral Valve Repair Center: Post-Repair TEE Assessment.

Medtronic: Echo and surgical techniques for retrograde cardioplegia-coronary sinus cannulation during minimally invasive cardiac valve surgery.

OA Anaesthetics; 2014 Feb 25;2(1):3. Anaesthetics considerations for robotic-assisted cardiac surgery.

A modified anaesthesia protocol for patients undergoing minimally invasive cardiac surgery by thoracotomy – a single center experience.

HSR Proceedings in Intensive Care and Cardiovascular Anesthesia; 2013. Current concepts for minimally invasive mitral valve repair.

2014 Clinical vignette from the surgical prospective

Chauhan S, Sukesan S. Anesthesia for robotic cardiac surgery: An amalgam of technology and skill. Ann Card Anaesth [serial online] 2010 [cited 2016 Apr 12];13:169-75. Available from: http://www.annals.in/text.asp?2010/13/2/169/62947

Career path: anesthesiologist

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If you’re an anesthesiologist or in anesthesiology, you should check out this guy’s blog. He’s real and states it how it is. 

Lately, I’ve been feeling a lot of what he describes here: http://www.blog.greatzs.com/2016/03/a-hard-days-night.html?m=1

I think in residency it was a tad easier to deal with the insane work hours bc all my friends were in the same boat. We all suffered together and had minimal free time. But now in the real world, where a lot of my friends are non-medical or have better work hours… I see a huge discrepancy in free time available. It’s taking a toll on me bc I want that free time too and I find myself overwhelmed with being a “Yes” person and ignoring “me”. Lately, it’s catching up and I need a disconnect. 

But apparently, according to this recent report, I’m not working that hard.  Maybe hospital administrators should know that OR efficiency (or lack thereof) is the bottleneck.  Perhaps parallel incentives where productivity-based pay instead of salaries would provide a bit of motivation. 

And I completely agree with this guy’s assessment and wonderment of trying to become an intensivist. I chose anesthesiology for a reason, not ICU, not internal medicine, etc.