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Cardiothoracic Anesthesiology Fellowship, University of Washington

The University of Washington Cardiothoracic Anesthesiology Fellowship is a one year clinical fellowship, with the option of a second research year. The fellowship is accredited by the ACGME. The goal of the clinical fellowship is to produce highly competent cardiothoracic anesthesia practitioners for either community or academic practice. The fellowship curriculum emphasizes intraoperative echocardiography and complex, high risk cardiothoracic surgery, including heart and lung transplantation, adult congenital heart disease, thoracic aortic surgery, and ventricular assist devices.

Description

Echocardiography

Intraoperative echocardiography is the essence of state-of-the-art cardiothoracic anesthesiology practice. The University of Washington cardiothoracic anesthesiology division has superb resources in echocardiography, under the guidance of Donald Oxorn, MD, FACC, Professor of Anesthesiology and Medicine (Cardiology) and Director of Intraoperative Echocardiography. Transesophageal echocardiography is performed in virtually all patients undergoing cardiac surgery, using the latest digital echocardiography imaging equipment. A world famous echocardiography laboratory (faculty includes Drs. Alan Pearlman and Catherine Otto) is available for consultation and participates in our teaching program. A cardiac surgery population with a large proportion of valvular and adult congenital heart disease provides superb opportunities to observe cardiac structural pathology, ranging from the common to the very rare. The diverse echocardiography experience of our fellowship is well represented in the, “Atlas of Intraoperative Transesophageal Echocardiography” authored by Drs. Oxorn and Otto. Fellows typically spend a month in the echocardiography laboratory becoming familiar with transthoracic echocardiography. Further transthoracic echocardiography experience is gained through the use of transthoracic echo for postoperative hemodynamic management in the ICU.

Scope of Practice

The core activities of the Cardiothoracic Clinical Fellowship take place at the University of Washington Medical Center. We also make use of resources from our other hospitals-- Northwest Hospital Medical Center, Childrens Hospital and Medical Center, and the Veterans Administration Medical Center. The cardiac surgery practice is under the direction of Edward Verrier, MD, Chief of Cardiothoracic Surgery and William K. Edmark Professor of Cardiovascular Surgery, and Gabriel Aldea, MD, Chief of Adult Cardiac Surgery. The program is of moderate size, but of enormous complexity, with many cases of valvular and adult congenital disease, heart transplant, cardiomyopathy requiring ventricular assist devices, and thoracic aortic surgery. Adult congenital heart disease is a major emphasis. Dr. Verrier is an adult congenital heart surgery specialist. Two of our anesthesiologists, Drs. Natrajan and Joffe, have extensive experience with both pediatric and adult congenital heart surgery. The thoracic surgery practice, under the direction of Douglas Wood, MD, and Michael Mulligan, MD, is a large program, also with enormous complexity, including lung volume reduction, complex pulmonary resections and pulmonary thromboendarterectomy for chronic pulmonary embolization. Our lung transplant program is one of the larger programs in the country. There are ample opportunities to perfect skill at thoracic epidural catheter placement, and management of single lung ventilation.

The Fellowship Year

Rotations include 1 month each in the echo lab, the cardiothoracic ICU, and attached to the adult congenital heart disease service. Didactic teaching includes the weekly combined Cardiology/Cardiac Surgery/Cardiothoracic Anesthesiology Conference that is a forum for review of interesting and difficult cases, often involving presentation of echocardiography, weekly TEE Review, and monthly Cardiothoracic Anesthesiology Journal Club. Every effort is made to enable our fellows to attend the didactic lectures and tutorials of the Cardiology and Cardiothoracic Surgery fellowship programs.

Research

The University of Washington is consistently one of the top medical research universities in the country. Fellows interested in obtaining research experience following a clinical fellowship will find many opportunities in both clinical and basic research.

Faculty

The Cardiothoracic Anesthesiology faculty currently consists of seven core members.

	T. Andrew Bowdle MD, PhD. Professor of Anesthesiology and Pharmaceutics (Adjunct), Chief of the Division of Cardiothoracic Anesthesiology. Education: Undergraduate education: University of California at Davis. Medical school: University of Washington. PhD in pharmacology, University of Washington (Medical Scientist Training Program). Anesthesia training: Residency in anesthesiology, University of Washington. Board certified in Anesthesiology, recertified 2002. Testamur of the Examination of Special Competence in Perioperative Transesophageal Echocardiography, 1999. Honors: Regent’s Scholar, University of California. Alpha Omega Alpha. Association of University Anesthesiologists. Appleseed Award for resident teaching. Current academic interests: Clinical pharmacology, depth of anesthesia monitoring, prevention of drug errors, prevention of central line complications Selected recent publications: Bowdle TA, Knutsen LSJ, Williams M. Anesthetics. In Comprehensive Medicinal Chemistry, 2nd edn, Vol. 6, Ed. M. Williams, Elsevier, Oxford, 2006, pp. 351-367. Bowdle TA, Edwards M, Domino K: Reducing error in cardiac anesthesia, Kaplan’s Cardiac Anesthesia, 5 th Edition. Edited by Kaplan J. Philadelphia, Elsevier, 2006, pp 1217-1233. Bowdle TA: Depth of Anesthesia Monitoring, Anesthesiology Clinics of North America. Edited by Vender J. Philadelphia, Elsevier, 2006; 24:793-822. Sebel PS, Bowdle TA, Ghoneim et al: The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004; 99:833-839. Domino KB, Bowdle TA, Posner KL et al: Injuries and liability related to central venous catheters: a closed claims analysis. Anesthesiology 2004; 100:1411-1418. Bowdle TA: Pharmacology of Analgesia, Wylie and Churchill-Davidson's A Practice of Anaesthesia. 7th Ed. Edited by Healy TEJ, Cohen, PJ. London, Edward Arnold, 2003 Schwarz B, Bowdle TA, Jett GK: Biphasic shocks compared with monophasic damped sine wave shocks for direct ventricular defibrillation during open heart surgery. Anesthesiology 2003; 98:1063-1069.
	Jörg Dziersk MD FRCA Clinical Assistant Professor of Anesthesiology Fellowship Director Education: Medical School: Ludwig-Maximilians-Universität München, Germany Anesthesia training: Imperial College School of Anaesthesia, London, UK Fellow of the Royal College of Anaesthetists, UK Certified as Specialist in Anesthesia in United Kingdom and Germany Fellowship in Cardiothoracic Anesthesia, University of Washington Testamur of the Examination of Special Competence in Perioperative Transesophageal Echocardiography Interests: Education in perioperative transesophageal echocardiography; thoracic aortic surgery, anesthesia and coexisting disease
	Denise Joffe, MD Clinical Associate Professor of Anesthesiology Education: Undergraduate education: McGill University, Montreal, Canada. Medical school: McGill University, Montreal, Canada. Anesthesia training: Residency in anesthesiology, McGill University, Montreal, Canada. Fellowship in adult and pediatric cardiothoracic anesthesiology, Mount Sinai Hospital, New York. Canadian anesthesiology fellowship exams 1992, Board certified in Anesthesiology (USA) 1994. Testamur of the Examination of Special Competence in Perioperative Transesophageal Echocardiography, 2005. Work experience: Montreal Children’s Hospital, Children’s Hospital of Pittsburgh, National Institutes of Health, Bethesda, MD, Robert Wood Johnson University Hospital, New Jersey, Children’s National Medical Center, Washington, DC Current academic interests: Congenital heart disease in children and adults. Ongoing studies: The hemodynamic assessment of dexmetetomidine in pediatric patients with bidirectional cavopulmonary anastomosis The hemodynamic assessment of dexmetetomidine in pediatric patients post cardiac transplantation Selected recent publications: DelPizzo K, Joffe D, Finkel J. Tracheal bronchus in a ten-month old patient for thoracoscopic resection of congenital cystic adenomatoid malformation. Pediatr Anaesth (in press). Cohen IT, Joffe D, Hummer K, Soluri A. Ondansetron oral disintegrating tablets: Acceptability and efficacy in children undergoing adenotonsillectomy. Anesth Analg 2005 ; 101:59-63 Joffe D, El-Rafai A, Thomas M. Fatal marrow emboli in a pediatric patient having posterior spinal instrumentation for scoliosis repair. Pediatr Anaesth 2005;16:89-91 Joffe D, Moak J. The anesthetic considerations of arrhythmias in the pediatric patient. Progress in Anesthesiology, Dannemiller, San Antonio, TX, 2000 Joffe D. Dysrythmias in the pediatric patient in The Pediatric Anesthesia Handbook, ed. Yemen T. McGraw-Hill Companies, 2002, pgs 179-195
	S. Lombaard MBChB (Pret) Assistant Professor, Department of Anesthesiology Education: Medical school: University of Pretoria, RSA. Anesthesia training: Residency in anesthesiology, Wellington Hospital, New Zealand. Primary Fellowship Examination of the Australian & New Zealand College of Anaesthesia (2000) Final Fellowship Examination of the Australian & New Zealand College of Anaesthesia (2002) Current academic interests: Simulation as teaching tool for anesthesia residents, 3D anatomy for TEE.
	Donald Oxorn MD, CM, FRCPC, FACC. Professor of Anesthesiology and Medicine (Cardiology, Adjunct). Education: Medical school: McGill University, Montreal, Quebec, Anesthesia training: Residency in anesthesiology: University of Western Ontario, London, Ontario, Canada. Fellowship in Critical Care Medicine, University of Maryland, Baltimore, Maryland Fellowship in Echocardiography, University of Toronto, Toronto, Ontario, Canada Fellow of the Royal College of Physicians of Canada Board certified in Anesthesiology (DABA). Board certified in Adult Transesophageal Echocardiography, National Board of Echocardiography Multiple teaching awards in Anesthesiology and Critical Care Medicine Current academic interests: Transesophageal Echocardiography Liaison Editor, Perioperative Echocardiography, Anesthesia and Analgesia Recent Work: Oxorn D. Transesophageal echocardiography: Monitoring ventricular function in the operating room-Impact on clinical outcome. In: Otto C.M., ed, The Practice of Clinical Echocardiography, 3rd ed. W.B. Saunders Company, 2006. Oxorn D, Otto C. Atlas of Intraoperative Echocardiography. Elsevier, 2007
	Kris Natrajan MB,BS; FRCA Clinical Assistant Professor of Anesthesiology, Adult and Pediatric Cardiothoracic Anesthesia Education: Medical School: Stanley Medical College, and University of Madras 1969. Neurosurgery residency North Staffordshire Hospitals UK Anesthesia training: Anesthesia Residency, University of Birmingham training scheme 1975-1981 Fellow of the Royal College of Anesthesia UK Testamur of the Examination of Special Competence in Perioperative Transesophageal Echocardiography Honours, Prizes for Surgery in Medical School. Merit Award “C” UK Former positions: Chairman Blackpool UK Director Cardiac Services Middlesbrough UK Head of Cardiac Anesthesia, Riyadh Saudi Arabia Expertise and Interests: Pediatric and adult congenital heart disease, TEE, Pulmonary hypertension, Lung transplants Computer generated animations for resident teaching.

Contact us

NOTE: THE FELLOWSHIP IS FILLED THROUGH THE 2008-2009 YEAR.

Inquiries and applications should be directed to:

Kati Koszegvari
Program Coordinator
Department of Anesthesiology
University of Washington
1959 NE Pacific Street, BB1415
Box 356540
Seattle, WA 98195-6540

E-mail: katibell@u.washington.edu
Phone: 206-221-6453

Applicants should send a cover letter describing their interests, along with a curriculum vitae. Qualified applicants will be asked to forward three letters of recommendation.

Dr. Dziersk Jörg Dziersk MD FRCA
Assistant Professor of Anesthesiology
Email: jorgd@u.washington.edu