Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery

Davy C. H. Cheng, MD, MSc, FRCPC, FCAHS, CCPEDr. Davy Cheng is a Distinguished University Professor and Former Acting Dean of Schulich School of Medicine & Dentistry, Western University. He holds the Chair in Evidence-based Perioperative Clinical Outcomes Research (EPiCOR) and is the co-founder and Medical Director of the Centre for MEDICI (Medical Evidence, Decision Integrity, Clinical Impact), which is a World Health Organization (WHO) Collaborating Center in the study of global surgery, anesthesia & perioperative care. Dr. Cheng served as the Chair / Chief of the Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, St. Joseph Health Care London, and Western University from 2001-2017. Dr. Cheng is also the founding Medical Director of the Cardiac Surgery Recovery Unit (2002), Critical Care Western, Department of Medicine. Dr. Cheng graduated from the Faculty of Medicine, University of Toronto in 1983 and completed his internal medicine internship and anesthesia residency in 1987. He joined as Faculty at the Toronto Western Hospital, University of Toronto after a Clinical Research Fellowship in 1988 and a Cardiovascular Anesthesia Fellowship at the University of Iowa Hospitals and Clinics, Iowa City in 1989. Prior to his appointment in 2001 at Western University, London, Dr. Cheng held the position of Professor and Deputy Chief of Anesthesiology at the Toronto General Hospital, University of Toronto and as Medical Director, Cardiovascular Surgery Program, University Health Network (UHN), Toronto. Dr. Cheng is a globally recognized healthcare leader in the forefront of research, practice and healthcare policy in the fields of perioperative medicine, cardiac surgery, critical care medicine, and evidence-based clinical decision-making. His pioneer work in fast track cardiac anesthesia and recovery has established the standard of cardiac anesthesia and recovery practice around the world(citations 10,544, h-index 54, i10-index 122). He co-chaired the Steering Committee and Expert Consensus Panel for the International Society for Minimally Invasive Cardiac Surgery (ISMICS), the European Association of Cardiothoracic Society (EACTS), as well as the World Health Organization (WHO) in practice guideline development.Janet E. Martin, BSc(Phm), PharmD, MSc(HTA&M), PhDeqDr. Janet Martin is an Associate Professor of Anesthesia & Perioperative Medicine and Epidemiology & Biostatistics at Schulich School of Medicine & Dentistry, Western University, London, Canada. She is also Director of the Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), and Co-Director of the WHO Collaborating Centre for Global Surgery, Anesthesia & Perioperative Care. Dr. Martin is recognized for leadership in clinical epidemiology, evidence synthesis, health technology assessment, and knowledge translation, especially as it relates to improving access to safe surgery, anesthesia and perioperative care in high-, middle- and low-income countries. Dr. Martin commonly serves as policy advisor for decisions related to public access to drugs, perioperative procedures, devices and technologies at the provincial and national level in Canada, and internationally. She has collaborated with more than 25 countries on global health issues, including priority-setting for universal healthcare, improving cost-effectiveness of care, and improving the value of local and global research. Dr. Martin provides case-based workshops and courses on “evidence-based medicine”, “clinical epidemiology”, “difficult decision-making in healthcare” in Canada, Europe, Asia, and Africa. She has published over 150 papers, 18 guidelines, and co-authored 2 books (H-index 42; 8583 citations).Tirone E. David, MD, FRCSC, OCDr. Tirone David is a University Professor of Surgery at the University of Toronto and the holder of the Melanie MunkChair of Cardiovascular Surgery at the Peter Munk Cardiac Centre. Dr. David has published 365 scientific papers, 35 chapters in medical textbooks as well as 4 surgical textbooks.  He has developed numerous operative procedures to treat patients with heart valve disease, complications of myocardial infarction, and thoracic aneurysms. One of these procedures is known as “David operation”. He has been a member of the editorial board of several medical journals. Dr. David is a member of numerous surgical and medical societies and is honorary member of the European Cardio-Thoracic Association, the Brazilian Cardiovascular Society, Italian Society for Cardiac Surgery, Southern Thoracic Surgical Association, German Society for Thoracic and Cardiovascular, Society of Cardiac Surgeons, and Japanese Association for Thoracic Surgery. Dr. David was elected honorary member of the Brazilian National Academy of Medicine in 2013. He was President of the American Association for ThoracicSurgery in 2004-2005 and the recipient of its Scientific Achievement Award in 2016. He received the Order of Ontario in 1993 and the Order of Canada in 1996, the highest honor given to civilians in Canada. He was elected University Professor in 2004, the highest honor the University of Toronto bestows to its professors.

• Section I. Introduction.- Overview of a Cardiac Anesthesia & Surgical Program.- Overview of a Cardiology Interventional Program.- Prognostic Risks and Preoperative Assessment.- Section II. Anesthesia and Cardiopulmonary Bypass Management.- Fast Track Cardiac Anesthesia Management in On-Pump and Off-Pump Coronary Artery Bypass Surgery.- Anesthetic Management in Valvular Heart Surgery.- Anesthetic Management in Robotic Cardiac Surgery.- Anesthetic Management in Interventional Cath Lab Procedures.- Circulatory Arrest and Neuroprotection.- Anesthesia for Combined Cardiac and Thoracic Surgery.- Anesthesia for Intrathoracic Transplantation.- Anesthesia for Patients with Ventricular Assist Devices.- Anesthesia in Pediatric Cardiac Surgery.- Anesthetic Management of Co-Morbid Diseases Affecting Cardiopulmonary Bypass.- Regional Anesthesia Techniques and Management.- Perioperative Monitoring in Cardiac Surgery.- Perioperative Transesophageal Echocardiography.- Essence of CPB Circuit and Intra-aortic Balloon Pump.- Cardiac Pharmacology.- Weaning From Cardiopulmonary Bypass and Low Output Syndrome.- Pulmonary Hypertension and Right Ventricular Dysfunction Post-CPB.- Perioperative Blood Conservation.- Antifibrinolytics and Coagulation Management.- Heparin Associated Thrombocytopenia and Alternatives to Heparin.- Management of Cardiac Surgical Emergency.- Section III. Perioperative Echocardiography Monitoring and Management.- Perioperative Transesophageal echocardiography.- Perioperative Transthoracic echocardiography.- Section IV. Surgical Technique and Postoperative Consideration.- Myocardial Protection During Cardiac Surgery.- On-Pump Aorto-Coronary Bypass Surgery.- Off-Pump Coronary Revascularization Surgery.- Robotic Coronary Artery Revascularization Surgery.- Surgery of the Aortic Valve.- Surgery of the Mitral Valve.- Surgery of the Tricuspid Valve.- Robotic Cardiac Valvular Surgery.- Surgery of the Transverse Arch and Cerebral Protection.- Surgery of Descending Thoracic Aorta.- Combined Cardiac and Vascular Surgery.- Surgery for Mechanical Complications of Myocardial Infarction.- Surgery for End-Stage Heart Disease and Heart Transplantation.- Lung and Heart-Lung Transplantation Surgery.- Ventricular Assist Devices Implantation.- Congenital Heart Surgery.- Ventricular Aneurysm Resection & Partial Left Ventriculotomy.- AICD and Pacemakers Insertion.- Section V. Cardiac Surgical Recovery Unit and Postoperative Complications Management.- Routine Cardiac Surgery Recovery Care: Extubation to Discharge Pathway.- Common Problems in Cardiac Surgery Recovery Unit.- Atrial and Ventricular Arrhythmia Management.- Tamponade and Chest Reopening.- Infection, Sternal Debridement and Muscle Flap.- Difficult Weaning From Mechanical Ventilation and Tracheotomy Care.- Renal Failure and Dialysis.- Neurological Complications and Management.- Section VI. Surgical Ward Management.- Routine Surgical Ward Care.- Common Ward Complications and Management.- Section VII. Appendices.