The Clinical Competency Committee in Adult Cardiothoracic Anesthesiology-Perspectives From Program Directors Around the United States.

The clinical competency committee offers a fellowship program a structured approach to assess the clinical performance of each trainee in a comprehensive fashion This special article examines the structure and function of this important committee in detail. Furthermore, the strategies for the optimal functioning of this committee are also discussed as a way to enhance the overall quality of the fellowship program.

Editorial Commentary: Anteromedial Meniscofemoral Ligament of the Anterior Horn of the Medial Meniscus: I've Never Seen That Before; but Has It Seen Me?

Although there is frequently an element of variability found in human anatomy, we tend to think of anatomic structures as following the pattern in which we, as surgeons, most frequently encounter them. Though it is possible that a variant pattern of a commonly encountered anatomic structure has "never been seen" by us as surgeons, the constant process of learning sometimes leads us to ask ourselves whether we have truly never encountered such a structure or condition before or whether we simply did not recognize it when it "saw us."

A Survey of Current Anesthesia Trends for Electrophysiology Procedures.

BACKGROUND: There has been a dramatic shift in recent years in anesthesia coverage for electrophysiology (EP) procedures. An anesthesiologist and electrophysiologist at our institution jointly developed a survey, which was distributed to the Society of Cardiovascular Anesthesiologists and the Heart Rhythm Society. Its goal was to document current practice patterns and examine perceived variability in coverage. METHODS: On approval of the leadership from the Society of Cardiovascular Anesthesiologists and the Heart Rhythm Society, an online survey was administered to the membership. The survey included demographic data, anesthetic type, and perceptions of the respondents. RESULTS: Four hundred seventy-nine surveys were completed. Thirty-eight percent were completed by electrophysiologists and 63% by anesthesiologists, giving a response rate of 8.24% for anesthesiologists and 13.6% for electrophysiologists. Of these, 57% of respondents worked in an academic setting. Over the past 2 years, 66.5% of respondents reported anesthesia involvement in EP cases increasing. These cases are reportedly covered by all anesthesiologists in a group 55% of the time, cardiac anesthesia 32.5%, and a designated team at the remainder of the institutions. Seventy-six percent of respondents reported having designated EP block time in the schedule. Ninety-two percent of respondents reported that patient satisfaction has increased with the involvement of anesthesia services. CONCLUSIONS: Anesthesia coverage for EP procedures has continued to increase with an increase in patient satisfaction. Anesthesiologists have had to adapt and provide designated block time to accommodate this increase and also, in some instances, form teams that go beyond simply cardiac anesthesiologists to care for these patients during their procedures.

Management of LVAD Patients for Noncardiac Surgery: A Single-Institution Study.

OBJECTIVE: To describe the experience regarding the perioperative management of patients with left ventricular assist devices (LVADs) who require anesthesia while undergoing noncardiac surgery (NCS) at a single medical center. DESIGN: Retrospective chart review SETTING: Academic medical center PARTICIPANTS: Patients with LVADs INTERVENTIONS: Medical records from April 1, 2009 through January 31, 2014 were reviewed for patients who underwent Heartmate II LVAD placement at this facility. Individual records were reviewed for NCS after LVAD placement, specifically investigating perioperative and anesthetic management. MEASUREMENTS AND MAIN RESULTS: Seventy-one patients underwent LVAD placement during this time period. Thirty-five patients (49%) underwent a total of 101 NCS procedures. Arterial catheters were placed in 19 patients (19%), and 33 patients (33%) were intubated for their procedure. No complications or perioperative mortality occurred related to the NCS. CONCLUSIONS: Noncardiac surgery is becoming more common in patients with LVADs. Anesthetic management of these patients outside of the cardiac operating room is limited. Patients with Heartmate II LVADs can safely undergo noncardiac surgery.

Müller-Weiss disease of the tarsal navicular: an idiopathic case.

Müller-Weiss disease of the tarsal navicular is a rare condition, the etiology of which remains unclear. We present the case of a 28-year-old woman with classic radiographic findings consistent with Müller-Weiss disease. The patient was successfully treated with a talonavicular-cuneiform arthrodesis of her right foot. Radiographs at 6 months postoperatively demonstrated a successful medial arch fusion. At 38 months follow-up, the patient was asymptomatic. The American Academy of Orthopaedic Surgeons ankle hindfoot score was 97, compared with a preoperative score of 32.