Page 16 - CASA Bulletin of Anesthesiology 2019 Issue 1

CASA Bulletin of Anesthesiology
Anesthesia Team and Surgeons Relationship -A surgeon’s perspective
Zhandong Zhou, MD, PhD,
St Joseph Hospital, Syracuse, New York
When I came to St Joseph hospital 16 years ago, we were doing most standard open-heart surgeries, so the cardiac anesthesia was not that demanding compared
to today’s standard. Although not everyone liked cardiac
anesthesia, all anesthesiologists took turns on cardiac cases.
There was no standard either. Most surgeons don’t understand much about cardiac anesthesia. We just want to get the case start on time, finish it quick, and get the next one to start. Some anesthesiologists can give 100 ml of Fentanyl for a small lady, some will just give 10-20
ml. One of the anesthesiologists even gives 5-7 liters of fluid for a routine case. We call him “Aquaman.” One anesthesiologist brought a stack of magazines to read during the surgery. It seems everyone understands that cardiac surgery is high risk, and our quality numbers based on the New York state reporting system are good. Like most Chinese physicians, I was easy going and rarely said anything or challenged anyone.
However, new technologies bring changes. Cardiac surgery soon began to face increasing competition from catheter-based technologies in Cath labs. It seems that people are no longer accepting open heart surgery as their first choice, even though it provides better long-term outcomes. The catheter-based technologies are becoming increasingly popular and newer generations of interventional cardiologists are more aggressive. This resulted in dramatically decreasing the occurrence of cardiac surgery in many hospitals. Nationwide, cardiac surgery volume decreased from ~500,000/year in 1995-1997 to a little over ~200,000/year today, which continues to decline.
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