Doctorate Of Medicine In Cardic Anaesthesia

About DM - Cardiac-Anaesthesia

Division of Cardiac Anesthesiology:
Cardiac anesthesiologists in the Department of Anesthesiology at Deenanath Mangeshkar Hospital are physicians who are specialists in the care of the patient with cardiac disease undergoing cardiac surgery and other procedures on the heart. Cardiac anesthesiologists are fellowship-trained in Cardiothoracic Anesthesiology and have additional expertise in ("Transesophageal Echocardiography", TEE). Our cardiac anesthesiologists have extensive experience in taking care of patients with cardiac disease for Adult and Pediatric cardiac surgical procedures with standard or non-invasive (percutaneous) techniques. Additionally, we provide anesthesia care for non-operating room interventions, such as percutaneous closure of congenital defects (atrial or ventricular septal defects) and electrophysiology (heart rhythm) procedures. The anesthesiologists are responsible for your pre-surgery "tune-up", so that you are best prepared for the surgical procedure and anesthesia, intra operative care during the surgery, and immediate post-operative recovery, including care in the Post operative-ICU At all times.

There shall be a uniform entrance examination to all medical educational institutions at the Postgraduate level namely ‘National Eligibility-cum-Entrance Test’ for admission to postgraduate courses in each academic year and shall be conducted under the overall supervision of the Ministry of Health & Family Welfare, Government of India.

In order to be eligible for admission to Postgraduate Course for an academic year, it shall be necessary for a candidate to obtain minimum of marks at 50th percentile in the ‘National EligibilityCum-Entrance Test for Postgraduate courses’ held for the said academic year. However, in respect of candidates belonging to Scheduled Castes, Scheduled Tribes, and Other Backward Classes, the minimum marks shall be at 40th percentile. In respect of candidates with benchmark disabilities specified under the Rights of Persons with Disabilities Act, 2016, the minimum marks shall be at 45th percentile for General Category and 40th percentile for SC/ST/OBC

The percentile shall be determined on the basis of highest marks secured in the All India Common merit list in National Eligibility-cum-Entrance Test for Postgraduate courses.

Provided when sufficient number of candidates in the respective categories fail to secure minimum marks as prescribed in National Eligibility-cum-Entrance Test held for any academic year for admission to Postgraduate Courses, the Central Government in consultation with Medical council of India may at its discretion lower the minimum marks required for admission to Post Graduate Course for candidates belonging to respective categories and marks so lowered by the Central Government shall be applicable for the academic year only.

The reservation of seats in Medical Colleges/institutions for respective categories shall be as per applicable laws prevailing in States/Union Territories. An all India merit list as well as State-wise merit list of the eligible candidates shall be prepared on the basis of the marks obtained in National Eligibility-cum-Entrance Test and candidates shall be admitted to Postgraduate Courses from the said merit lists only.

There shall be no admission of students in respect of any academic session beyond 31st August under any circumstances or beyond the date announced by the National Medical Commission/Supreme Court of India. The Universities shall not register any student admitted beyond the said date.

Highlights

Here are some of the course highlights of DM in Cardiac Anaesthesia

Fees Structure

The fee structure for DM in Cardiac Anaesthesia varies from college to college. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for DM in Cardiac Anaesthesia is around Rs.6 thousand to Rs. 20 lakhs per year.

Colleges offering DM in Cardiac Anaesthesia

Various medical colleges across India offer courses for pursuing DM in (Cardiac Anaesthesia).

As per National Medical Commission (NMC) website, the following medical colleges are offering DM in (Cardiac Anaesthesia) courses for the academic year 2022-23.

Fee

The fee for the D.M. Cardiac Anaesthesiology course varies from institute to institute, but it is generally between INR 5-15 lakhs per year.

Salary and Jobs:

The salary of a D.M. Cardiac Anaesthesiologist depends on their experience, skills, and the institution they work for. On average, they can earn between INR 15-30 lakhs per year. Career opportunities for D.M. Cardiac Anaesthesiologists are available in government and private hospitals, cardiac centres, and research institutes.

D.M. Cardiac Anaesthesiology Career opportunities:

Some of the career opportunities for D.M. Cardiac Anaesthesiologists are:

Consultant Anaesthesiologist

Cardiac Anaesthesiologist

Professor of Anaesthesiology

Researcher

Medical Director of a Cardiac Centre

Intensive Care Specialist

In conclusion, D.M. Cardiac Anaesthesiology is a super-specialty course in medicine that provides students with the skills and knowledge to manage patients undergoing cardiac surgeries. The course is in high demand, and there are ample career opportunities for graduates in this field.

D.M. Cardiovascular Anaesthesiology or Doctor of Medicine in Cardiac Anaesthesiology is a Doctorate Anesthesia therapeutic course. Specialist of Medicine in Cardiac Anaesthesiology course is set up to train applicants in the standards and routine with regards to Cardiac Anesthesia to empower them to direct anesthesia and escalated care to heart patients. Additionally, they are given the expertise that how to work as staff/specialist in Cardiac Anesthesia and Cardiac Thoracic, preoperative and postoperative concentrated consideration. M.D. (Cardiovascular Anaesthesiology) is three years term based course and it is vocation arranging in nature that gives many openings for work to the up-and-comers after its consummation. 

Qualification 

• Applicants who have M.D. Anaesthesiology from University perceived by MCI (Medical Council of India) 
• The choice strategy for affirmation of DM in Cardiac Anesthesia is to be made as a selection test both in principle and clinical evaluation held in the foundation. The choice ought to be founded on legitimacy as it were. 

Employment Types 

• Anesthesia Specialist 
• Heart Anesthetist 
• Heart Technician 
• Clinical Associate 
• Specialist Anesthesia 
• Basic Care Consultant 
• Speaker/Associate Prof. 
• Sr. Inhabitant

Syllabus

DM in Cardiac Anaesthesia is a three years specialization course that provides training in the stream of Cardiac Anaesthesia.

NMC till date as of (25/02/23) has not defined a Competency-Based Curriculum for DM Cardiac Anaesthesia. The course content of Amrita Vishwa Vidyapeetham below provides a basic outline of what a DM in Cardiac Anaesthesia candidate has to undergo while training:

DETAILED SYLLABUS

BASIC SCIENCES

ï‚· ANATOMY: Cardiac embryology, development of heart, pulmonary and vascular anatomy, coronary artery anatomy

ï‚· PHYSIOLOGY: Cardiac cellular physiology, hemodynamic, autonomic nervous system, cardiac functions, blood physiology, coagulation cascade and cardiac action potential.

ï‚· Cardiac arrhythmias

ï‚· Pulmonary: Pulmonary physiology. Pulmonary function tests, blood gas analysis, physiology of ventilation.

Pulmonary airway mechanics, one-lung ventilation. Thoracotomy and pulmonary physiology. Renal, hepatic, CNS, endocrinal system, others, metabolic effects of surgery. Endocrines response to anaesthesia and surgery

ï‚· PATHOPHYSIOLOGY: Heart failure, congenital defects, COAD, cardiopulmonary reserves, acquired cardiac & pulmonary diseases. Vascular pathology.

ï‚· Immunological response, metabolic response during CPB

ï‚· PHARMACOLOGY: Total circulatory arrest. Pharmacokinetics &

Pharmacodynamics of Anaesthetic and vasoactive drugs. Biochemical reactions, applied concepts. Drugs related to anaesthesia practice. Cardiovascular drugs. Bronchodilators

ï‚· Current concepts in antibiotic usage. Anti-arrhythmic drugs, nitric oxide

ï‚· PHYSICS: Basic concepts. Analyzing, measuring & monitoring devices, electronics, and computing patients' data. Laser in cardiac surgery, robotic technique

ï‚· EQUIPMENT: Computer application, Maintenance monitoring techniques, Equipment in OT, Equipment for transport of patients,

ï‚· ICU equipment

MONITORING IN ANAESTHESIA

Invasive & Non-Invasive monitoring techniques for Pre-peri & Post-operative periods in the cardiothoracic centre:

 Understanding of basic concepts of monitoring

 Indications, cost-effectiveness, complications

 Equipment usage & knowledge of accessories

Knowledge of the following monitoring —

ï‚· Cardiac functions: ECG, ABP, Vent. Pressures, Calculation of cardiac output, resistance, Flow, Echo, Doppler’s & (CAT, PET, NMR)

ï‚· Pulmonary functions: PFT, Blood gases, Acid-base Pulm. Airway mechanics.

ï‚· Coagulation Profile: Temp. renal, B. Sugar, Enzymes. ACT Heparin & Protomine regulation, thromboelastography.

ï‚· Neuromuscular blockade: And other Recent advances in monitoring. BIS cerebral oximetry evoked potential monitoring, and CNS monitoring during CPB.

CLINICAL SCIENCES

ï‚· PAEDIATRIC: history of pediatric cardiac anaesthesia, pediatric heart disease in developing world

ï‚· DEVELOPMENT ISSUES: intrauterine development of the cardiovascular system, intrauterine development of the cardiovascular system, pediatric anaesthesia pharmacology

ï‚· PREOPERATIVE EVALUATION: preoperative evaluation and preparation of pediatric patients with cardiac disease, cardiac catheterization and other radiographic examinations, pediatric electrocardiography and cardiac electrophysiology, and pediatric echocardiography.

ï‚· PRINCIPLES OF PER OPERATIVE MANAGEMENT: anaesthetic and perioperative management, monitoring of the pediatric cardiac patient, physiology and techniques of extracorporeal circulation in a pediatric cardiac patient, profound hypothermia and circulatory arrest, vital organ preservation during surgery for congenital cardiac disease, management of post bypass myocardial dysfunction, hemostasis, coagulation and transfusion in a pediatric cardiac patient, management of post bypass pulmonary hypertension and respiratory dysfunction.

ï‚· ANESTHESIA FOR CARDIAC SURGICAL PROCEDURES: septal and endocardial cushion defects, tetralogy of Fallot, transposition of great vessels, anomalies of aortic arch and valve, anomalies of the pulmonary valve and right ventricular outflow tract, tricuspid atresia, hypoplastic left heart syndrome, double outlet right ventricle, truncus arteriosus, anomalies of systemic and pulmonary venous return, abnormalities of atrioventricular valves, coronary artery anomalies, cardiomyopathies, pulmonary hypertension, persistent fetal circulation and Eisenmengers syndrome, pediatric cardiac and lung transplantation, secondary vascular anomalies and cardiac tumours, anaesthesia for non-cardiac surgery in children and adults with congenital heart disease.

ï‚· Postoperative care: General principles, cardiovascular dysfunctional and pharmacological support, postoperative respiratory dysfunction and its management, renal, hepatic, gastro and neurological dysfunction, postoperative pain management in pediatric cardiac patients, anaesthesia for cardiac procedures in pediatric ICU.

ï‚· ADULT: PREOPERATIVE ASSESSMENT AND MANAGEMENT:

Preoperative assessment of cardiac risk, The cardiac catheterization laboratory:

Diagnostic and therapeutic procedures in the adult patient, Anti-ischemic drug therapy, Chronic Treatment of congestive heart failure, Antihypertensive therapy, Etiology and treatment of perioperative cardiac arrhythmias.

ï‚· PHYSIOLOGY AND MOLECULAR BIOLOGY: Advances in cardiovascular physiology, Coronary physiology and Atherosclerosis, Molecular cardiovascular medicine, and Systemic inflammation.

ï‚· MONITORING: Hemodynamic Monitoring, Advances in Electrocardiographic monitoring, Intraoperative echocardiography, Central nervous system monitoring, and coagulation monitoring.

ï‚· ANAESTHETIC PHARMACOLOGY: Effects of inhalation anaesthetics on systemic hemodynamics and the coronary circulation, opioids in cardiac anaesthesia, Pharmacology of intravenous anaesthetic induction drugs, Muscle relaxants and cardiovascular system, Pharmacokinetics and principles of drug

infusions in cardiac patients

ï‚· ANESTHETIC TECHNIQUES FOR CARDIAC SURGICAL PROCEDURES:

anaesthesia for myocardial revascularization, Valvular heart disease, Anesthesia for patients with congenital heart disease, Thoracic aortic disease, Anesthesia for electrophysiological procedures, Uncommon diseases and cardiac anaesthesia, Cardiac pacing and electro version, Anesthesia for heart, Lung, and heart-lung

transplantation

ï‚· MANAGEMENT OF CARDIOPULMONARY BYPASS AND ASSOCIATED

PROBLEMS: Extracorporeal devices and related technologies, Cardiopulmonary bypass and the anesthesiologist, Transfusion medicine and coagulation disorders, Pharmacologic management of perioperative left and right ventricular dysfunction, techniques of circulatory assistance.

ï‚· POSTOPERATIVE CARE: Postoperative respiratory management, Postoperative cardiovascular management, Central nervous system dysfunction after cardiopulmonary bypass, Critical care medicine for the cardiac patient

ï‚· PRACTICE MANAGEMENT: The impact of managed care on cardiac anaesthesia, cost containment in anaesthesia and cardiac surgery, quality of life and patient satisfaction surrounding cardiovascular surgery measuring and improving the outcomes of coronary artery bypass graft surgery.

ï‚· THORACIC ANAESTHESIA AND ONE-LUNG VENTILATION

o Indications for thoracic surgery

o Preoperative assessment

o Anesthetic management

o Preoperative preparation

o Investigation, premedication, intraoperative management

o One lung ventilation: indications, contraindications, positioning of the patient in thoracic surgery,

o Physiology of one-lung ventilation

o Methods for separation of lungs

o DLT: types, positioning, placement checking, possibilities of DLT malposition, checking with FOB

o Management of OLV

o Postoperative management

CARDIOPULMONARY BYPASS

o Historical development

o Blood pumps in CPB

o Circuitry and cannulation techniques

o Principles of oxygenator function

o Ultrafiltration and dialysis

o Mechanical circulatory support devices

o Cardiopulmonary bypass for minimally invasive cardiac surgery

o Temperature management in cardiac surgery

o Embolic events

o Endocrine, metabolic and electrolyte responses

o Cardiopulmonary bypass and lung

o Immune system and inflammatory response to CPB

o Kidney function and cardiopulmonary bypass

o Neurologic effects of CPB

o Hemodilution and priming solutions

o The blood surface interface

o Hematologic effects and coagulopathy

o Coagulation testing

o Anticoagulation for CPB

o Heparin neutralization

o Pharmacologic prophylaxis for post-CPB bleeding

o Conduct of CPB

o Patient safety in CPB

o Unusual problems in CPB

o Termination of CPB

o ECMO for respiratory support in adults

o Perfusion for thoracic aortic surgery in adults

o Noncardiac surgical application of CPB

o Pediatric cardiopulmonary bypass an overview- state of art and future

o Myocardial protection and preservation for neonates and infants

o Brain injury following infant cardiac surgery and neuroprotective strategies

o ECMO for infants and children

o Circulatory assist devices for infants and children

o Subsystem care - cerebral, Renal Hepatic protection, Cerebral protection, cerebral monitoring

o Total circulatory arrest, left heart bypass

o Anaesthesia management during CPB

o Pharmacokinetics & Pharmacodynamics of drugs during CPB

INTENSIVE CARE MANAGEMENT

 Organizational aspects

 Shock

 Acute coronary care

 Respiratory failure

 Gastroenterological emergencies

 Acute renal failure

 Neurological disorders

 Endocrine disorders

 Obstetric emergencies

 Infection and immune disorders

 Severe and multiple trauma

 Environmental injuries

 Pharmacological considerations

 Metabolic hemostasis

 Haematological management

 Transplant

 Pediatric intensive care

INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY

ï‚· Principles of echocardiography: physics, digital echocardiography, imaging artefacts, and pitfalls, optimizing 2D echo

ï‚· Intraoperative examination: surgical anatomy correlated with echocardiographic imaging planes, assessment of global ventricular function, right ventricular function, regional ventricular function, mitral valve, aortic valve, tricuspid and pulmonic valves thoracic aorta and prosthetic valves. Assessment of congenital heart disease in adults

ï‚· Decision-making in critical care TEE in a critical care setting, assessment of perioperative hemodynamics

ï‚· Surgical decision making in coronary artery disease: assessment of myocardial viability, assessment in higher risk myocardial revascularization, assessment of mitral valve in ischemic heart disease, assessment in off-pump myocardial revascularization.

ï‚· Surgical decision-making in valvular heart disease: surgical consideration in mitral and tricuspid valve surgery, assessment in mitral valve surgery, surgical consideration in aortic valve surgery, assessment in aortic valve surgery.

ï‚· Surgical decision making in major vascular surgery: Assessment of surgery of Aorta

ï‚· Surgical decision-making in congestive cardiac failure: Pathophysiologic, assessment of cardiomyopathy, surgical considerations in nontransplant surgery for congestive cardiac failure, assessment in surgical procedures for CHF, assessment of cardiac transplantation

ï‚· Surgical decision making in Interventional Cardiovascular Medicine and Non-cardiac surgery: Assessment in cardiac intervention, assessment in noncardiac surgery.

BRONCHOSCOPY

 History of rigid bronchoscopy

 History of flexible fibreoptic bronchoscopy

 Anatomy of larynx trachea, bronchi and classification of lung segments.

 Indications for FOB

 Anaesthesia for diagnostic and therapeutic bronchoscopy

 Interventional bronchoscopy

 Tracheal stents

 Percutaneous dilatational tracheostomy and bronchoscopy

 Technique and equipment care for FOB

 Virtual Bronchoscopy

RECENT ADVANCES

Knowledge of recent developments in the field of Cardiothoracic & Vascular surgery

 Cardiology - PTCA, Balloon embolectomy etc.

 Heart-lung transplant - physiology, pharmacology (Anaesthetic consideration) -

Donor–recipient selection

 Immunosuppression etc.

 Cardiac assisting devices - Artificial heart, IABP, LHAD

 Advances Pulm. support - ECMO, H.F. Ventilation

 Blood substitutes

 Current advances and concepts in drugs, equipment, and monitoring methods

 Virtual bronchoscopy

Career Options

After completing a DM in Cardiac Anaesthesia, candidates will get employment opportunities in Government as well as in the Private sector.

In the Government sector, candidates have various options to choose from which include Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector, the options include Resident Doctor, Consultant, Visiting Consultant (Cardiac Anaesthesia), Junior Consultant, Senior Consultant (Cardiac Anaesthesia), and Cardiac Anaesthesia Specialist.

List of College Hospitals With DM Cardiac Anaesthesia

Below list of medical colleges/hospitals in India for DM Cardiac Anaesthesia is ranked based on how candidates preferred these colleges during NEET SS All India Quota counselling.

Admission Procedure For DM - Cardiac-Anaesthesia

Admission of students to the DM in Cardiothoracic Anesthesiology course is done based on merit secured by the students in the entrance examination, which assess both the clinical and theoretical skills of the candidates.

Documents required for DM. Cardiac anesthesiology admission:

1. Migration Certificate (No objection certificate from the University last attended)
2. Passing/Degree certificate of the last qualifying degree examination
3. Mark-list of the last qualifying degree examination
4. Character certificate (from the head of the Institute from which the student has obtained his qualifying degree.
5. Documentary proof for date of birth
6. Gap certificate (if applicable)
7. Research Proposal *
8. No objection certificate from the employer (if employed)

NOTE:- Students are requested to note that their application will not be considered for admission if the above certificates are not enclosed with their application.

Eligibility criteria for seeking admission to the DM in Cardiothoracic Anesthesiology

For seeking admission to the DM in Cardiothoracic Anesthesiology course in the above-mentioned medical colleges, candidates must have completed their MD in Anesthesiology from an institution approved by the Medical Council of India.

NEET SS – 2020 qualified candidates who have been allotted to Amrita School of Medicine by the MCC, New Delhi are eligible to report for admissions for the academic year 2020-21.

For more details regarding DGHS guidelines, please visit MCC website

Note: Stipend will be paid as per Government norms

Entrance Exam. For DM in Cardiothoracic Anesthesiology

Cardiothoracic Anesthesiology is a sub-specialty of the anesthesiology discipline in the field of medicine and this field is devoted to post-operative care, intra-operative care and pre-operative care of adult patients, who undergo cardiothoracic surgery. It is the most demanding and intellectually challenging sub-specialty in the main branch of Anesthesiology.

DM in Cardiothoracic Anesthesiology is a super-specialty course in the field of medicine offered by a few medical colleges in India and the names of government colleges offering this course in India are given below: 

• Institute of Postgraduate Medical Education & Research, Kolkata

• Sri Jayadeva Institute of Cardiology, Bangalore

• All India Institute of Medical Sciences, New Delhi 

How to preparation tips for DM - Cardiac-Anaesthesia?

History of cardiac surgery in India:

The history of cardiac surgery in India is relatively young. While the first heart surgeries were documented in the West in the late 1800s, in India, the first cardiothoracic surgery department was started in the erstwhile Carmichael Medical College (now R.G Kar Medical College) in 1944, though the initial few years were probably spent in performing thoracic surgeries. Subsequently, other centres such as Christian Medical College (CMC), Vellore started performing the initial cardiac surgeries in the country. Ligation of a patent ductus arteriosus (PDA) was performed on 2nd March, 1950 at CMC, Vellore marking the initiation of cardiac surgery in India. This was followed by the first Pott's shunt in 1951, Blalock–Taussig shunt in 1953, closed mitral commissurotomy in 1953, and repair of coarctation of the aorta in 1956, all of these surgeries being carried out at the CMC, Vellore. Vellore was not alone, however, as developments in cardiac surgery were happening at other places in India. Closed mitral commissurotomy was carried out around the same time in Mumbai at the King Edward Memorial (KEM) Hospital and Seth GS Medical College.[1] Similarly, cardiac surgery was started in other cities such as Kolkata and Chennai. An important contribution in training a number of cardiac surgeons and cardiac anaesthesiologists was that of the Railway hospital in Perambur, where the cardiac surgery department was established in 1977. However, the initial 3 decades from 1950 to 1980 witnessed a slow growth in cardiac surgery with the bulk of operations being closed mitral commissurotomies, PDA ligation, pericardiectomies, etc. The first coronary artery bypass graft (CABG) surgery was probably performed in the year 1975, with Mumbai and Chennai being the first cities in India to perform this operation. Although the first MCh program in cardiac surgery started in 1967 at AIIMS New Delhi, it was not until the late 1980s and early 1990s that cardiac surgery witnessed an exponential growth in the country, which coincided with the entry of the corporate sector into this field.

Basic Sciences

 ANATOMY: Cardiac embryology, development of heart, pulmonary and vascular anatomy, coronary artery anatomy.

 PHYSIOLOGY: Cardiac cellular Physiology, haemodynamics, Autonomic nervous system, Cardiac functions, Blood Physiology, Coagulation cascade, and action potential.

 Cardiac arrhythmia:

 Pulmonary: pulmonary physiology, pulmonary function tests, blood gas analysis, physiology of ventilation.

 Pulmonary airway mechanics, one lung ventilation, Thoracotomy and pulmonary physiology, Renal, Hepatic, CNS, endocrinal System, others System, metabolic effects of surgery, Endocrines response to anaesthesia and surgery.

 PATHOPHYSIOLOGY: Heart Failure, Congenital defects, COAD, Cardiopulmonary reserves, acquired cardiac & pulmonary diseases. Vascular pathology.

 Immunological response and metabolic response during CPB.

 PHARMACOLOGY: Total circulatory arrest, Pharmacokinetics & Pharmacodynamics of anaesthetic and vasoactive drugs, biochemical reactions, applied concepts. Drugs related to anaesthesia practice.

 Cardiovascular drugs, Bronchodilators.

 Current concepts in antibiotics usage, antiarrhythmic drugs, and nitric oxide.

 PHYSICS: Basic concepts, Analyzing, measuring & monitoring devices, electronics, computing of patient’s data. Laser in cardiac surgery, robotic technique.

 EQUIPMENT: Computer application, Maintenance, monitoring techniques, equipment in OT, equipment for transport of patients.

 ICU equipment.