Early in the Fellowship year a fellow administers anesthesia to patients in relatively good physical condition who are undergoing more or less routine cardiac operations. Subsequently the fellow is assigned more complex and challenging cases.

The Cardiac Anesthesia & Intensive Care Program at the Toronto General Hospital has been recognized internationally as a prominent research and teaching centre in cardiac anesthesia.
Leading research in the following areas has allowed our centre to contribute and change the perioperative care of cardiac surgical patients in terms of reducing the postoperative morbidity and optimizing cost containment. In collaboration with multidisciplinary subspecialties, we have:

•safety and morbidity outcome in early extubation anesthesia in cardiac surgery
•established the cost benefit and reduction in resource use by early extubation in the post-cardiovascular intensive care unit and early hospital discharge
•identified the perioperative risk factors in postoperative morbidity and mortality in fast track cardiac surgery
•identified the etiology for preoperative anemia in cardiac surgical patients
•efficacy of antifibrinolytic agents in blood conservation during cardiac surgery
•rational use of postoperative chest x-rays in the post cardiac ICU
•perioperative management of pain in cardiac surgery procedures

Current research includes:

•neuroprotection
•blood substitutes
•renal protection
•outcome studies

Perioperative Transesophageal Echocardiography Program
The University Health Network, Toronto General Hospital performs approximately 2500 cardiac surgical cases per year. At TGH, TEE is an intraoperative diagnostic tool for assessment of the adequacy of surgical repair for a broad spectrum of procedures. There is a large volume of valve repairs; aortic root replacements with valve sparing, ventricular myectomies for HOCM and congenital heart repairs. The TEE program offers fellows a broad exposure to TEE use both as routine monitor and more importantly as a diagnostic tool. It is expected that all fellows will acquire a basic clinical proficiency in the use and application of perioperative TEE. To complement the "hands-on" operating room exposure didactic TEE teaching sessions are held every two weeks. Moreover, TEE conferences are held twice a month to discuss interesting cases and review selected topics relevant to the use of intraoperative TEE.