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OK, thank you. Um So um hi guys. So it looks we we've got quite a few but we said we'll wait for five minutes. Um And then if people wanna show up or anything and then we'll, we'll start. Um But yeah, so I'm Christine, I'm the core of uh Leicester Anesthetic um and Critical Care Society. Um My core Sharon is also in the chap. So, and together we've um helped with the lovely step and her team in organizing uh a talk to prepare for you. And uh lovely doctor YF here is going to um give a talk on cardiac anesthesia. So, Doctor Youf is a dual anesthetic and itu consultant and he's also the ECMO lead at the Glenfield and also the research lead for anesthetics in critical care if that is right. So, um he's got a lot, a wealth of experience. Uh I'm sure if we've got time, he'll be happy to take any questions you have at the end. Um And without further ado I will hand over to Doctor Eth. Thank you very much Christine for introducing me and just so I don't get into trouble with my colleagues. I am not the ECMO lead, but um I uh I, one of the CMO consultants um and I have a keen interest in ECMO for cardiac failure um as you can imagine, kind of aligns with um this talk really. Um Yeah, thank you very much for inviting me. And um I'm always uh very um happy to um sort of inspire the next generation of cardio kinesis um where we, we, we need, we need more cards for our future. Um And a as, as you'll see in my presentation, the landscape, the way we do cardiac anesthesia is changing, just like how we do, how we practice any branch of medicine. Um Cardiac anesthesia is evolving and changing as well. OK. So um to start off with cardiac anesthesia is, is a subspecialty anesthesia. So um all cardi Anestis are general anesthetist, so they can do general anesthesia, but then it has a bit of an added skill and attribute on top of it, which requires um extra training. And um that is required to look after patients requiring cardiac surgery of all forms. You can be an adult cardio kinesis or a pediatric cardios. And actually, there are quite a lot of cardios who do both. Um But this is, this has been changing over the years um in which you get more subspecialisation, people tend to stick to one form or the other, but there's still room to do both. Um It's, it's a very dynamic specialty uh you have to have immediate expertise to be able to deal with um sudden changes in um cardiovascular function and cardiovascular derangement. Um And so that's for anybody that wants to do it. Those are the things that gives you the bite, the excitement of wanting to be a card Anestis. So what are the skills in attribute required to do this? Um I think the one very key thing is that you have to be very uh proficient in perative echocardiography, which um you are required to perform not just um diagnostic um interventions, but also um to guide therapeutic interventions and also actually to guide your management of patients. Um You will be well well versed and used to using complex hemodynamically monitoring um modalities such as the pulmonary artery catheter. Um you'll be able to manage the patient interface between um going on cardio pulmonary bypass and coming off it, which is quite unique. Um And also um it's well well known that card Anestis um have a particular expertise in managing coagulopathy because actually we induce coagulopathy and we have to treat it and our use of blood and blood products can be quite high. So we have to have a bit of an expertise in that. And most blood anesthesia, blood transfusion committees are um attended by cardio kinesis, but generally, it also requires some personal attributes really. Um I'll be honest, it's not for everybody. You need to have a strong personality and um the cardiac theater is a very charged environment. And as you can imagine to be a cardiac surgeon, you've got to be a really strong personality, to be a cardiac anesthetist who the cardiac surgeon relies on. You also need to be a strong personality, someone who um can take the lead and actually direct the course of of treatment. Um cardiac theater is a highly stimulating environment. You'll be getting a lot of feedback and information from the patient, from the surgeon, from all your monitoring advices from perfusionist, from everybody. And you've got to synthesize that very quickly and make a judgment. Um I'll be cheeky and say sometimes you need to deafen yourself to everything and decide this is what I need to do. But it's about kind of making a balance between all that information and deciding on your, on what to do and believe it or not. I mean, everybody, if you, if you watch um medical drama, you think the cardiac surgeon runs theater. Um but a cardi Anestis actually does run theater and actually when things go wrong, everybody's looking at you for leadership um having that calm external person a helps. Well, even though you are really like, you know, losing it inside, it helps because everybody looks to you and we'll, we'll, we'll latch on to that and kind of believe, ok, yeah, things are going wrong but someone knows what they're doing and we're dealing with it and during that period, there needs to be constant conversation between you and the surgeon. So good, good thing in cardiac anesthesia. The the surgeons are very, very invested in the patient doing well. So they, they contribute. But in terms of how you execute things, there's got to be a very good communication, uh strong communication between you and the surgeon. Now, what's very common if you look at most cardiac anesthesia firms is that it's very common to ascertain that there's a good relationship between the surgeon and the anesthetist and that is often well encouraged. Um And so.