台灣心胸麻醉的機會與挑戰
 

心胸麻醉醫療是麻醉專業中最具挑戰的領域之一，許多國家都成立心胸麻醉醫學會並建立專科醫師制度，美國Society of Cardiovascular Anesthesiologists與歐洲European Association of Cardiothoracic Anaesthetists並制定心胸麻醉相關準則，提升了全球心胸麻醉的安全與品質。亞洲地區1994年也成立Asia Society of Cardiothoracic Anesthesia (ASCA)，定期舉行國際會議。台灣於2000年成立心胸血管麻醉醫學會至今20年，對國內心胸手術麻醉品質提升有相當大的貢獻。然而心胸麻醉醫師的專業養成與訓練內容，仍需要明確的匡列與規範。近年全球心胸手術進展特別是微創手術如達文西手術、TAVI、MitraClip等等發展快術，人工心臟、VAD、ECMO、PCPS等普及化，麻醉監測系統BIS、Entropy、腦氧、3D TEE等也全面提升，專業麻醉醫師的訓練需求可說非常急迫。最新文獻提到美國麻醉住院醫師訓練僅20例心麻課程是無法達成EPA所要求獨立安全執行的目標，美國許多醫院要求心麻醫師須具備一年的fellow訓練並取得國家心超認證(National Borad of Echocardiography, NBE)。去年台灣麻醉專科醫師考試也開始增列TEE口試項目，緊跟世界潮流。心麻專考試要求須先有心超學分認證。體循、心超、科際溝通可說是心胸麻醉訓練最需加強的領域，台灣心麻學會亦定期辦理相關課程，包含超音波工作坊、ERAS工作坊與跨領域聯合訓練工作坊等，期待為台灣心胸麻醉醫療領域更加提高專業素養。

Big Challenge of Cardiothoracic Anesthesia in Taiwan
 

Cardiothoracic anesthesia is one of the most challenge task in general practice of anesthesia. Certification of cardiothoracic anesthesia is established in many countries. In Taiwan, we initiated the Taiwan Society of Cardiothoracic and Vascular Anesthesia (TSCVA) since 2000, and around 200 physicians got the board of certification. However, the programs for our trainees of board certification still need further improvement. Recently, minimal invasion procedures such as Da Vince cardiac surgery, TAVI, MicraClip as well as artificial heart, VAD, ECMO, PCPS developed rapidly. Anesthesia monitoring including BIS, Entropy, brain oxymetry, 3D TEE et. al. are widely used in daily practice. Advanced programs for anesthesia resident physicians and fellowship doctors are required. We have initiate several essential workshops for trainees. Continue improvement of the educational programs is our task.