Anaesthesia at Royal Brompton Hospital

The anaesthesia department at Royal Brompton Hospital provides a world-leading anaesthetic service for different cardiothoracic conditions in patients of all ages. 

The team is made up of 21 consultants, eight specialist registrars and 2 clinical fellows, working across 6 operating theatres (including one hybrid theatre), 5 catheter laboratories, CT, MRI, and the Royal Brompton Diagnostic Centre which opened in February 2022. 

Meet the team

Head of department 

• Dr S Trenfield

Departmental / service lead

• Director of theatres: Dr D Alexander
• Direction of medical education: Dr M Lane
• College tutor: Dr N Zimbler
   
• Congenital / paediatric anaesthesia: Dr TC Aw
• Cath lab: Dr F Del Sindaco
• Complex aortic: Dr A Ghori
• Complex mitral: Dr N Zimbler
• Pulmonary hypertension: Dr D Alexander
• Thoracic surgery: Dr K Fogg
• Pre-assessment: Dr A Elkhatteb
• Lung lavage: Dr T Pickworth
• Pain management: Dr K Fogg (adults) / Dr S Jaggar (paediatrics)

Consultants

• Dr D Alexander
• Dr TC Aw*
• Dr P Bianchi*
• Dr K Bramley
• Dr F Del Sindaco
• Dr A Elkhatteb*
• Dr K Fogg
• Dr J Gan*
• Dr A Ghori
• Dr K Good
• Dr S Jaggar*
• Dr B Keogh*
• Dr M Lane*
• Dr S Mele*
• Dr T Pickworth
• Dr R Stenz*
• Dr S Trenfield
• Dr A Vlachou
• Dr J Weale*
• Dr N Zimbler

*Paediatric / congenital 

Departmental secretary

Mr W Hartigan 
Email: w.hartigan@rbht.nhs.uk 

Our expertise

We offer a comprehensive cardiothoracic service for heart and lung conditions in adults and children, including congenital and acquired cardiothoracic conditions. We also provide an acute service for the management of ascending aortic dissections.

We have a fully staffed point-of-care lab within the theatre complex and 24-hour on site biomedical engineering cover.

We specialise in:

Whole lung lavage for alveolar proteinosis

Pulmonary alveolar proteinosis (PAP) is an extremely rare lung disease in which the alveoli of the lung become congested with a mixture of excess lipoprotein material and non-functional macrophages. In collaboration with our respiratory physician, we utilise lung lavage to help manage this condition.

Transcatheter valve and device interventions

We offer a bespoke intervention service for valvular disease in adults and children, using innovative techniques. For example, through a hybrid procedure, we used a supra-annular placement of a Melody® valve in an infant with unrepairable left atrioventricular septal defect.

We are the first and only centre in the UK to offer the Tendyne™ Transcatheter Mitral Valve Replacement. We routinely perform the MitraClip™ procedure in patients unsuitable for surgical repair and have used the same device successfully in severe tricuspid regurgitation. 

In addition, we recently established a nurse led sedation service for transcatheter aortic valve implantation which has been extremely successful. 

Pulmonary hypertension

Royal Brompton Hospital is a regional centre for pulmonary hypertension in the UK. We anaesthetise patients with severe pulmonary hypertension for various surgical and non-surgical procedures, both cardiac and non-cardiac. In conjunction with obstetric colleagues, we provide anaesthesia and post-operative care for high-risk pregnant women with congenital or acquired cardiac disease, particularly those with severe pulmonary hypertension. 

Complex aortic surgery

We provide anaesthetic support for complex aortic surgery ranging from the intrathoracic ascending aorta to the abdominal descending aorta. We commonly use spinal cord monitoring, left heart bypass and single lung ventilation to achieve the best outcomes. 

Transcatheter PDA closure in extreme prematurity

Haemodynamically significant patent ductus arteriosus (PDA) is associated with increased mortality and morbidity in extremely premature infants (weight < 1500g). We are the largest centre in Europe performing transcatheter PDA device closure in this cohort.

Peri-operative transoesophageal echocardiography (TOE)

Our consultants are formally accredited in peri-operative TOE. We are expert practitioners and trainers in interventional and congenital cardiac echocardiography incorporating all aspects of advance qualitative and quantitively assessment. We use 2D and 3D imaging to guide our surgical and cardiac interventionalist and optimise pacing.

We have a dedicated TOE teaching centre and recently acquired a Heartworks TOE simulator for teaching and training. 

Education and training

Cardiothoracic anaesthesia

We have an active training programme in all aspects of cardiothoracic anaesthesia, led by the college tutor. Our weekly protected teaching includes a comprehensive lecture programme, journal clubs, TOE teaching and case discussions.

Clinical governance occurs monthly and is devoted to morbidity and mortality reviews and audits. Anaesthesia-based adverse incident reporting reviews take place once every three months.  

All members of staff have access to the Imperial College, National Heart & Lung Institute and departmental libraries. In addition, trainees have their own reading room in which five computers with full search facilities and internet access are available for their sole use. 

The Trust runs regular EPLS, ALS and CALS courses and all trainees are encouraged to maintain current certification.  

SPRinT simulation

The SPRinT programme has developed and patented various models, including the open-chest Harley model, the open-chest ECMO model and an innovative adult open-chest model to enhance fidelity in our scenarios.

This programme has been recognised with numerous national awards for education and training in patient safety. Dr M Lane leads the programme in the anaesthetic department.

We run both high and low fidelity simulation training in both adult and paediatric patients for cardiac and thoracic scenarios.

Our paediatric simulations is part of the Simulated interPRofessional Team Training (SPRinT) programme.

Non-anaesthetist sedation course

The department runs a biannual course for all non-anaesthetic staff administering sedation or care for sedated patients. This course consists of a half-day of lectures and, for those interested, a further half-day recognising and treating complications, in the Chelsea and Westminster Hospital simulation centre.

Fellowship

This fellowship is aimed at doctors who have completed their training or who are interested in expanding their exposure to cardiac and thoracic perioperative care. We currently offer two fellowship options:

• Royal Brompton Hospital fellowship – One year fellowship programmes in adult or paediatric cardiothoracic anaesthesia (2 posts).
• Royal Brompton Hospital and Evelina Children's Hospital fellowship - Joint 18-month paediatric cardiac and PICU fellowship – 9 months at ECH, 6 months at RBHT and 3 months at ECH PICU (1 post).

Successful candidates will have extensive exposure to clinical anaesthesia for all types of acquired adult, congenital and paediatric cardiac surgical procedures, catheter laboratory work, including electrophysiology, and structural intervention (device closures, trans-catheter valve implantation).

There is extensive TOE teaching and opportunity to gain experience in peri-operative TOE. All fellows are encouraged to undertake formal examination and accreditation in perioperative TOE.

Please contact our college tutor for any further information.