Dr Julián Rios

Cardiothoracic Anaesthetist | Full-time

Cardiothoracic Anaesthetist at the UK’s largest cardiovascular centre and one of the largest in Europe. Role combining high-acuity clinical practice, perioperative echocardiography, education and service development across cardiac, aortovascular and thoracic anaesthesia and interventional cardiology.

Clinical responsibilities

Provide comprehensive perioperative care for patients undergoing routine, complex and emergency adult cardiac surgery.

Deliver anaesthesia for thoracic procedures, including video-assisted thoracoscopic surgery (VATS), robotic-assisted thoracic surgery (RATS) and open thoracotomy.

Manage complex open, endovascular and hybrid aortic procedures as a member of the aortovascular anaesthesia team, including open thoracoabdominal aortic aneurysm (TAAA) repair using left-heart bypass, frozen elephant trunk (FET) surgery, complex aortic reconstruction, thoracic endovascular aortic repair (TEVAR), fenestrated endovascular aortic repair (FEVAR) and branched endovascular aortic repair (BEVAR).

Provide anaesthetic support for structural and interventional cardiology procedures, including transcatheter aortic valve implantation (TAVI), transcatheter mitral valve repair, closure of patent foramen ovale (PFO), atrial septal defects (ASD) and patent ductus arteriosus (PDA), aortic coarctation stenting, and complex electrophysiology procedures.

Lead perioperative transoesophageal echocardiography (TOE) during cardiac and aortovascular surgery, performing and interpreting approximately four to six studies per week.

Participate in a high-intensity theatre on-call rota, managing cardiac, aortovascular, thoracic and interventional cardiology emergencies.

Provide clinical cover in the Cardiac Intensive Care Unit (CICU) and High Dependency Unit (HDU).

Deliver general anaesthesia and sedation for breast cancer surgery, gynaecological surgery, brachytherapy and fertility procedures.

Teaching, leadership and service development

Lead education for Operating Department Practitioners (ODPs), strengthening their knowledge and practical skills in cardiothoracic anaesthesia.

Teach and supervise Queen Mary University of London medical students, anaesthetic trainees rotating through cardiothoracic anaesthesia and cardiac intensive care, and national and international fellows in cardiothoracic anaesthesia and intensive care.

Lead regional anaesthesia training and simulation.

Contribute to the development of the regional anaesthesia service for cardiothoracic surgery, supporting Enhanced Recovery After Cardiac Surgery (ERACS) pathways and improving perioperative analgesia and recovery.

Developed institutional guidelines for the use of chest-wall regional nerve blocks following cardiac and thoracic surgery.

Contribute to a quality-improvement project evaluating thromboelastography (TEG) during rewarming from cardiopulmonary bypass, with the aim of developing local, evidence-based transfusion guidelines for complex cardiac and aortovascular surgery.

The Royal London Hospital, London
One of London’s leading trauma and emergency care centres. Alongside specialist cardiothoracic practice, maintain a broad general anaesthetic practice, providing perioperative care for colorectal, ENT, endocrine, orthopaedic, trauma, plastic, spinal and ophthalmic surgery. Deliver anaesthesia in remote and non-theatre environments, including interventional radiology. This varied practice maintains broad expertise in perioperative medicine and the management of patients with complex comorbidities.

Alongside substantive employment, undertook additional locum shifts providing consultant-led perioperative care for patients undergoing cardiac and breast surgery, as well as electrophysiology and structural cardiology procedures.

Completed an advanced fellowship in Cardiothoracic Anaesthesia and Intensive Care at Barts Heart Centre, working in a full-time clinical role within one of Europe’s leading cardiovascular centres.

Responsibilities included preoperative assessment and perioperative management of patients undergoing elective and emergency cardiac surgery, thoracic surgery, interventional cardiology procedures, and bronchoscopy.

Gained extensive experience in the anaesthetic management of patients undergoing the full spectrum of adult cardiac surgery, from routine procedures to highly complex elective and emergency cases, including complex aortic surgery.

Worked closely with the interventional cardiology and electrophysiology teams, providing perioperative care for patients undergoing structural heart interventions and complex electrophysiology procedures. This included anaesthetic management for transcatheter valve interventions, septal defect closure procedures, electrophysiology ablations, and device implantation.

During this fellowship, developed advanced skills in perioperative haemodynamic management, transoesophageal echocardiography (TOE), and multidisciplinary decision-making in high-risk cardiovascular patients.

As part of the on-call rota, supported the management of patients presenting through the Heart Attack Centre (HAC) and gained significant experience in the assessment and stabilisation of acutely unwell cardiovascular patients.

Also provided senior clinical support to junior trainees within the Cardiac Intensive Care Unit (CICU), contributing to patient management, escalation decisions, and multidisciplinary communication.

Actively participated in departmental quality improvement initiatives and led a project evaluating the effectiveness and safety of temporary epicardial pacing systems following cardiac surgery, contributing to improvements in postoperative patient care.

The fellowship provided extensive educational opportunities including simulation training, advanced TOE teaching, multidisciplinary case discussions, journal clubs, and formal lecture programmes. These experiences strengthened my clinical expertise, leadership skills, commitment to patient safety, and interest in education and quality improvement.

Completed an advanced fellowship at Royal Papworth Hospital, one of the UK’s leading specialist cardiothoracic centres. I provided comprehensive perioperative and critical care for patients undergoing the full spectrum of cardiac and thoracic surgery and structural and interventional cardiology procedures.

Gained extensive experience in complex cardiac and aortovascular surgery, thoracic surgery, pulmonary thromboendarterectomy (PTE), and heart, lung and combined heart–lung transplantation.

Managed patients requiring advanced mechanical circulatory support, including ventricular assist device (VAD) implantation and extracorporeal membrane oxygenation (ECMO).

Developed advanced expertise in haemodynamic management, perioperative decision-making and the critical care of patients with severe cardiopulmonary disease.

Worked closely with cardiothoracic surgeons, intensivists, cardiologists, perfusionists and specialist nursing teams within a tertiary referral environment.

Regularly delivered departmental teaching and supervised junior doctors, medical students and nursing staff.

As Rota Master for the Senior Clinical Fellow cohort, coordinated clinical rotas and supported departmental workforce planning.

Contributed to clinical audit and quality improvement, including a prospective audit of 100 patients evaluating acute pain management following thoracic surgery and the effectiveness of perioperative analgesic strategies.

This fellowship provided a strong foundation for subsequent consultant practice and specialist interests in complex cardiothoracic and aortovascular anaesthesia, regional anaesthesia, enhanced recovery and critical care.

Worked in average 50 hours a week and included daily activity in theatre and on call commitments in obstetrics and intensive care unit (ICU).

Duties comprised perioperative care of patients in theatres as neurosurgery, general surgery, breast surgery, urology, cardiothoracic surgery, trauma and orthopaedics, obstetrics and gynaecology, dental, vascular surgery and robotic surgery. When on call, main responsibilities involved taking care of ICU (general and cardiac) patients, deteriorating patients on the ward, critical ill patients (adults and children) in the A&E department and obstetrics patients. In addition, attended morbidity and mortality meetings every week along with departmental clinical lectures and participated in teaching of junior medical staff and nurses.

During this period, worked with the Mobile Intensive Care Ambulance Service (MICAS) in combination of intensive care medicine and retrieval medicine based at the intensive care unit (ICU) at Cork University Hospital. Roughly 70% of activity was based on intensive care unit looking after general and cardiac critical care patients under supervision of the anaesthesia/ICU consultant. Apart from that, took care of deteriorating patients on wards, patients in emergency department requiring critical care services and was involved in intrahospital transfers of critical patients to MRI suite, interventional radiology and CT scan. Another 30% of activity comprised interhospital transfers of critically ill patients requiring escalation of care from level 1 and 2 ICU to level 3 and 4 for ECMO, lung, heart or liver transplantation.

Worked as a full-time Consultant Anaesthetist at Hospital Universitari Dexeus, a tertiary referral hospital affiliated with the Autonomous University of Barcelona and providing a comprehensive range of surgical services.

Delivered elective anaesthetic services and participated in a resident consultant on-call rota, providing emergency anaesthesia across major surgical specialties, including obstetrics, paediatrics, trauma, ENT and emergency surgery.

Undertook the preoperative assessment, optimisation and perioperative management of patients undergoing colorectal, endocrine, upper gastrointestinal, orthopaedic, trauma, plastic and reconstructive, vascular, urological, neurosurgical and bariatric procedures.

Developed extensive expertise in advanced airway management, particularly in complex ENT and maxillofacial emergencies involving facial trauma, mandibular fractures, deep-neck space infections and intraoral abscesses.

Regularly managed anticipated difficult airways using advanced techniques, including awake fibreoptic intubation.

Provided obstetric anaesthesia for elective and emergency caesarean sections, labour analgesia and the perioperative management of high-risk obstetric patients.

Delivered anaesthesia for paediatric day-case surgery and procedural sedation within endoscopy and interventional radiology suites.

Provided postoperative care in the Post-Anaesthesia Care Unit (PACU), focusing on safe recovery, effective pain management and the early recognition and treatment of complications.

Taught and supervised specialist anaesthesia trainees and contributed to departmental educational activities.

This post consolidated independent consultant-level expertise in perioperative medicine, emergency anaesthesia, advanced airway management, multidisciplinary practice and complex clinical decision-making.

Provided comprehensive perioperative care across a broad range of surgical specialties, including:

Spinal and neurosurgery

Plastic and reconstructive surgery

ENT and maxillofacial surgery

Urological and ophthalmic surgery

Major general surgery, including bariatric procedures

Trauma and orthopaedic surgery

Observership in anaesthesia: thoracic surgery, neurosurgery, general surgery, traumatology surgery, urology surgery, spine surgery, major vascular and emergency surgery.

Provided perioperative care for patients undergoing vitrectomy, retinal detachment repair, cataract surgery and aesthetic periocular procedures, using regional anaesthesia, sedation or a combination of both techniques.

Provided comprehensive perioperative care for patients across ASA physical status classifications I–IV.

Conducted preoperative assessment and optimisation through the anaesthetic pre-assessment clinic.

Delivered general anaesthesia for spine, head and neck, ENT, plastic and aesthetic, general, thoracic, vascular, urological, paediatric and gynaecological surgery, as well as obstetric and gastroenterology procedures.

Provided regional anaesthesia—including spinal, epidural and peripheral nerve block techniques—for trauma and orthopaedic, urological, obstetric, general, vascular, plastic and ophthalmic surgery.

Delivered procedural sedation in endoscopy and radiology suites and for vascular, ophthalmic, plastic, dermatological and maxillofacial procedures.

Managed postoperative monitoring, recovery, analgesia and early complications within the Post-Anaesthesia Care Unit (PACU).

Worked as a full-time Consultant Anaesthetist at Hospital Quirónsalud Marbella, providing comprehensive perioperative care for elective and emergency patients within a tertiary multidisciplinary hospital.

Undertook preoperative assessment and optimisation in the pre-assessment clinic and delivered general anaesthesia, regional anaesthesia and procedural sedation.

Independently managed patients across ASA physical status classifications I–IV, including patients with significant comorbidities undergoing complex surgery.

Practice covered cardiac and thoracic surgery; neurosurgery and spinal surgery; ENT, head and neck, and maxillofacial surgery; general and vascular surgery; plastic and aesthetic surgery; urology; ophthalmology; trauma and orthopaedic surgery; paediatric surgery; and gynaecology and obstetrics.

Provided anaesthesia and sedation in remote and non-theatre environments, including cardiology laboratories, interventional radiology, respiratory medicine, gastroenterology and endoscopy suites.

Managed postoperative care within the Post-Anaesthesia Care Unit (PACU), including pain management and the early recognition and treatment of complications.

Contributed to the development of departmental clinical protocols and participated in clinical audit and quality-improvement initiatives.

Supported the education and clinical supervision of junior medical staff.

This role strengthened expertise in perioperative medicine, advanced airway management, regional anaesthesia and the management of complex patients across a broad range of surgical specialties.

Provided perioperative anaesthetic care for patients undergoing elective surgical and diagnostic procedures.

Conducted preoperative assessment and optimisation.

Delivered general anaesthesia for general, plastic and aesthetic, trauma and vascular surgery.

Provided and monitored procedural sedation for gastroscopy and colonoscopy.

Managed postoperative recovery, analgesia and monitoring within the Post-Anaesthesia Care Unit (PACU).

Specialist Training in Anaesthesiology, Critical Care and Pain Management | Four-year programme

Completed a four-year specialist training programme at Hospital Universitario Virgen de las Nieves, a 1,369-bed tertiary university hospital providing comprehensive surgical, medical, trauma, paediatric, obstetric and critical care services.

Gained extensive experience in perioperative medicine, intensive care, emergency anaesthesia, and acute and chronic pain management.

Completed training across cardiac, thoracic, vascular, transplant, upper gastrointestinal, neurosurgical, paediatric, orthopaedic, trauma, ENT, maxillofacial, obstetric, gynaecological, ophthalmic, plastic and reconstructive, urological and general surgery.

Undertook dedicated rotations in intensive and postoperative critical care, cardiac and thoracic surgery, vascular surgery, paediatric anaesthesia, neurosurgery and pain medicine.

Developed expertise in general and regional anaesthesia, ultrasound-guided regional techniques, advanced airway management, perioperative assessment and optimisation, enhanced recovery, trauma care, obstetric and paediatric anaesthesia, and intensive care medicine.

Participated in departmental teaching, morbidity and mortality meetings, simulation, clinical governance and academic activities.

Completed additional training in difficult and paediatric airway management, ultrasound-guided regional anaesthesia, neuromuscular monitoring, non-invasive ventilation and perioperative ultrasound.

External tertiary referral rotations

University Hospital Clínico San Cecilio, Granada

Gained specialist experience in the perioperative management of complex open and endovascular thoracic and abdominal aortic aneurysm and dissection repair, including TEVAR and FEVAR.

This rotation established long-standing specialist interest in complex aortovascular anaesthesia.

University Hospital La Fe, Valencia

Managed patients in the postoperative surgical intensive care unit following cardiac, thoracic and vascular surgery; liver, kidney, combined pancreas–kidney, heart and lung transplantation; and major neurosurgical and trauma procedures.

Gained experience in advanced organ support, including extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP) support, renal replacement therapy, neurological monitoring and percutaneous tracheostomy.

This programme established a comprehensive foundation in perioperative medicine, critical care, multidisciplinary practice and patient safety.

The role at the primary care hospital was to attend adults and paediatrics emergencies. In addition, worked part time as GP in a public neuropsychiatry and geriatric centre looking after this special medical population.

Responsibilities were to attend children, adults, and pregnant patients in the consultation and hospitalisation rooms, emergency department and maternity ward respectively.

Worked looking after patients at the emergency department including adults and children.

Worked in emergency medicine in the adult and paediatric patient.

Duties were to attend patients (children, adults, and pregnant) in primary care, hospitalisation rooms, emergency department and delivery rooms.

Completed a full-time rotating medical internship, averaging approximately 60 hours per week and including overnight and weekend duties. Gained broad clinical experience across emergency medicine, paediatrics, obstetrics, internal medicine, general surgery and surgical specialties, and family medicine.