Cardiovascular Anesthesia PDF Print E-mail

Cardiac anesthesia is a subspecialty that involves the demanding intraoperative medical care of patients with coronary artery disease (requiring bypass surgery), valvular heart disease (requiring valve repair or replacement), or complex aneurysm repair. In addition to their heart disease, these patients often have other underlying medical problems called co-morbidities such as peripheral arterial disease (PAD), lung disease (COPD), hypertension, diabetes, or obesity that can impact how we deliver your anesthetic. It is the role of the anesthesia team (anesthesiologist and nurse anesthetist) to understand your medical problems and to deliver as optimal care as we are able during surgery to try to maximize a safe outcome for you.

 

Preoperative Evaluation

American Anesthesiology's preoperative evaluation attempts to both familiarize patients with the cardiac anesthesia care team and address any concerns and/or expectations regarding cardiac surgery. Prior to the day of your surgery, an anesthesiologist will go over your history and various tests (for example, labs, EKG, cardiac catherization results, etc.). Occasionally, we are able to leave the operating room to meet with you and explain what will transpire before, during and after your surgery as it pertains to anesthesia. Occasionally we will call to gather more information after we have reviewed your chart prior to the date of the surgery.

 

Day of Surgery

On the day of surgery, you will either be transported from the floor or come in from home to our same day surgery area prior to surgery. Our anesthesiologist and nurse anesthetist will visit with you and your family to review the history, assess any changes in health, examine you and discuss the proposed anesthetic plan in words that you and your family can understand. We will review AA’s anesthesia consent and answer any questions that you may have. When your surgeon, operating room nurses, and anesthesia are ready we will transport you to the operating room. Typically, we administer a sedative called Versed through the IV. This medication will help ease your anxiety as well as may make it unlikely you will remember much from this point forward until you wake up in the ICU. We will make every effort to try to make your transport to the operating room relaxing and as stress-free as possible. Pain medicine may be given in addition to the sedative to assure your comfort.

 

Intraoperative Care

Once you have been placed on the operating room bed, we will place various monitors to try to ensure your safety during your operation. We will deliver oxygen by gently placing an oxygen mask over your mouth and nose. We will induce general anesthesia by injecting medication through your IV. It generally takes about 30-60 seconds to fall asleep after we start. We will place a breathing tube into your trachea (also known as wind pipe). We will breathe for you during the surgery until you wake up in the ICU. After you are asleep we will place two invasive lines (an arterial line and a pulmonary artery catheter) that help guide any treatment that your heart may need during or after your surgery. We keep you asleep through a combination of anesthetic gas though the breathing tube, pain medicines and more sedatives.

 

Invasive Lines

 

Arterial Line

The arterial line (known also as A-line) is a monitor that usually is placed as you go to sleep but may also inserted prior to surgery while you are awake. This is a catheter that we usually placed in your radial artery by your wrist where you can check your pulse. Sometimes we place the catheter in your groin in the femoral artery if your surgeon plans to use that artery as one of your bypass grafts. We use this line to tightly monitor your blood pressure during the surgery.

 

Pulmonary Artery Catheter

A pulmonary artery catheter helps monitor your heart during and after your surgery in the ICU. It usually is placed after you are asleep but may be inserted prior to surgery. This catheter is introduced through a large vein in your neck or chest and goes directly into your heart. This monitor allows your anesthesia providers to guide treatment for your heart by monitoring the fluid pressures in your body as well as your heart function. Based on the information observed through this catheter, we may give more or less fluids or add medication to assist either your heart or blood pressure.

 

Transesophageal Echocardiography

Transesophageal echocardiography (TEE) is similar to an ultrasound you may have had on your chest to look at your heart before the day of your surgery. It involves placing a probe into the your esophagus after you are asleep. This allows us to stay out of your surgeon’s way during the surgery. Unless there is a contraindication to placing the probe, all patients will receive the TEE for their surgery. Your anesthesiologist will use the TEE to visualize the your heart as it beats. We look at your heart to tell how well it squeezes, how various parts of your heart are working like the heart valves and different parts of the heart walls. It allows your anesthesiologist to assist your surgeon during your surgery to deliver the best outcome for you. This probe will be removed at the end of surgery before you are transported to the ICU.

 

Care After Cardiac Surgery

At the end of surgery, you will be transported with monitoring to the ICU. Patients are kept asleep and on a breathing machine immediately following surgery. The ICU team consisting of your surgeon, an Intensivist (a doctor specializing in care of ICU patients), your ICU nurse, and respiratory therapist will take over care from your anesthesia providers at this time. You will remain sedated until various physiologic parameters are stable and the anesthesia wears off.

 

Once stable, your sedation will stop and you will awake from your sleep. As soon as you are awake and your strength returns, your ICU team will remove your breathing tube. Your anesthesiologist’s techniques have significantly reduced that time required to be asleep from the operating room until you are awake and off the breathing tube. The length of time on a ventilator can vary from person to person, but a general rule of thumb is that you will wake up 4 to 6 hours after arriving in the ICU.

 

Questions

The physicians of American Anesthesiology are always available to answer any questions you might have concerning your care. If there is time available prior to your surgery, then your surgeon can arrange a consultation with us if necessary. American Anesthesiology and its physicians look forward to helping you and your family get through what can be a difficult time for both your family and yourself.