What is cardiovascular anesthesia or cardiac anesthesia?
Cardiovascular anesthesia, or cardiac anesthesia, is a unique and challenging subspecialty involving an array of complex procedures performed on patients. Cardiovascular anesthesiologists have special training in anesthesia for cardiac (heart), thoracic (lungs), and vascular (blood vessels) surgeries. Cardiac patients frequently have additional medical problems such as hypertension, diabetes or lung disease, which can complicate medical management. The additional training that cardiovascular anesthesiologists receive helps assure a safe outcome during surgery.
What is stress free anesthetic management?
Southeast Anesthesiology Consultants practices Stress Free Anesthetic Management. This means that all cardiac anesthesia techniques are specifically designed to reduce stress on the heart and body during the procedure. Heart rate, contractility, stroke volume (the volume of blood injected with each contraction), pre-load (volume of blood coming to the heart) and after-load (roughly equates to the blood pressure) are some of the components of cardiac workload and stress. These factors are monitored throughout surgery to assure patient safety. Each component is controlled or manipulated to reduce strain on the heart during surgery. The impact of each of these manipulations on the other organ systems is also taken into account during the operation.
How is cardiovascular anesthesia different from other forms of anesthesia?
Cardiovascular anesthesia is different from regular anesthesia because of the stress that can be placed on the heart, lungs and arteries during surgery. For this reason additional monitoring devices are used. These include:
- Central Venous Line or Pulmonary Artery Catheter- Immediately before cardiac surgery commences either a central venous line or a pulmonary artery catheter is placed. The catheters allow medications to be administered immediately to the heart. These catheters are also useful in monitoring pressure and function of the heart, lungs and surrounding circulation during and after surgery.
- Arterial Line - During preparation for cardiac surgery, a catheter (A-Line) is placed in a patient’s artery. It allows the medical team to continually monitor blood pressure and heart rate throughout surgery. It also allows for ongoing blood chemistry analysis without the need for further needle sticks. This catheter is usually placed in the radial artery (the artery felt when checking the wrist for a pulse.
- Echocardiogram - This is a device that allows physicians to directly view the heart. This procedure is also known as the cardiac ultrasound, cardiac echo, or echo. It allows the anesthesiologist and surgical team to review the cardiac valve area and function for any abnormalities or leaks.
- Cardiopulmonary Bypass - a pump is used to temporarily take over the function of the heart and lungs. Also called the Heart Lung Machine, the pump maintains the circulation of blood and oxygen.
What happens after cardiovascular surgery?
Following cardiac surgery the patient is transferred to the hospital's intensive care unit. During recovery the patient remains asleep with a breathing tube in place. The patient will be placed on a ventilator (a breathing machine) for a period of time to help with respiration. While patients in the past have remained in a heavily sedated state for 15-30 hours, our physicians have been successful in reducing these times dramatically. Many of our patients can expect to have their breathing tubes removed a few hours after surgery.
What are the risks associated with cardiovascular anesthesia?
Complications with cardiac anesthesia are not very different from general anesthesia and the majority of patients have few if any complications before, during and after surgery. Although cardiovascular surgery has more risks than other surgeries, having an anesthesiologist that is board certified in anesthesia, and fellowship trained in cardiac will ensure you receive the best possible care.