Cardiac Anesthesia

I wanted to write a short post about cardiac anesthesia, the most exciting, stressful, and fun experience I had on my rotation. The cardiac cases are long, intense stressors on patients who can be fairly sick. During the anesthesia pre-operative visit, we spend a long time getting to know the patient, ordering tests, and preparing a plan. The montoring is complex; one case had two arterial lines (femoral and radial), two IVs, a pulmonary artery catheter through a central line, a trans-esophageal echocardiogram, and a bispectral index (neurological monitor). We prepare over a dozen medications, infusions, and emergency resuscitation drugs. We check and recheck everything. During the case, we manage everything tightly, titrating blood pressure medications, anesthetics, analgesics, antiarrhythmics. We follow arterial blood gases closely, optimizing the patient for bypass. After bypass, we pace the patient's heart and support the rhythm with medications. It requires working closely with the surgeon, perfusionist, and the OR team. Along with vigilance, cardiac anesthesia requires constant reappraisal of the clinical situation.