Cardiac Anesthesia

I started my two-month block of cardiac anesthesia. We focus on open-heart surgeries such as coronary artery bypass grafts, valve repairs and replacements, and aortic surgeries. We also cover vascular cases like carotid artery and abdominal aortic surgery as well as procedures in the cardiac catheterization lab. The open-heart cases are big surgeries that often take all day and utilize cardiopulmonary bypass. From an anesthesia standpoint, I have to arrive quite early in the morning because the set-up is fairly intricate. After starting an IV and an arterial line, I generally induce anesthesia, intubate the patient, get additional access, and place a large catheter in the neck as well as a multi-lumen catheter to give vasoactive drugs. We place a transesophageal echocardiography probe to take a look at the heart, and it's very helpful that I did my echo rotation last month.

In cardiac surgery more than anything else, the anesthesia is tied to the surgery so that what the surgeons do to the heart reflects what I see on the monitors and what I do with my ventilator affects the surgery. Furthermore, nearly all heart pathology is pertinent to anesthesia; if we don't understand the patient's coronary blood supply and valve status, we can cause a lot of harm on anesthetic induction. We also have to interact with a third provider, the perfusionist who is in charge of cardiopulmonary bypass. Thus, this is an important rotation to learn about anticoagulation and reversal as well as massive transfusions because bleeding is often prominent. We have to learn how to control hemodynamics when the surgeons cannulate the great vessels to set up bypass and how to check that everything is positioned well and working by echo.

It will be a good rotation but a tiring one. I am confident that by the end, I'll be much more comfortable with advanced heart disease, placing intravascular lines, and managing coagulopathy.