Coagulopathy

One of the other aspects of anesthesia for heart surgery is understanding and managing bleeding. The amount of time a patient is on bypass, especially if it is over 3 hours, correlates with the amount of coagulopathy. Since we do a lot of complex surgeries on multiple valves or the aortic arch, we often have very long bypass runs. As blood goes through the artificial heart-lung circuit and as the body cools, the effectiveness of platelets decreases dramatically. As the surgeons get into bleeding and transfusions are given, the proteins necessary to form clot are depleted.

As a result, at the end of long cases, I've given tons of product - units after units of platelets, fresh frozen plasma, cryoprecipitate, and blood. In extreme circumstances, we consider newer, expensive medications like recombinant factor 7 and FEIBA, a factor complex mostly used in hemophilia. As a resident, I also learn about dynamic measures of bleeding and clotting such as thromboelastography, a test only used in anesthesia and surgery. Even if I don't go into cardiac anesthesia, learning and experiencing this is important because the same principles apply to severe trauma or critically ill patients.

Image of platelets is in the public domain, from Wikipedia.