Monitors

The anesthetic plan for a cardiac surgery needs to take into account all the possible things that could go wrong and what we'd need to treat the patient. As most patients have coronary artery disease, valve disorders, or aortic pathology that requires tight control of blood pressure, we place an arterial line for blood pressure monitoring before the patient goes off to sleep. After intubation, we usually place multiple large bore IVs in case there is severe blood loss requiring lots of fluid or transfusion. In the neck, we usually place a large introducer to aid in volume resuscitation as well as a multi-lumen catheter for drips. In some cases, we place a cerebral oximetry monitor to make sure the brain is being perfused or a pulmonary artery catheter to measure cardiac output and monitor pulmonary artery pressures.

All of this preparation takes a good amount of time and when I started the rotation, I would routinely bring in the patient at 7 and hand them off to the surgeons around 8. Today, I was extremely pleased; we were ready for our 3 vessel coronary artery bypass surgery at 7:18AM. As with everything, planning and preparation as well as practice makes everything smooth.