Cardiothoracic anaesthesia is a sub-specialty of Anaesthesia. Cardiothoracic Anaesthetists take care of all aspects relating to the anaesthetic care of patients having surgery to the heart, lungs and structures of the thorax (chest). Some cardiothoracic procedures include:
Due to the diverse nature of cardiothoracic anaesthesia, we have included a number of frequently asked questions.
Almost all patients undergoing any cardiothoracic surgery will be given a general anaesthetic (GA). Most cardiac operations take several hours, and the type of surgery being done necessitates the need for a GA.
In relation to cardiac surgery, there are a number of possible complications, and usually these are directly related to the age and general pre-operative health of the patient. The overall risk of mortality for coronary artery bypass surgery is around 2% in the healthy population. The more common risks to be aware of include:
The risk of each of these will depend on the individual patient and should be discussed with your surgeon and anaesthetist before surgery.
Post-operatively, patients are generally transferred to the Intensive Care Unit (ICU) where they will remain sedated and closely monitored. Initially, most patients will continue to receive anaesthetic medication and have their breathing assisted by a ventilator. When heart function and breathing are within normal limits, patients will have the anaesthetic medication reduced, and the patient will be ‘woken’ up gradually in the ICU.
The duration of a patients’ stay in ICU varies greatly, however in most cases it may just be overnight or 1-2 nights. Patients that have had complicated surgery or sick patients may spend many days in ICU. Once discharged from ICU, patients will then spend a further 5-10 days in hospital before being discharged home. Patients that have had prolonged hospitalisation may be transferred to a rehabilitation hospital for a period of time before being discharge home.
This may relates to a brain injury sustained as a result of the surgery. There is a great deal of scientific data that demonstrates subtle changes to the brain after cardiac surgery, and there are multiple reasons for this. There has been many advancements with technology over recent years with the widespread use of ultrasonography and cerebral oximetry. In most cases, the patient’s memory will improve over time, however, this may take many months.
For most heart operations, the heart is stopped so that the surgeon can perform the required surgery on a still heart. During this time, the pumping of blood through the body is replaced with a machine and is called extra-corporeal bypass. This machine is operated and monitored by the medical perfusionist who is an anaesthetist who has had further training. During your heart operation, you have two anaesthetists looking after you -one to put to sleep and look after you during the operation, the second to manage the bypass machine.
The chance of needing a blood transfusion depends on numerous factors, the most important factors relate to your pre-operative blood count and the complexity of the surgery. With elective surgery the chance of needing a transfusion is small (less than 10%), but with complex operations on emergency patients, the need for a transfusion of blood or blood products (which aid in the clotting of the blood) can become highly likely.
If you have concerns relating to receiving blood or blood products, you should alert your surgeon and anaesthetist at the earliest opportunity. In an elective situation, there may be the opportunity to improve the blood count in the weeks leading up to the surgery.
At the end of surgery, you will be kept asleep with anaesthetic medicine and transferred to the ICU where you will be kept asleep for the first few hours. After a short period has passed with improvement in your condition, the sedating medicine will be reduced and you will be allowed to start to wake up. Once heart function and breathing is satisfactory, the breathing tube will be removed.
Our aim is to keep you as comfortable and pain free as possible. After surgery, pain medicines will be administered through the intravenous cannula (the drip) and are generally very effective at controlling and minimising pain.
In the first few hours after the surgery, most people do not remember being in pain. After you awaken, you will be given control of the pain killers with a PCA (Patient Controlled Analgesia) where strong pain killers are administered through the IV cannula via a push button which you control.
Once you are awake, your breathing is the one thing that you will have to work on. The physiotherapist will show you how to perform breathing exercises in order to improve your lung function. When stronger, getting out of bed and walking around is also important.
Below are a number of additional resources that you may find helpful.
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