Anesthesiology for Cardiac Procedures and Surgery

There are several types of cardiac procedures which may involve the services of an anesthesiologist. These include:

1. Cardioversions, the conversion of an abnormal heart rhythm to a normal one.
2. Electrophysiologic studies, which involve identifying areas inside the heart where extra beats are formed, and possibly removing them.
3. Pacemaker placements
4. TAVRs which is a minimally invasive surgical procedure used to replace the aortic valve in one’s heart.
5. Open heart surgery, including coronary artery bypass, surgery on the aorta or pericardium, and valve replacement or repair.

Many of the procedures done in the catheterization laboratory are performed using varying levels of sedation, from light sleep to general anesthesia. All open heart surgery is done in the cardiac operating rooms under general anesthesia.

Planning for your open heart surgery begins when your cardiologist discovers a potentially correctable problem, and receives your approval to contact a cardiac surgeon for a consultation. If you and your surgeon agree on a plan, your case is scheduled and the department of anesthesiology is notified. We will come visit you, either in your hospital room if you are an inpatient, or in a consultation room if you are an outpatient. Outpatients are asked to come to the hospital ususally the day before their surgery for a preoperative anesthesia assessment, lab screening if indicated, and to receive special medications and instructions for the night before surgery. You may meet an anesthesiologist who will not actually be providing care for you to discuss the cases together before your surgery. You will always meet with your personal anesthesiologist before the procedure, who can answer any questions which may have come up after your initial preoperative visit.

There are some specific instructions for you the night before your surgery. If you are an inpatient, the floor nurses will have all the preoperative orders from your doctors. If you are an outpatient, you will be given a list of instructions before you leave your visit. Instructions include:

  • You should eat a light meal the evening before surgery.
  • Take all your usual medications, unless instructed otherwise.
  • Patients on blood thinning medications will have special instructions on how to manage them in the days before surgery.
  • Patients with diabetes will be given instructions on insulin management.
  • Unless your surgery is scheduled late in the day, you should not have anything to eat or drink after midnight. The only exception is enough water to swallow your medications on the morning of surgery. It is ok to brush your teeth.
  • Please do not chew gum, eat candy, or smoke the morning of surgery.

On the morning of surgery, you may be given a medication to help relax you before arriving in the operating room. Your family can be with you up until you enter the operating room area. Your anesthesiologist will greet you, and will need to start an IV while you are in the pre-procedure area. Once in the operating room, you will move to a special bed. Your anesthesiologist will place a monitor in an artery to watch your blood pressure during the operation. The anesthetic is given to you intravenously, and you will fall asleep quickly. Once asleep, your anesthesiologist has special procedures to do to ensure your safety during the operation. We are with you during the entire operation. When the surgery is done, you are still asleep. Your anesthesiologist will take you to the intensive care unit (ICU), where you will awaken later in the day. After you are awake and stable, a breathing tube will be removed. You will spend at least one night in the ICU.

While the risks of anesthesia have been steadily declining over the past twenty years, your procedure is not without risk. Your risks may include:

  • A heart attack or stroke
  • Bleeding requiring a transfusion
  • Hoarseness from many possible sources
  • Numbness in hands or feet
  • Infection or swelling at IV sites

Your risk of dying from the procedure is directly related to the severity of your heart condition, combined with the overall state of your health. Your surgeon and anesthesiologist will discuss this with you during your preoperative visit. It is imperative that you ask any questions you have about your surgery. Do not be embarrassed about asking us about our experience, successes, complications and training. This is an extremely important decision you are making, and you have the right to be well informed.