FAQs: Cardiac Anesthesia

A cardiac anesthesiologist is a doctor (MD) who has completed four years of college, four years of medical school, at least four years of graduate-level medical training (a year of internship and three years in an anesthesiology residency program), and at least one year of a cardiac anesthesia fellowship program. During these many years of education and training, cardiac anesthesiologists become very knowledgeable about many areas of medicine, including cardiology, internal medicine, critical care, and pharmacology. However, a cardiac anesthesiologist’s education does not end with the completion of fellowship training. Because the field of cardiac anesthesiology is constantly evolving and expanding, cardiac anesthesiologists continually update their knowledge and skills through regular participation in educational courses and symposia, earning certifications as appropriate or required.

You probably will not get to know your cardiac anesthesiologist as well as your cardiologist and/or cardiac surgeon. You may not even be conscious or fully aware while this member of your cardiac team does much of his or her work. Nonetheless, this doctor plays many important roles in your care before, during, and after your surgery or procedure, and is an essential member of the cardiac team.

Specifically, your cardiac anesthesiologist:

• Ensures your comfort during surgery or a cardiac procedure with the use of anesthetics tailored to your specific medical condition and existing health issues
• Continually monitors your vital functions (such as breathing, heart rate and rhythm, blood pressure, body temperature, oxygen saturation, and fluid and blood needs) throughout and immediately following surgery or a procedure, making medical decisions on your behalf as necessary
• Manages your care, including any pre-existing medical conditions, throughout surgery and the immediate post-operative period
• Manages your pain during the immediate post-operative period to make you as comfortable as possible
• Provides expert consultation on many issues pertaining to your care, including pain management, anticoagulation, and airway management

There are four basic types of anesthesia:

• General anesthesia
• Regional anesthesia
• Local anesthesia
• Sedation

If you are having cardiac surgery, you must have general anesthesia, which renders you unconscious, immobile, and unable to experience pain or other sensations. You will also have no recollection of anything that occurred while you were under general anesthesia.

If you are undergoing a diagnostic or therapeutic cardiac procedure in the Cardiac Catheterization Lab or Electrophysiology Lab, you may require only local anesthesia and/or sedation. There are varying levels of sedation, but often you will be given a sedative that produces a “twilight sleep,” in which you are not unconscious, but may fall asleep and have little or no recollection of events.

The preoperative interview has two important purposes. One is to provide your cardiac anesthesiologist with essential information about your health history and habits so he or she can properly plan and manage your anesthesia and care during and following your surgery or procedure. If, for example, you have a chronic medical condition, such as allergies or asthma, your cardiac anesthesiologist must know this information in order to tailor your anesthesia to your specific situation. In addition, your cardiac anesthesiologist will ask about your use of cigarettes, alcohol, and prescribed or illicit drugs, as these affect how your body responds to anesthesia. The other important purpose of the preoperative interview is to give you an opportunity to ask questions and voice any concerns you may have.

If you are having general anesthesia, you will not be conscious (aware) during your entire operation. You will not experience pain or other sensations and cannot be aroused until and unless the cardiac anesthesiologist chooses to wake you. Be assured that throughout your entire operation, your cardiac anesthesiologist continually monitors and adjusts your level of anesthesia so that you are always adequately anesthetized. However, you may be aware (but sedated), during pre-surgical preparations, so you may have some recollection of the operating suite after your surgery is over

You may need a blood transfusion. Today’s blood supply is extremely safe, but the risk is not zero. If you have any specific concerns about this issue, please discuss them with your cardiac anesthesiologist.

No cardiac surgical procedure is without some degree of risk, which your surgeon will discuss with you prior to your operation. Fortunately, serious complications and death from general (or other types of) anesthesia are very rare today, despite the fact that more cardiac surgery is now performed on older, sicker patients and younger, tinier infants than in the past.

The increased safety of general anesthesia is due to many factors, including:

• New, safer drugs
• Sophisticated new anesthesia and monitoring equipment
• Broader, more extensive training of anesthesiologists
• National standards of care that reflect current best practices

Side effects from general anesthesia may occur, but the vast majority are not serious, do not last long, and are treatable. Side effects may include sore throat, headache, back pain, and/or fatigue. Some patients experience nausea or vomiting, but this occurs less frequently than in the past.

When you wake up after your operation depends on many factors, including the type of surgery you undergo. Most likely, you will awaken in the Cardiac Intensive Care Unit.

Some discomfort after a major surgical procedure is to be expected. But strong, effective painkilling drugs are routinely provided to cardiac surgical patients so they can be as comfortable as possible. Patients and families should be reassured to know that the Cardiac Intensive Care Unit staff members are very aware of the importance of effective pain management and very experienced at managing patients’ pain.

At Massachusetts General Hospital, we keep families informed of the patient’s status at regular intervals during a cardiac operation. Your family members may visit you as soon as you are moved to the Cardiac Intensive Care Unit or (for children) the Pediatric Intensive Care Unit.