Anaesthesia for Cardiac & Thoracic Surgery

Anaesthesia
  • Preoperative Assessment
  • Monitoring
  • Myocardial Revascularisation
  • Valvular Disorders
  • Thoracic Surgery
  • Cardiopulmonary Bypass
  • Circulatory Assist Devices
  • Postoperative Care
  • Related Links

Preoperative Assessment

The American Society of Anesthesiology site includes general Practice Guidelines for the basics of preoperative evaluation and perioperative care of patients with cardiac stents.

The Society of Cardiovascular Anaesthetists has an excellent site, including the.2007 ACC/AHA Guidelines for Perioperative Cardiovascular Evaluation for Non-cardiac Surgery, 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade

A review of adult patients with congenital heart disease is available from the excellent Adult Congenital Heart Association site. AMHA has a sub-section on congenital heart disease.

The BJA has a great 2002 v88 no5 editorial on pacemakers and ICDs in the anaesthesia setting. Here is Marc Rozner’s GasNet discussions about pacemakers.

JACC focused update 2008 for prevention of endocarditis in valvular cardiac disease 2008. See also the American Heart Association Bacterial Endocarditis Guidelines.

Resuscitation

The Australian Resuscitation Council provide resuscitation guidelines and fowcharts.

Dan Moos’ Basic Guide for Resuscitation in Developing Countries is a well presented resuscitation manual. It can be found on the IFNA site.


Monitoring

US ASA’s Practice Guideline for basic monitoring, Pulmonary Artery Catheter and blood usage guidelines.

Echocardiography is well represented on the Web, including these sites:

  • 2010 ASA/SCA Guideline for Transoesophageal Echocardiography.
  • Editorial on intraoperative TEE and TEE in the outpatient setting from the Internet Journal of Anesthesiology
  • The ACC/AHA Guidelines for Clinical Application of Echocardiography 1997.
  • The Echocardiography Laboratory of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson School of Medicineprovides us with an electronic journal of cardiac ultrasound, containing images and medical articles. Surprisingly good!
  • Anaesthestist.com TOE/TEE library.

Other echo sites include :

  • American Society of Echocardiography
  • Yale Cardiothoracic Imaging

Myocardial Revascularisation

The Heart Surgery Forum presents a number of resources related to cardiac surgery, with extensive discussion of minimally invasive techniques and off-pump CABG.

The ACC site should be visited for a review of their Clinical Guidelines. A recent addition is the 2004 Guideline for Coronary Artery Bypass Grafting.

The Society of Thoracic Surgeons has information for adult patients having cardiac surgery including stenting vs surgery , CABG information. and what to expect after cardiac surgery.


Valvular Disorders

Antibiotic prophylaxis – ACC/AHA 2008 Update.

The Heart Surgery Forum also addresses issues concerning patients undergoing valve surgery, with emphasis on minimally invasive techniques.

ACC/AHA Guidelines for Management of Patients with Valvular Disease 2006

The Society of Thoracic Surgeons has this primer for patients needing Aortic Valve surgery, Mitral Valve Replacement or repair.

2007 STS/SCA Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery


Thoracic Surgery

The Society of Thoracic Surgeons homepage provides Society info as well as full text cardiovascular and thoracic journal articles. TheCardiothoracic Surgery Network is a great site.

The American College of Chest Physicians (ACCP) The Journal Chest provides abstracts and PDF’s..


Cardiopulmonary Bypass

The Internet Journal of Perfusionists provides us with some useful articles.

Additional sites worth checking out:

  • American Academy of Cardiovascular Perfusion
  • American Board of Cardiovascular Perfusion (ABCP) – certification
  • American Society of Extracorporeal Technology (AMSECT) (now incorporating PerfList)
  • Extracorporeal Life Support Organisation (ELSO)
  • Perfusion.com Homepage – info about platelet gel etc.
  • University of Michigan Extracorporeal Life Support Home Page
  • Aust and NZ College of Perfusionists.

Circulatory Assist Devices

Very detailed review on the SCA site.

AHA advice for patients. – also from NIH

Wikipedia.


Postoperative Care

Postoperative bleeding is an unwanted complication, and may be related to platelet dysfunction. Paparella’s 2004 review. Pathophysiology of bleeding and clotting Achneck Circulation 2010. The use of thromboelastography is addressed in the Internet Journal of Anesthesia.

Postoperative Pain Management is the subject of a separate Virtual Anaesthesia Textbook chapter.


Related Links

  • PubMed
  • Canadian Cardiovascular Society.
  • Cardiothoracic Surgery Network is an invaluable resource.
  • The Heart Surgery Forum is a must see site with very extensive resources.
  • The American Heart Association (AHA)
  • American College of Cardiology site has a wealth of clinical information including practice guidelines and archived presentations from the ACC Learning Center. You must first complete the free online registration.
  • Society of Cardiac Anesthesiologists

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