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Hi. My name is Greg Fischer, I’m the Director of Adult Cardiothoracic Anesthesia here at The Mount Sinai Medical Center. Most patients are admitted on the day of surgery. You will check into the preoperative clinic and be brought to the holding area where you will meet your anesthesiologist who will be taking care of you on the day of surgery. Once you are brought into the operating room you will meet your perfusionist and the nursing staff who will be taking care of you as well. The anesthesiologist will then hook up additional monitoring modalities to you such as EKG, blood pressure and pulse oximetry devices. After that, a mask will be placed over your mouth and nose, allowing you to breathe 100 percent oxygen. This is just a safety procedure where we are washing out all of the nitrogen from your lungs and replacing it with oxygen. After a time of 2 to 3 minutes has passed, very potent IV anesthetics will be injected into your veins, and you will softly and quietly drift off to sleep. Once you are asleep the anesthesiologist will insert a tube into your wind pipe. This will guarantee that your lungs will always have enough oxygen to guarantee good oxygenation to your brain and other vital organs during the procedure. The anesthesiologist will then place additional lines; you will get a large IV placed into your neck, which will allow us to measure the pressures around your heart, and give medications very close to the heart should this be necessary during the case. And finally a TEE probe, a Transesophageal Echocardiography probe; that is ultrasound, which enables the anesthesiologist to look at your heart during the procedure, will be inserted into your food pipe. After all of this is performed, which takes the anesthesiologist approximately 45 minutes to complete, you will be prepped and draped by the surgical team, and the operation will start.
Additionally the cardiac anesthesiologist is trained to perform an echo exam. Echocardiography is the technology that enables us to look at your heart prior to going on cardiopulmonary bypass. The information gained from our TEE exam is then passed on to the surgeon, which he then utilizes when he plans his valve repair.
It is important to stress, and I would like to put your mind at ease, that a member of the anesthesia team will always be with you during the entire perioperative procedure. The anesthesiologist is busy during the surgical procedure monitoring and optimizing your vital signs, as well as performing an echocardiographic exam. When we separate from cardiopulmonary bypass, and your valve is fixed, we re-asses the valve with echo and make sure that the valve is functioning perfectly. After separating from cardiopulmonary bypass, the surgeons then close the chest and you are then transported by the anesthesia team to the intensive care unit.
We provide the highest quality of care, beginning with the period before surgery and culminating in an outstanding Pain Management service—a continuous spectrum of care.
Your experience with us will begin when you come in for preoperative testing. Here you will be greeted by one of the physicians from the Department of Anesthesiology. In a private consultation room, your past and present medical history will be discussed. Afterwards, they will review how the anesthesia will be managed in your specific case and discuss what you need to do to prepare yourself the evening before surgery. Please feel free to ask any and all questions that you may have regarding your care.
Because everyone’s situation is unique, we encourage you to discuss with your anesthesiologist or your surgeon any concerns that are not covered here.
Before, during and immediately after surgery, your anesthesiologist assumes the role of your medical doctor.
On the morning of surgery, after you have gone through the preadmission department, you will be brought to the preoperative holding area. At this time, you will be introduced to the anesthesiologists who will be responsible for your care. Once again your medical history will be reviewed as well as the plan for anesthesia. Any and all questions you may have will be thoroughly addressed at this time. Because your treatment does not end with the completion of surgery, you will also meet the physicians from our pain management department. At this time, a plan for your postoperative care will be discussed. Prior to entering the operating room and intravenous will be started and a mild sedative will be given.
During your mitral valve repair you will be given general anesthesia. Your condition will be carefully monitored, controlled, and treated by your anesthesiologist, who uses sophisticated equipment to track the ways your body is responding.
You will be unconscious and have no awareness or other sensations during this period. The duration and level of anesthesia is calculated and constantly adjusted with great precision. A breathing tube may be inserted through your mouth to maintain proper breathing. At the conclusion of surgery, your anesthesiologist will reverse the process, and you will regain awareness in the recovery room.
Once the procedure has been completed, you will be brought out of the recovery room where our dedicated nursing staff will care for you until the time you are transferred to your hospital room. Family members can come to visit you at a time approximately 20 minutes after you’ve arrived in the recovery room.
Preparing for anesthesia
For most procedures, you must have an empty stomach to minimize the chances of regurgitating any undigested food or liquids. Some anesthetics suspend the normal reflexes that prevent food and drinks from entering your lungs, so for your safety, you will be told to fast (take no food or liquids) before surgery.
In addition, the anesthesiologist may instruct you to take certain medications with a little water during your fasting time. For your own safety, it is very important that you follow these instructions carefully; if not, it may be necessary to postpone surgery.
Cigarettes and alcohol affect your body just as strongly, and sometimes more so, then any of the medically prescribed drugs you may be taking. Because of their effects on your lungs, heart, liver, and blood, to name a few, cigarettes and/or alcohol can change the way an anesthetic will work during surgery. So it is crucial to let your anesthesiologist know about your consumption of these substances, and also to mention any over-the-counter medications or herbal/holistic medicines you have been taking. This is equally important for so-called street drugs, such as marijuana, cocaine, amphetamines, and the like.
People are sometimes reluctant to discuss these things, but it is worth remembering that such discussions are entirely confidential, and that various privacy laws protect whatever your doctor writes about them in the medical record. Your anesthesiologist’s only interest in these subjects is in learning enough about your physical condition to provide you with the safest anesthesia possible. So, in this case, honesty is definitely the best policy, and the safest one.
All operations and all types of anesthesia entail some risks, which depend on many factors, including the type of surgery and medical condition. Your anesthesiologist takes multiple precautions to prevent complications and fortunately, adverse events are very rare. You should speak to your anesthesiologist if there are any issues that you are particularly concerned about.
Please feel free to direct any questions or express any of your concerns to your anesthesiologist ahead of time. We want to make your surgical and anesthetic experience as safe and pleasant as possible.
Portions of the above are based on "Anesthesia and You" (©1994) by the American Society of Anesthesiologists. A copy of the full text may be obtained from: ASA, 520 N. Northwest Highway, Park Ridge, IL 60068-2573. www.asahq.org