Anesthesiology and the heart: Working together for the best outcomes

american society of anesthesiologists

A guest column by the American Society of Anesthesiologists, exclusive to

February is a little more than candy hearts and heart-shaped arrows—February is prominent as American Heart Month, helping doctors and patients better understand cardiac health and how to best care for one of the most important organs.

Each medical specialist takes great care to focus on heart health and ensure patients receive the highest quality care. Anesthesiologists, for instance, have advanced systems and techniques to monitor, regulate and stabilize heart function during any surgical procedure. It is important to understand how anesthesia and cardiac health relate.

At a basic level, anesthesia makes the heart beat with less intensity and lowers blood pressure. On a healthy heart, this creates a minimal impact on its function, and only standard monitoring is necessary for a safe procedure. However, when there are heart defects or pre-existing conditions, anesthesia needs to be coupled with precise monitoring and vigilance.

Patients and physicians need to work together to determine any heart conditions prior to surgery, even problems that may otherwise be undetected or unrelated. It is incredibly important for patients to be truthful and open with physicians about exercise tolerance, chest pain or pressure, or any other warning signs. Anesthesiologists will ask questions and perform a brief physical exam to confirm there are no undiagnosed heart issues, but be sure to be honest with your physician to ensure the best surgical outcomes.

For surgery on the heart, the level of monitoring is greater than in general procedures. For example, there will be an arterial line added to provide moment-by-moment blood pressure monitoring rather than a simple reading every three to five minutes from an exterior cuff. This arterial line looks just like a regular IV catheter, but is placed in an artery instead of a vein.

Some anesthesiologists also are trained in transesophageal echocardiography (TEE), particularly those who have completed year-long fellowships in cardiothoracic anesthesiology. With TEE, a probe can be inserted into the esophagus and stomach to provide detailed ultrasound images of the heart. This allows constant monitoring of heart function to make quick decisions about the need to administer fluid or blood, as well as medications that affect the blood pressure and pumping function of the heart. Beyond monitoring the heart during surgery, this technology can also be used as a diagnostic tool to detect structural heart problems and determine the effectiveness of a cardiac procedure while patients are still in the operating room.

When administering anesthesia for a heart surgery or when a significant pre-existing cardiac condition exists, specially trained cardiothoracic anesthesiologists will often be assigned to the operation. Similarly, anesthesiologists have the option to bring in a cardiothoracic anesthesiologist as a consultant or even defer specific cases to the specialist when they feel those skills are needed. Anesthesiologists work together to determine the best team to care for patients.

After surgery, it is crucial for patients to closely self-monitor for any problems. While anesthesia for most procedures is not commonly associated with severe post-operative complications, patients need to tell their physician about any unusual or adverse effects, including shortness of breath, chest pain, or any other concerns.

The heart is one of the most important systems in the body. Be sure to maintain a healthy heart through proper habits and honesty with your anesthesiologist during the perioperative process. It is a simple way to enjoy a long life.

John R. Rotruck is a member of the American Society of Anesthesiologists’ Committee on Cardiovascular and Thoracic Anesthesia. 

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