Anesthesia and Heart Surgery: The Facts
Dr. Gage Parr tells listeners everything they need to know about anesthesia and heart surgery.
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Learn more about K. Gage Parr, MD
K. Gage Parr, MD
K. Gage Parr, MD is an Assistant Professor of Anesthesiology and Critical Care Medicine.Learn more about K. Gage Parr, MD
Transcription:
Dr. Michael Smith (Host): According to some studies conducted within the last decade, there are good survival rates found in open heart surgery. But yet, it remains a scary surgery for many patients. Welcome to the GW Medical Faculty Associates podcast. I'm Dr. Mike Smith. Today’s topic: anesthesia and heart surgery, the facts. My guest is Dr. Gage Parr. Dr. Parr is assistant professor of anesthesiology and critical care medicine and director of quality improvement. Dr. Parr, welcome to the show.
K. Gage Parr, MD (Guest): Thank you very much.
Host: So obviously somebody hears that they need open heart surgery. That’s going to involve anesthesia. This is a very scary thing that they're going to have to go through. But I know that there’s been a lot of improvements in the anesthesia, in the open heart surgery. So could you maybe Dr. Parr just give us a good history of kind of where we were with the surgery and where we are today.
Dr. Parr: So I think the main thing to know is that as anesthesia for open heart surgery has evolved and progressed, we’ve really gone from a very, very deep long last general anesthetic to one that is tailored to fit the needs of the surgery and the time of the surgery. That we often—If people were talking to a friend or family member that had anesthesia for open heart surgery maybe 10/15 years ago, they may have been asleep for a day after the surgery. We’ve really moved beyond that to having people awake and off the ventilator within an hour or two after their surgery is over. If the case is amenable to it, we may wake you up in the operating room at the end of the surgery just as if you were having your gallbladder or your appendix out. So we’ve really progressed a great deal in taking care of patients and tailoring the anesthetic to meet the needs of the patient.
Host: Right, right. So, Dr. Parr, what does that ultimately mean though? If I'm coming out of anesthesia quicker, what does that mean in terms of my outcome, my hospitalization stay, all of that kind of stuff?
Dr. Parr: Well, obviously the less amount of time you're under general anesthesia, the better it is for your brain and your body. General anesthesia is extremely safe, but it’s an abnormal state. People think of it as being asleep, but it is not asleep like if you're home in bed. It is a medically induced state, and the least amount of time we can keep you in that state the better off you are. It’s better for your brain and your body to have as least exposure to the anesthetics as possible, but still get you through the surgery safely.
Host: Right. So if somebody is listening to this and maybe they have scheduled open heart surgery, what are some of the questions? What are some of the themes that the patient should do in preparation for the surgery and in preparation for receiving the anesthesia?
Dr. Parr: So the things that they should before coming in, make sure that they have talked to their surgeon and their cardiologist and know which medications are appropriate to take the day of surgery and which are not. Many of these patients coming in for open heart surgery will be on a lot of medications. Some of them we really want the patients to take prior to the surgery, and some of them we don’t. So that is an important thing to know. They should know when is the last time they should have something to eat or drink, just like any surgery.
Then they should know that because this is open heart surgery and we are operating on the heart and potentially using a heart lung machine—which is a machine that takes over the function of the heart and the lungs during the surgery so that the heart can be operated on in the safest possible manner. They should know that they're going to have some extra monitoring lines placed for their safety. These lines may go in before they're asleep, may go in after they're asleep. It’s up to the decision of the anesthesiologist on that day and what’s the safest for the patient. But they’ll have an IV placed in one of the arteries that goes to the hand. It’s the artery that when you feel your pulse. We’ll put an IV there. That is to measure the blood pressure with every beat of the heart so that we know what their blood pressure is beat to beat.
Patients who are having open heart surgery sometimes have compromised heart function because of the disease process that’s going on with their heart, and we may need to give medications to help the heart beat more effectively. Those tend to go through a central line, or an IV placed in the neck. So the patient should know that they're going to have that placed either before they're asleep or after they're asleep, and that decision will be made as to what’s the safest for the patient.
Then additionally one of the big advances in the last 10 to 15 years with anesthesia for open heart surgery is that we’re able to do ultrasounds of the heart while the patient is undergoing surgery. So we can get pictures of the heart before and after treatment to make sure that the treatment—One, to plan the appropriate treatment for the patient, and two, to make sure that that treatment has been effective. So many of these patients will have had this done, especially if they're having valve surgery, before the surgery, but we do it again during the surgery. It’s an ultrasound of the heart called a transesophageal echo, or TEE. So cardiac anesthesiologists are well versed in doing those and reading those studies and helping guide the surgery. So the patient should know that that’s a potential too for monitoring during surgery.
Host: You mentioned in a sense of specialty here, right. A cardiac anesthesiologist. So can a patient expect that someone like you who does anesthesiology for open heart surgery has some extra training? Can you kind of maybe run through that a little bit?
Dr. Parr: Right, sure. So cardiac anesthesiology is generally an extra year after anesthesia training. So anesthesia training is four years after medical school. Then to do cardiac anesthesia, it’s another year after that. It’s done at a place—I did mine at Brigham and Women’s in Boston in Massachusetts. It’s a place that does a high volume of cardiac surgeries so that you get a lot of exposure to taking care of these patients in a year. You learn not only how to manage the patient with cardiac disease in the intraoperative setting, but you also learn how to do this transesophageal echocardiography or TEE. There is board certification in that TEE.
Host: Right. That’s great. So should a patient then… Do you think it’s important that if they're going to have open heart surgery that they request that they have the cardiac anesthesiologist? The person, like yourself, who’s gone through that extra training. Is that something they should ask for?
Dr. Parr: In any place that does open heart surgery, that is pretty much a given that if you're going to have open heart surgery there are special cardiac anesthesiologists on staff who are taking care of those patients. Additionally at GW, if there are patients who are not having open heart surgery but have cardiac issues of some sort and the surgeon would feel more comfortable having a cardiac anesthesiologist take care of that patient, we do that also.
Host: Gotcha. So great information Dr. Parr. Let’s go ahead and end. I just want you in summary to kind of let the audience know. What’s a good summarizing statement that you would like the audience to know about cardiac anesthesiology?
Dr. Parr: I would like them to know that cardiac anesthesiologists are especially trained anesthesiologists who, and they’ve been especially trained to take care of patients with cardiac disease and cardiac problems. In particular, patients undergoing open heart surgery, but also patients with cardiac issues going through all sorts of surgery. That we have extra knowledge of how to take care of patients with cardiac issues and diagnose use TEE.
Host: Dr. Parr, excellent interview. I want to thank you for the work that you're doing and thank you for coming on the show today. You're listening to GW Medical Faculty Associates Podcast. For more information, go to gwdocs.com. That’s gwdocs.com. I'm Dr. Mike Smith. Thanks for listening.
Dr. Michael Smith (Host): According to some studies conducted within the last decade, there are good survival rates found in open heart surgery. But yet, it remains a scary surgery for many patients. Welcome to the GW Medical Faculty Associates podcast. I'm Dr. Mike Smith. Today’s topic: anesthesia and heart surgery, the facts. My guest is Dr. Gage Parr. Dr. Parr is assistant professor of anesthesiology and critical care medicine and director of quality improvement. Dr. Parr, welcome to the show.
K. Gage Parr, MD (Guest): Thank you very much.
Host: So obviously somebody hears that they need open heart surgery. That’s going to involve anesthesia. This is a very scary thing that they're going to have to go through. But I know that there’s been a lot of improvements in the anesthesia, in the open heart surgery. So could you maybe Dr. Parr just give us a good history of kind of where we were with the surgery and where we are today.
Dr. Parr: So I think the main thing to know is that as anesthesia for open heart surgery has evolved and progressed, we’ve really gone from a very, very deep long last general anesthetic to one that is tailored to fit the needs of the surgery and the time of the surgery. That we often—If people were talking to a friend or family member that had anesthesia for open heart surgery maybe 10/15 years ago, they may have been asleep for a day after the surgery. We’ve really moved beyond that to having people awake and off the ventilator within an hour or two after their surgery is over. If the case is amenable to it, we may wake you up in the operating room at the end of the surgery just as if you were having your gallbladder or your appendix out. So we’ve really progressed a great deal in taking care of patients and tailoring the anesthetic to meet the needs of the patient.
Host: Right, right. So, Dr. Parr, what does that ultimately mean though? If I'm coming out of anesthesia quicker, what does that mean in terms of my outcome, my hospitalization stay, all of that kind of stuff?
Dr. Parr: Well, obviously the less amount of time you're under general anesthesia, the better it is for your brain and your body. General anesthesia is extremely safe, but it’s an abnormal state. People think of it as being asleep, but it is not asleep like if you're home in bed. It is a medically induced state, and the least amount of time we can keep you in that state the better off you are. It’s better for your brain and your body to have as least exposure to the anesthetics as possible, but still get you through the surgery safely.
Host: Right. So if somebody is listening to this and maybe they have scheduled open heart surgery, what are some of the questions? What are some of the themes that the patient should do in preparation for the surgery and in preparation for receiving the anesthesia?
Dr. Parr: So the things that they should before coming in, make sure that they have talked to their surgeon and their cardiologist and know which medications are appropriate to take the day of surgery and which are not. Many of these patients coming in for open heart surgery will be on a lot of medications. Some of them we really want the patients to take prior to the surgery, and some of them we don’t. So that is an important thing to know. They should know when is the last time they should have something to eat or drink, just like any surgery.
Then they should know that because this is open heart surgery and we are operating on the heart and potentially using a heart lung machine—which is a machine that takes over the function of the heart and the lungs during the surgery so that the heart can be operated on in the safest possible manner. They should know that they're going to have some extra monitoring lines placed for their safety. These lines may go in before they're asleep, may go in after they're asleep. It’s up to the decision of the anesthesiologist on that day and what’s the safest for the patient. But they’ll have an IV placed in one of the arteries that goes to the hand. It’s the artery that when you feel your pulse. We’ll put an IV there. That is to measure the blood pressure with every beat of the heart so that we know what their blood pressure is beat to beat.
Patients who are having open heart surgery sometimes have compromised heart function because of the disease process that’s going on with their heart, and we may need to give medications to help the heart beat more effectively. Those tend to go through a central line, or an IV placed in the neck. So the patient should know that they're going to have that placed either before they're asleep or after they're asleep, and that decision will be made as to what’s the safest for the patient.
Then additionally one of the big advances in the last 10 to 15 years with anesthesia for open heart surgery is that we’re able to do ultrasounds of the heart while the patient is undergoing surgery. So we can get pictures of the heart before and after treatment to make sure that the treatment—One, to plan the appropriate treatment for the patient, and two, to make sure that that treatment has been effective. So many of these patients will have had this done, especially if they're having valve surgery, before the surgery, but we do it again during the surgery. It’s an ultrasound of the heart called a transesophageal echo, or TEE. So cardiac anesthesiologists are well versed in doing those and reading those studies and helping guide the surgery. So the patient should know that that’s a potential too for monitoring during surgery.
Host: You mentioned in a sense of specialty here, right. A cardiac anesthesiologist. So can a patient expect that someone like you who does anesthesiology for open heart surgery has some extra training? Can you kind of maybe run through that a little bit?
Dr. Parr: Right, sure. So cardiac anesthesiology is generally an extra year after anesthesia training. So anesthesia training is four years after medical school. Then to do cardiac anesthesia, it’s another year after that. It’s done at a place—I did mine at Brigham and Women’s in Boston in Massachusetts. It’s a place that does a high volume of cardiac surgeries so that you get a lot of exposure to taking care of these patients in a year. You learn not only how to manage the patient with cardiac disease in the intraoperative setting, but you also learn how to do this transesophageal echocardiography or TEE. There is board certification in that TEE.
Host: Right. That’s great. So should a patient then… Do you think it’s important that if they're going to have open heart surgery that they request that they have the cardiac anesthesiologist? The person, like yourself, who’s gone through that extra training. Is that something they should ask for?
Dr. Parr: In any place that does open heart surgery, that is pretty much a given that if you're going to have open heart surgery there are special cardiac anesthesiologists on staff who are taking care of those patients. Additionally at GW, if there are patients who are not having open heart surgery but have cardiac issues of some sort and the surgeon would feel more comfortable having a cardiac anesthesiologist take care of that patient, we do that also.
Host: Gotcha. So great information Dr. Parr. Let’s go ahead and end. I just want you in summary to kind of let the audience know. What’s a good summarizing statement that you would like the audience to know about cardiac anesthesiology?
Dr. Parr: I would like them to know that cardiac anesthesiologists are especially trained anesthesiologists who, and they’ve been especially trained to take care of patients with cardiac disease and cardiac problems. In particular, patients undergoing open heart surgery, but also patients with cardiac issues going through all sorts of surgery. That we have extra knowledge of how to take care of patients with cardiac issues and diagnose use TEE.
Host: Dr. Parr, excellent interview. I want to thank you for the work that you're doing and thank you for coming on the show today. You're listening to GW Medical Faculty Associates Podcast. For more information, go to gwdocs.com. That’s gwdocs.com. I'm Dr. Mike Smith. Thanks for listening.