00560 Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator

Name of the Procedure:

Anesthesia for procedures on heart, pericardial sac, and great vessels of chest without pump oxygenator.
(Also known as Cardiac Anesthesia without Cardiopulmonary Bypass)

Summary

This procedure involves the administration of anesthesia to patients undergoing heart, pericardial sac, and great vessel surgeries in the chest, without the use of a pump oxygenator (bypass machine). The anesthesia ensures the patient remains unconscious and pain-free during the operation.

Purpose

The procedure addresses conditions like severe coronary artery disease, valvular heart disease, or pericardial effusion that require chest surgery. The goal is to provide safe and effective anesthesia, ensuring patient comfort and stability throughout the surgery.

Indications

• Severe coronary artery disease needing bypass surgery
• Heart valve repair or replacement
• Pericardial effusion/conditions requiring drainage or surgery
• Procedures on major chest vessels without the use of a cardiopulmonary bypass machine

Preparation

• Patients typically must fast for several hours before the procedure.
• Medication adjustments might be necessary as directed by the healthcare provider.
• Preoperative diagnostic tests like blood work, ECG, echocardiogram, or chest X-rays are commonly required.

Procedure Description

1. Preoperative Assessment: Evaluating the patient’s medical history, physical condition, and necessary diagnostic tests.
2. IV Line Placement: Intravenous lines are inserted for medication administration.
3. Monitoring: Continuous monitoring of heart rate, blood pressure, and oxygen levels.
4. Induction of Anesthesia: Administration of sedative and anesthetic agents to induce unconsciousness.
5. Maintenance of Anesthesia: Use of inhaled or intravenous anesthetics to maintain anesthesia during the surgery.
6. Airway Management: Intubation and mechanical ventilation to support breathing.
7. Monitoring and Support: Ongoing monitoring and management of physiological parameters.

Duration

The duration of anesthesia corresponds with the length of the cardiac procedure, typically ranging from 3 to 6 hours.

Setting

Performed in a hospital operating room equipped for cardiac surgery.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (if a bypass machine is required at any point)

Risks and Complications

• Common Risks: Nausea, vomiting, sore throat (from intubation)
• Rare Risks: Allergic reactions to anesthesia, heart attack, stroke, pulmonary complications
• Complications Management: Immediate intervention by the surgical team to manage any adverse events

Benefits

• Ensures the patient feels no pain during surgery
• Helps stabilize vital signs during complex cardiac procedures
• Expected to facilitate a successful surgical outcome

Recovery

• Immediate Post-Procedure: Monitoring in a recovery room or ICU for initial recovery
• Care Instructions: Monitor vital signs, manage pain, and prevent complications.
• Recovery Time: Varies; typically a hospital stay of 5-7 days
• Follow-up: Scheduled follow-up visits to assess recovery and adjust medications.

Alternatives

• Local or Regional Anesthesia: For less invasive procedures
• Use of a Cardiopulmonary Bypass Machine: For more complex heart surgeries requiring an oxygenator
• Medical Management: Drugs or less invasive treatments for underlying cardiac conditions

Patient Experience

• During Procedure: The patient will be unconscious and unaware of the procedure.
• Post-Procedure: Grogginess, mild pain or discomfort at the incision site, and sore throat are common. Pain is managed with medication, and comfort measures are provided to aid recovery.