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Anesthesiology

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Cardiothoracic Anesthesiology

The division of cardiothoracic anesthesia is a section of the Department of Anesthesiology and an integral part of the Cardiothoracic Surgery team. Our goal is to provide anesthesia for all types of cardiothoracic surgeries. Services include a comprehensive assessment prior to surgery, anesthesia and monitoring of vital organ systems during the surgical procedure, and intensive care unit and pain management consultation after the surgery.

General anesthesia is used for most of the planned cardiothoracic surgical procedures. This produces a state of deep sedation and unconsciousness that permits the surgeons to operate while the patient is asleep. During this time continuous monitoring of vital organ systems is performed throughout the entire procedure. In addition, the current technology allows us to use special devices and techniques to monitor the function of the heart and promote blood conservation during the procedure.

The transesophageal echocardiography machine allows us to get an in depth, real-time image of the heart’s muscle and valve functions that is unattainable with the human eye. Very fine details of the internal structures of the heart can be visualized and monitored throughout the operation. This ultrasound technology aids us in optimizing your hearts function both before and after surgical repair.

At the Heart and Vascular Institute of New Jersey, we have adopted the techniques of blood conservation that have been pioneered by the New Jersey Institute for the Advancement of Bloodless Medicine & Surgery at Englewood Hospital and Medical Center and have applied it to cardiac surgery. Some of the techniques that we use include acute normovolemic hemodilution, advanced cell saver technology and our on site point-of-care blood conservation and coagulation monitoring center.

Acute normovolemic hemodilution – The patient’s blood is removed and stored using a sterile technique prior to cardiopulmonary bypass. The blood removed is then replaced with volume expanders to enhance the circulation of the patient's remaining blood. This technique prevents the blood that is removed from being exposed to the adverse effects of the cardiopulmonary bypass machine. Although the cardiopulmonary bypass machine is necessary to perform most cardiopulmonary bypass procedures, it can cause unintended damage to the patient's own blood. At the end of the procedure, when cardiopulmonary bypass has terminated, the patient's blood that was removed is given back.

Cell Saver - A device that recycles the patient's own blood that is shed during surgery. During the procedure the shed blood is collected, washed with saline and then returned to the patient.

On site point-of-care blood conservation and coagulation monitoring center - A state-of-the-art intraoperative laboratory is set up to provide us with on site information regarding the status of the patient’s blood clotting system. These tests allow us to obtain important information throughout the procedure to help us minimize blood loss during cardiac surgery and optimize blood conservation.

After the surgery we assist in the medical management of the patient in the cardiothoracic intensive care unit. In addition, we provide pain management services in an attempt to minimize postoperative pain and hasten the patient’s discharge home. When appropriate, this may include patient controlled analgesia, which is a device that delivers pain medicine upon the patient's demand using the push of button.

 

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