Principles of cardiac anaesthesia

This article describes the anaesthetic management of patients undergoing cardiac surgery. The techniques used are principally those applied to patients with ischaemic heart disease, which represents 56% of all cardiac surgery carried out in the UK. Where appropriate, management strategies for those patients with aortic and mitral valve disease are discussed. Monitoring techniques used for cardiac anaesthesia are detailed along with a description of peripheral arterial and central venous cannulation. The use of pulmonary artery catheterization, transoesophageal echocardiography, near infrared spectroscopy and bispectral index monitoring are also discussed in relation to the cardiac patient. Induction and maintenance of anaesthesia is covered, with a summary of the relevant agents used, particularly emphasizing their effect on the cardiovascular system. Finally, a brief description of the use of neuraxial blockade for cardiac surgery is included.