Anesthesia in Cardiac Surgery

The cardiac surgical procedures are increasingly performed each year up to a number >700000 (data in 1997 in US) per year, of which >600000 are coronary artery bypass grafting (CABG) procedures. After 1997, there has been a gradual decrease in CABG procedures as percutaneous coronary interventions (PCI) grow. In 2005, a total of 699000 cardiac surgical procedures were reported, including 469000 surgical coronary revascularization procedures. It is still debated whether CABG procedures will continue to decrease as relative benefits of PCI continue to be evaluated. As the number of aging population increases and risk factors (e.g.,obesity and diabetes) occur, cardiovascular diseases are also estimated to increase; however, it is not clear that changes in life style or advancing medical management will reduce the prevalance and incidence of these diseases. Although the cardiac surgery is not the primary solution, CABG procedures are still the most commonly performed cardiac procedures and it will remain one of the management options (Thys,2009;London et al,2008). There is an explosive growth in these procedures due to improvements in operative outcomes, inclusion of older and sicker patients for cardiac surgeries and expansion of these surgeries to community hospitals. However, although the physicians develop greater confidence and capacity to perform the procedures, the morbidity, mortality and resource utilization are still higher in the elderly population; especially in octagenarians. Scott et al. (2005) reported longer intensive care unit (ICU) and hospital stay with higher rates of postoperative renal failure and neurologic complications; and Baskett et al. (2005) reported more death and stroke after CABG in octagenarians. As the cardiac surgical procedures grow with an aging population with increased mortality and morbidity, more anesthesiologists become specialized in cardiovascular anesthesiology, practicing cardiac anesthesia excusively in active cardiac surgical centers; changing their focus from anesthetic management of patients with cardiovascular diseases to cardiovascular medicine; medical and surgical management of cardiovascular patients (Thys,2009).