Cardiac Anaesthesia

• Cardiothoracic Anesthesia

The largest and most complicated subspecialty in anesthesiology is cardiothoracic anesthesia. Patients are frequently at high risk, with pulmonary, cardiac, and systemic comorbidities, and surgical procedures can present considerable physiologic problems to the anesthesiologist. Thoracic anesthesia has evolved into its own field within the broader field of cardiothoracic anesthesia, distinct from cardiac anesthesia. The use of moderate-dose opioids, shorter-acting muscle relaxants, and volatile anesthetics has fundamentally changed cardiac anesthesia from a high-dose narcotic technique to a balanced strategy combining moderate-dose narcotics, shorter-acting muscle relaxants, and volatile anesthetics. This new paradigm has rekindled interest in perioperative pain management, which includes multimodal approaches including localized blocks, intrathecal morphine, and additional nonsteroidal anti-inflammatory medications that help with fast tracheal extubation. This has resulted in a shift away from the traditional model of recovery for patients in the intensive care unit, with weaning protocols and intensive observation, toward management more in line with the recovery room practice of early extubation and rapid discharge, which has shifted cardiac patients' care to more specialized postcardiac surgical recovery units.