[Anaesthesia for open-heart surgery in adults]

Each year, about 5 000 adults undergo heart surgery (most of them open-heart surgery) in Norway. The purpose of this overview is to address specific problems associated with anaesthesia in these patients.

The paper is based on literature identified through a non-systematic search in PubMed and own experience with clinical work and research.

In Norway, general anaesthesia is always used in open-heart surgery. Some patients have such severely impaired heart function that it needs to be supported by inotropic drugs or mechanical devices. The patients are given heparin during surgery, and many also receive preoperative treatment with drugs that affect haemostasis. Profuse bleeding, during or after surgery, is sometimes challenging. The brain is at risk because the blood flow generated by the heart-lung machine is unphysiological, and because air or solid particles may embolize from the heart or aorta during the intervention. Renal failure after heart surgery is a serous complication with high mortality. Some anaesthetics probably have direct cardioprotective effects. Tight control of blood glucose seems to be justified, even if the level of optimal serum blood glucose is still debated.

Several organ systems are at risk during heart surgery. In addition to providing pleasant and painless sleep for the patient and good working conditions for the surgeon, the anaesthetist cooperates with the team about securing optimal organ protection.