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A Survey Comparing Cardiac Operating Room Setup and Anesthetic Management Among Academic US Adult Cardiothoracic
1Department of Anesthesia, Division of Cardiothoracic Anesthesiology, UCSD Medical Center, Sulpizio Cardiovascular Center, La Jolla, CA.
Objectives:
To evaluate contemporary practice patterns in cardiac operating room setup and intraoperative management across academic adult cardiothoracic anesthesiology programs in the United States.
Design:
Cross-sectional survey study.
Setting:
Accredited US adult cardiothoracic fellowship anesthesiology programs.
Participants:
The survey was emailed to the program directors of the 76 accredited fellowship programs on the Society of Cardiovascular Anesthesiologists website; 51 programs responded (67%).
Interventions:
None.
Measurements And Main Results:
Responses were analyzed to assess nationwide practices in several common cardiac surgery cases or clinical scenarios. Norepinephrine is the most commonly prepared inotrope and vasopressor for coronary artery bypass graft. Nitroglycerin and nicardipine are the most commonly prepared vasodilators during setup for coronary artery bypass graft. In left and right ventricular dysfunction, epinephrine is the most commonly used first-line inotropic agent. Bivalirudin is the preferred heparin alternative in the setting of heparin-induced thrombocytopenia. Forty percent of programs report routinely performing regional anesthesia during cardiac surgery. Antifibrinolytic use is nearly evenly split nationwide between tranexamic acid and ε-aminocaproic acid. Most institutions use inhaled nitric oxide intraoperatively as a pulmonary vasodilator. Propofol is the preferred sedative, followed by dexmedetomidine for intensive care unit transport of patients.
Conclusions:
Contemporary practice patterns among academic cardiothoracic anesthesiology programs in the United States can be inferred from the data gathered in this nationwide survey. Equipped with this, institutional and individual self- assessment of current practices can lead to targeted quality improvement and further investigation for optimal strategies in cardiac anesthesia.
