It is impossible to say when or who began Cardiac Anesthesiology, but it is possible to describe the evolution of this new medical specialty over the past seventy-five years. Cardiac Anesthesiology can be defined as the anesthetic practice focused on the preoperative, intra-operative and postoperative evaluation and management of patients with cardiac and intra-thoracic vascular disease. Those practicing cardiac anesthesiology generate new knowledge applicable to all, but have a primary focus on cardiovascular, pulmonary, renal and central nervous systems. Cardiac anesthesiology has evolved spectacularly especially over the past 30 years, changing from a practice focused on the anesthetic management of patients with cardiovascular diseases to a practice of cardiovascular medicine that contributes to the medical and surgical management of cardiovascular patients.
At MMHRC Cardiac Anesthesiology has evolved over the past thirteen years. Our vision is to innovate and deliver high quality, cost effective anesthesia care and pain management; to create rewarding careers for our staff; and to develop leadership in the field of cardiothoracic anesthesia and cardiac rehabilitation.
The caseload comprises approximately 3580 cardiac procedures from 2003 to 2011. This covers the entire gamut of cardiothoracic anesthesia i.e anesthesia for Coronary Artery Bypass surgery, Valvular heart surgery, Congenital cardiac surgery and Thoracic & Vascular surgery.
About 85- 95% of our coronary revascularisation has been done on a beating heart, which requires quality care anesthesia and immense hemodynamic monitoring.
In line with the advancements in cardiac surgery, our department performs valve repairs for suitable patients with good results.
Cardiac anaesthesiologists play a major role in performing peri-operative Transesophageal Echocardiography (TEE) thereby providing adequate assessment tailored to the pathology involved.
Our ICU is a 9 bedded specialized post surgical intensive care unit with multi-channel monitors and invasive outputs.
In our ICU we cater to Post Operative Beating Coronary Bypass Graft surgeries (OP-CABG), Valve replacement surgeries ( MVR, AVR, DVR), Congenital heart surgeries (ASD, VSD) and Aortic Aneurismal surgeries with full fledged dedicated nursing staff.
We have 24 hours backup of ventilators, intra Aortic balloon pump (IABP) and dialysis bed to cater to any emergency that may arise.
A dedicated and well-trained staff is always in attendance, and each patient receives individual care by a single nursing personnel. An anesthesiologist is available round-the-clock, and nothing is left to chance. This assures adequate post-operative care of the cardiac patient.
In cardiac and post-cardiac surgical patients requiring prolonged mechanical ventilation, percutaneous tracheostomy is performed on a routine basis to facilitate secretion removal and to wean the patient off the ventilator.
Transesophageal Echocardiography (TEE)
Few areas in cardiac anesthesia have matured in the recent past as much as the use of intra-operative Transesophageal Echocardiography (TEE).
It provides distinct real time images of the heart.
An evaluation by TEE may be required to obtain the most precise information to guide surgical intervention (e.g., myocardial revascularization, valvular competence and repair of congenital heart defects) and to guide pharmacological support and/or fluid administration in the peri-operative period.
TEE is the biggest leap in haemodynamic monitoring and is a useful tool in the hands of cardiac anesthesiologist.
In our hospital, TEE is used by the cardiac anesthesiologist during mitral valve repair and heart failure surgeries and has become imperative for the successful outcome of these surgeries.
Perioperative Glycemic Control
Diabetes is a well-recognized independent risk factor for mortality due to coronary artery disease. When diabetic patients need cardiac surgery, either coronary-aortic by-pass (CABP) or valve operations (VO), the presence of diabetes represents an additional risk factor for these major surgical procedures. Although there is evidence to suggest new techniques like off-pump CABG and the use of arterial grafts have improved outcomes in diabetic patients, the optimal treatment for multi-vessel CAD continues to evolve for the diabetic patient population, which despite improvements in revascularization still suffers from significantly worse outcomes when compared to the general population. Utmost care is taken to maintain tight glycemic control during the perioperative period in our department to reduce wound infection and other comorbidities. We are also actively involved in the postoperative follow up of lifetime glycemic control of the cardiac surgery patients.
- Cardiac rehabilitation has been given a special and well-deserved attention this year.
- We have a dedicated Cardiac Rehabilitation team (including a dietician and a physiotherapist) which takes care of the rehabilitative needs of the patient.
- Cardiac rehabilitation includes all measures used to help people with heart disease return to an active and satisfying life and to prevent recurrence of cardiac events.
- These services include both inpatient and out patient cardiac rehabilitation.
- The aim of this program is to educate the patient and emphasize the need to apply the appropriate medical regimen in addition to the non-pharmacological treatment modalities of cardiac rehabilitation to achieve maximal benefit.
- Dr S Kumar was elected Secretary of the Indian Society of Anesthesiologists, Madurai for a period of three years ( from October 2010 to September 2013).
- Dr S Kumar was elected Honorary Secretary of the Indian Medical Association, Madurai Meenakshi Branch for a period of three years (from January 2011 to December 2013).
Dr S Kumar was elected Editor in Chief of Madurai Medical Journal which is the official journal of the Indian Medical Association, Madurai Meenakshi Branch for a period of three years ( from January 2011 to December 2013).
- A host of academic activities form part of the calendar and ensures that the team is kept abreast of the latest developments in anaesthesia.
- Dr S Kumar actively participated as Faculty in the National Conference of Cardiac Anesthesia in 2011 in Bangalore.
- Dr K Balamurugan and Dr Ajay Viswanathan Dixit actively participated in the National Conference of Cardiac Anesthesia in 2011 in Bangalore.
- Dr S Kumar actively participated as Faculty in the Chennai Cardiac Update in 2010 in Chennai and delivered a guest lecture on the topic ‘Routine Atrial Fibrillation Prophylaxis in Cardiac Surgery'.
- Looming large on the horizon are the prospects of
- Minimally invasive cardiac surgery
- Heart failure surgeries
- Heart Transplantation
- Key-hole Robotic Cardiac surgeries
- Thoracoscopic Lung Surgeries
‘We are here to add what we can to life, not to get what we can from life.'
- William Osler
The past year has been a dynamic one. With the same enthusiasm, dedication and commitment, we are looking forward to meet all the challenges in the years ahead.
- Dr. S. Kumar, MD, (Anaes) - Sr. Consultant & Head
- Dr. D. Karthikeyan, MBBS, DA - Registrar
- Dr. Dhinakaran Daniel, MD, (Anaes) - Registrar