what's up everybody my name is max feinstein and i'm an anesthesia resident at the mount
sinai hospital in new york city in this video i'm going to be narrating a tour through the
cardiac anesthesiologist's setup for open heart surgery on cardiopulmonary bypass
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as i go through this tour i'll be highlighting all of the features of this operating room
setup that make this type of anesthesia very unique. without further ado let's dive in
we'll start off by talking about the IV
pole immediately to the right of the patient which as you can see has two alaris pumps on
it so that we can infuse a lot of different medications throughout the course of the case
the medications hanging right now are the ones that we know we're going to start with
and those include a crystalloid called isolyte which really just serves as a runner to get the
rest of the medications into the patient, an antifibrinolytic agent called tranexamic
acid which is used to reduce bleeding, and a vasopressor called norepinephrine
on the second set of pumps we have an antibiotic called vancomycin. the rest of these channels
are empty but we can add other medications as needed throughout the course of the case
all of this tubing connects to one large set of stopcocks which will ultimately
be connected to a central line. peeking out just behind the set of infusion pumps is an
auto transfusion system called a Sorin Extra which is actually managed by the perfusionist
in this case who sits right back here with the rest of this equipment which also
is managed by the perfusionist and this includes a hemostasis management system
and of course a cardiopulmonary bypass circuit through which the patient's blood flow will be
diverted so they can be oxygenated and ventilated during the course of the case
just above the anesthesia machine we have a cerebral oximetry device
which allows us to monitor the oxygen saturation of the brain, and immediately next to that is
a bispectral index [BIS] monitor which is used to assess the level of anesthetic depth
below these devices we have a computer which has our electronic health record which is standard
for any operating room, next to that is the main screen for controlling our ventilator.
this touch screen monitor has controls for mode
tidal volume, respiratory rate and so forth and on our monitor you can see that there are
many different data points that can be displayed including heart rate, arterial blood pressure,
left atrial pressure, pulmonary artery pressure, and many others. just underneath these screens
we have several important pieces of equipment including a bispectral index monitor sticker,
an endotracheal tube, a direct laryngoscopy blade, an oral airway, and we have a magnet ready to go.
magnets are used by anesthesiologists when we need to manage pacemakers or
implantable cardiodefibrillators. here's the rest of the ventilator circuit which will eventually be
connected to an endotracheal tube once that gets placed, and importantly we have a yankaur suction
device which is always extremely important for safe management of a patient's airway.
Next to our ventilator is the anesthesia cart which contains a lot of equipment and medications.
here are the medications that have been drawn up and ready to go for this specific case
they include midazolam fentanyl propofol rocuronium heparin epinephrine norepinephrine
esmolol nitroglycerin and calcium chloride any other medications that need to be drawn up during
this case can easily be found in one of the cart's drawers next to the medications are electrodes
which will be placed on a patient's chest and back and eventually connected to a defibrillator
one piece of equipment that's ubiquitously found in cardiac anesthesia operating rooms
is this pacemaker. this pacemaker will ultimately be hooked up to leads that are
implanted by the surgeon the whole reason why we use cardiopulmonary bypass is so
that we can actually stop the heart from beating so the surgeon can operate on it
but then once the surgeon's done we need to get the heart beating again
and sometimes it needs a little bit of help which is why we have this pacemaker
I'll quickly point out this device that we lovingly call a "monster" which is just a
frame that goes above the patient's head to protect it during surgery from anything
that's on the surgical field this device is a trans-esophageal echo machine which is used
by cardiac anesthesiologists to assess cardiac function throughout the course of these surgeries
this is what the probe looks like and i'll also point out that part of doing cardiac anesthesia
fellowship which is a year of sub-specialty training after finishing anesthesia residency
includes becoming certified in transesophageal echocardiography. to the left of the operating
table is a second IV pole which includes a special type of bag that we connect our arterial lines to.
these transducers allow us to measure blood pressure inside of arterial or venous systems.
below the transducers is this warmer called a ranger which can be used to heat up any type of
fluid that's being transfused into the patient. just behind this warmer is all the equipment
needed to set up an arterial line which includes a sterilizing chlorhexidine swab, an arm board
to improve anatomy for placing an, arterial line a set of sterile gloves a 20 gauge angiocatheter
used for the arterial line a syringe to inject local anesthetic to make this a less uncomfortable
procedure, and sterile tegaderm underneath to secure the arterial line once. it's not shown
in this video is a similar looking setup which is used to place a central line also used very
commonly during these cases. several feet away are these defibrillators which can be used to deliver
electrical shocks to a patient's heart. these defibrillators are important ways for us to manage
a patient's electrical activity in their heart so we have them ready to go for these surgeries.
one special feature on our operating table is this warming blanket
which sits underneath the patient and can help keep them warm
however there are often periods of cooling a patient during cardiopulmonary bypass
these stickers have special pads on them that help protect pressure points during surgery,
and this is a warming device called a Bair hugger that delivers warm air to that special
blanket that i just mentioned. well that wraps up this tour of the cardiac anesthesiologist's
operating room setup. thanks very much for watching i'll see you next time