Why is the relationship between cardiothoracic surgeons and anaesthetists closer than other specialties?

First of all the anaesthetist has to induce the patient in anaesthesia, and keep them safe until the cardiac or pulmonary operation has improved the cardio-respiratory status. The patients subjected to this type of surgery traditionally have very advanced disease, necessitating surgical intervention.

Both surgeons and anaesthetists manipulate the cardio-respiratory variables at the same time and therefore it is paramount the team working has solid foundations. The surgeon will also manipulate the very organs which are maintaining cardio-respiratory homeostasis. Therefore each must have awareness of what the other is doing.

In this chapter we will focus on the foundations of cardiothoracic surgery interactions with anaesthesia and explain basic concepts and reasons for disagreement between the specialties in the hope of providing the knowledge basis for a harmonious relationship and the best surgical outcomes.

What are the most important requirements from the cardiothoracic anaesthetist?

It has to be remembered that cardiothoracic surgery commonly involves risk of higher magnitude than other surgical specialties. With this in mind, and patient safety and best outcomes remaining paramount, we have to focus on the anaesthetic interventions required. It is commonly believed that major cardiac or thoracic surgery cannot be conducted without general anaesthetic. While this is true of most cases, almost all of these procedures can be done under epidural anaesthesia.