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A history of cardiothoracic anaesthesia 

A history of cardiothoracic anaesthesia
A history of cardiothoracic anaesthesia

R. Peter Alston

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date: 26 September 2020

Cardiothoracic anaesthesia is a little over 100 years old but allows millions of patients around the world to safely undergo surgery within the chest and the heart. The pneumothorax problem was the first major challenge overcome with tracheal intubation and intermittent positive pressure ventilation. Lung isolation was overcome using bronchial blockers, double-lumen tracheal tubes, and made more reliable by the use of fibreoptic bronchoscopy. Cardiopulmonary bypass allowed cardiac surgery to develop but presented another hurdle to overcome, including maintaining anaesthesia during the procedure. Most anaesthetic drugs have been applied to cardiac anaesthesia. Morphine, then high-dose opioid ‘anaesthesia’ gained widespread popularity until demonstrated to have no influence on outcome. Total intravenous anaesthesia currently has ascendency over inhalational techniques despite the current best evidence indicating it is associated with a higher mortality and incidence of myocardial infarction. Pulmonary artery catheters have now been superseded with transoesophageal echocardiography, although both were introduced without an evidence base on outcome. Drugs, such as aprotinin, have been found to reduce blood loss and transfusion, but abandoned because of poor evidence. Despite all the blind alleys that cardiothoracic anaesthesia has taken, it produces good outcomes for patients undergoing surgery within their chest and on their hearts.

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