Having general anaesthetic for heart surgery

Understanding more about having an anaesthetic for heart surgery is important so your heart surgery and recovery goes as smoothly as possible. 

Your well-being is our top priority, and we are here to support you. We are happy to answer your questions and concerns.

General anaesthetic

A general anaesthetic gives a state of controlled unconsciousness. This is like being asleep and you do not feel any pain.

The anaesthetist, will discuss with you about which type is best for your specific situation.

The anaesthetist

The anaesthetist is the expert in charge of keeping you safe during surgery. You will meet the anaesthetist before your surgery.

This will be either in the pre-assessment clinic or on the ward after you have been admitted to hospital. They will review your health check results and may do some simple checks like listening to your chest.

There are different types of anaesthetic and the anaesthetist will discuss with you which type is best for you.

Regional anaesthetic

This is also called a peripheral nerve block. This blocks some nerves to numb a bigger part of your body. Your anaesthetist may choose to use this type for certain keyhole (minimally invasive) procedures.

Epidural anaesthesia

This involves inserting a tiny tube (catheter) in your back. This type is used in addition to having a general anaesthetic.

General anaesthetic

You will be unconscious (deep sleep) and feel nothing during the whole operation.

Having an anaesthetic

For all types of anaesthetic, you will be attached to monitors to measure your heart rate, blood pressure and oxygen levels. We will also give you extra oxygen and sedation to help you relax.

If you are having general anaesthetic, we will insert 2 thin tubes (cannulas) in a vein and an artery. The anaesthetic medicine will be injected through the tube in your vein. The tube in your artery is to continuously measure your blood pressure.  

You will become unconscious within a minute or so. We will then insert a plastic tube into your windpipe to give you oxygen. A machine called a ventilator will then blow oxygen into your lungs. It will also give you anaesthetic gas to keep you unconscious.

Next, we insert another cannula into a vein in your neck. This is so the anaesthetist can monitor your heart closely.

The anaesthetist might also use an ultrasound tube, called transoesophageal echocardiogram (TOE) to look at your heart during the operation. This gives more information about your heart's chambers and valves. Your anaesthetist  will discuss if you need a TOE before your operation. They will also explain any potential risks.

Risks, side effects and complications

Having a transoesophageal echocardiogram (TOE)

There is a slight risk of complications with this procedure but they are rare. About 1 in 1000 people may have:

• a tear in your foodpipe (oesophageal perforation)
• an injury to your foodpipe (oesophageal injury)
• bleeding (haematoma)
• damage to teeth (dental injury)

Blood loss and transfusions

It is normal to have some blood loss during surgery. Fluids are injected into your veins to replace any lost blood. If possible, your own blood may be collected using a special machine (cell saver), allowing it to be given back to you. This is called a blood transfusion. 

Blood transfusions are extremely safe. Sometimes additional blood transfusions are needed during or after your operation. Any additional blood needed is thoroughly checked.

Anaesthetic

There can be some side effects to having an anaesthetic.

Very common to common (1 in 10 to 1 in 100 cases)

• feel sick (nausea)
• have a headache
• feel drowsy
• have blurred vision

These usually get better on their own.

Uncommon (1 in 1,000 cases)

• damage to teeth
• breathing difficulties

Rare or very rare (1 in 10,000 to 1 in 100,000 cases)

• damage to the eyes
• very severe allergies

Awareness during your surgery is also very rare. This is when you become conscious during some part of an operation. We use monitors to record how much anaesthetic is in your body and how your body is responding to it. This allows your anaesthetist to judge how much anaesthetic you need to keep you unconscious. If you have any concerns or questions about this, you can discuss it with your anaesthetist.

During heart surgery

The heart is a remarkable organ, but for most heart surgeries, it is necessary to work on it when it is not beating. In these cases, the surgical team will connect you to a specialised pump known as a bypass machine. This machine takes on the vital roles of both the heart and lungs, allowing the surgical team to perform the necessary procedures. This phase typically lasts between 1 to 3 hours.

Throughout your operation you will be closely monitored by the anaesthetist and a dedicated technician.

After heart surgery

You will be moved to our Overnight Intensive Recovery (OIR) unit where we care for people who have had major surgery.

Some people might be transferred to an Intensive Care Unit (ICU).

During your stay in OIR or ICU, you will continue to have anaesthetic medicine to keep you sedated. We monitor your:

• heart rate
• blood pressure
• breathing
• kidney function

We make frequent adjustments to fluids and medicines to help with your recovery.

You will be kept on a breathing machine (ventilator) usually for 4 to 6 hours.

Recovery for people who have heart surgery often means they need extra support for longer. This is especially in complex cases or for people with pre-existing medical conditions.

Once you are awake we will remove the breathing tube and you will be able to breathe normally through your nose and mouth.

You will still be connected to monitors, drips, and may have 1 or 2 tubes draining fluids from your chest.

You may have some wires inserted to help to maintain your heart rate. These wires are usually removed 3 to 4 days after surgery.

We will give your strong painkillers through the cannula in your vein during and after the operation. Once the chest drain has been removed, you will be given tablets to control your pain.

Most patients spend 12 to 48 hours in OIR or ICU before moving to Doulton high dependency unit (HDU).

Recovering from your heart surgery

Recovery from heart surgery can be more complicated compared to other types of operations. You may need additional support, such as:

Breathing support

If your lungs need some extra help, we will keep you on a breathing machine. This happens in about 1 in 10 cases. You are likely to be asleep during this time.

If we need to keep you on the breathing machine for longer than a few days, we might need to use a tracheostomy, which is a temporary tube in your neck to help you breathe. This happens in about 1 in 100 cases. The tracheostomy can be removed when you are able to breathe normally.

Monitoring bleeding

It is normal to have some bleeding after the surgery and the doctors and nurses will keep a close eye on it. If there's too much bleeding, you may need further surgery to stop the bleeding. This is one of the reasons why you are kept unconscious for a few hours after the operation.

Heart rhythms

About 3 out of 10 people have some problems with their heart rhythm. In these cases, the surgeon will put in temporary wires during the operation to help your heart beat normally. In a few cases, a permanent pacemaker might need to be fitted.

Kidney support

Sometimes, your kidneys might need a bit of extra help to work properly. In these cases we use a machine to clean your blood while your kidneys take a break. You might need a drip into your vein for this. This happens in about 1 in 50 cases.

Heart pumping assistance

In about 1 in 100 cases, your heart may need a bit of help to pump blood effectively while it is still recovering. Your doctor might use medicines or artificial pumps until your heart can do the job on its own. Your surgical team will talk to you about these possibilities before the operation, if they think you might need them.