Anesthesiology and Intensive Care

DE-AIRING THE HEART AFTER CARDIAC SURGERY   After completing the repair and as the cardiac chambers are closed or as CABG is being completed, the heart must be freed of as much air as possible before it begins to eject into the systemic circulation. Clinical studies have demonstrated a correlation between the number of gaseous microemboli and the severity of neuropsychological impairment after surgical procedures employing CPB. Thus, special maneuvers are necessary to avoid air embolism, as has clearly been demonstrated by intraoperative echocardiography.  The exact steps and sequences and the time of de-airing may vary, but the principles are well established: 

     Transesophageal Echocardiography (TEE) is often  performed by a cardiac anesthesiologist to evaluate, diagnose, and treat patients in the perioperative period. TEE is very useful during many cardiac surgical procedures (e.g., mitral valve repair, off-pump and on-pump CABG).  It helps to detect and quantify the disease preoperatively as well as to assess the results of surgery immediately after the procedure.  If the repair is found to be inadequate,