Advances in Anesthesia for Cardiac Surgery

Dear Colleagues,

Traditionally, anesthesia for cardiac surgery has been a rather standardized approach inside the operating room, consisting of narcosis with high-dose opioid-induced analgesia, muscle relaxation and mechanical ventilation for up to several hours after the end of surgery in the intensive care unit (ICU).

More recently, cardiac surgery and cardiac anesthesia have both rapidly evolved after the introduction of minimally invasive cardiac surgery (MICS) and percutaneous and hybrid cardiothoracic procedures (the latter performed mostly outside the operating theatre), involving a multitude of health care professionals. In 2019, the first guidelines on early recovery in cardiac surgery were published, and since that time, numerous studies highlighted the advantages of earlier extubation (fast-track) in terms of reduction in postoperative complications such as stroke, respiratory insufficiency and acute kidney injury. Some centers even favor an on-table extubation (ultra-fast-track), which appears to further reduce intensive care unit and hospital stay. Interestingly, clinical research is now also focusing on the patient’s own experience and their perceived quality of life after surgery.

Preoperative patient evaluation and pre- and posthabilitation are important issues from the anesthesiologist’s point of view, because patients physical ‘fitness’ is pivotal for early postoperative recovery. Providing optimal postoperative care, including early respiratory physiotherapy and early mobilization, is of the utmost importance to reduce complications, especially postoperative cognitive dysfunction. Although the overall mortality associated with cardiac surgery has significantly decreased over time, improving the quality of perioperative care in a progressively older and sicker population remains an important issue.

Optimal perioperative hemodynamic management, ischemic preconditioning, transfusion strategies and neurological outcomes are some of the more extensively debated topics in the literature.

Minimally invasive cardiac surgery and fast-track cardiac anesthesia are here to stay and will, together with a quickly developing interventional cardiology, promote a new multidisciplinary and hybrid approach.

The aim of this Special Issue is to focus on the most relevant and interesting innovations in cardiac anesthesia in the last 5 years and to provide readers with an updated overview of the state of the art in the field of cardiac anesthesia.

We therefore welcome the submission of original articles or review articles focused on recent scientific evidence in the following fields:

1. Minimally invasive cardiac surgery and fast-track anesthesia.
2. Ultra-fast-track anesthesia (on-table extubation) and chest wall blocks.
3. Opioid-free anesthesia and alternative drug approaches.
4. Anesthesia and transcatheter therapies.
5. Transesophageal ultrasound in minimally invasive cardiac surgery.
6. Recent developments regarding perioperative acute kidney injury.
7. Neurologic monitoring and outcomes after cardiac surgery.
8. Risk assessment, complications and the impact of pre- and posthabilitation.
9. Cardiac anesthesia and patient satisfaction.
10. Cardiac anesthesia and machine learning.

Authors are encouraged to emphasize the impact of novel findings on anesthesia management for cardiac surgery patients.

Dr. Christopher M. Munch
Dr. Pietro Giorgio Malvindi
Guest Editors

Manuscript Submission Information

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• enhanced recovery after cardiac surgery (ERACS)
• minimally invasive cardiac surgery (MICS)
• ultra-fast-track an-esthesia
• chest wall blocks in cardiac anesthesia
• opioid-free anesthesia in cardiac surgery
• neurologic dysfunction and cardiac surgery
• pre- and posthabilitation in cardiac surgery