RT Book, Section A1 Wasnick, John D. A1 Hillel, Zak A1 Kramer, David A1 Littwin, Sanford A1 Nicoara, Alina SR Print(0) ID 8551745 T1 Chapter 17. Cardiopulmonary Bypass T2 Cardiac Anesthesia and Transesophageal Echocardiography YR 2011 FD 2011 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-171798-4 LK accessanesthesiology.mhmedical.com/content.aspx?aid=8551745 RD 2024/11/05 AB Perfusion science is a unique discipline unto itself and a full discussion of its many intricacies is far beyond the scope of this introduction to cardiac anesthesia and echocardiography. Still, much that is unique to cardiac anesthesia care can be in some degree related to the use of cardiopulmonary bypass (CPB). At the start it is important for the practitioner new to cardiac anesthesia to establish a close working partnership with their perfusionist colleagues. Perfusionists are certified healthcare professionals who devote their careers to the management of circulatory support. In most institutions they work under the direct authority of the attending surgeon; however, from time to time they are under the medical direction of the anesthesiologist. At no times must they be considered a substitute for an appropriately qualified anesthesia practitioner in the operating room. Hence, during the "bypass run" a member of the patient's anesthesia team must be physically present in the operating room. During CPB, the anesthesiologist and the perfusionist work together to bypass the functions of the heart and the lungs so that cardiac surgery may proceed. The pump's flow becomes the patient's cardiac output (CO). The oxygenator of the CPB machine provides gas exchange. Simply put, the hemodynamic principles, which guide normal patient management, are operative when the bypass machine is in use. Blood pressure is still the product of cardiac output and systemic vascular resistance—except that the CPB machine provides the cardiac output.