During heart surgery, what happens in the operation room?

Columbia University Department of Surgery
Columbia University Department of Surgery
Typically, the patient is brought into the operating room by the anesthesia team. If the patient is anxious, perhaps a mild medication is given through an IV, prior to entering the room. The patient is positioned comfortably on the operating room table and an oxygen mask is applied to the face.
Medications are given to make the patient sleepy and ultimately as deep sleep begins. A breathing tube is then placed into the airway and final preparations are made. These preparations include painting the body with a liquid that kills bacteria, the administration of antibiotics, the placement of monitoring catheters, and the application of sterile drapes. 
The surgeon will then perform a “time out”. This is sort of like the checklist performed by airline pilots. The procedure is reviewed. The nurses confirm that all necessary equipment is present and accounted for. The perfusionist confirms that blood is available. The procedure will then commence. In a typical open heart procedure, there are eight to ten people in the room. There is an anesthesiologist and/or a resident physician or nurse anesthetist. There are one or two perfusionists (the folks who run the heart-lung machine). There is a scrub tech or nurse, who passes the instruments to the surgeon.
Additionally, there is a circulating nurse, who is responsible for making the operation run smoothly, by procuring all necessary devices and instruments. Finally, there is the lead surgeon who is typically assisted by another surgeon, a resident in training, a physician’s assistant or a nurse assistant. Heart procedures, may involve a wide range of techniques. Some may use a combination of stenting an open heart surgery, which is called a hybrid procedure. Other procedures may utilize small incisions that do not involve opening the breast-bone. These are called minimally invasive procedures. Operations may not require the heart-lung machine and are therefore named OPCAB, or off-pump coronary artery bypass.
The most essential point is that there are several members of the team that all work together to achieve a common goal: a perfect operation that will benefit the patient.

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