Does anyone have any good references / texts that would help me follow along with what is going on in a bypass case in terms of what the surgeon is doing. For example, the specific order of how things happen (when you would expect to put clamps on, take clamps off, rewarm), and the terminology they use (yellow on, red off, etc.) to the perfusionist. I am trying to get a better understanding of how the flow fits into what I should be doing with my anesthetic and what I should be preparing for.
Thanks
This is somewhat specific to a cardiac program, i.e. the language one group of surgeons uses, how they interact with a group of perfusionists, and maybe even the sequence of some events is a little different between institutions. Equipment and protocols are different, as are the steps for a CABG v. valve, so it will be difficult for you to find one standard guideline to a pump case. Rewarming protocols vary greatly, and are affected by things like the type of case, the frailty of the patient, or what time of day it is-"I've got a plane to catch, we're not cooling on this case"
Best thing you can do is tell your attending one day you want to focus on what the surgeon is doing. You'll still get the lines, induction, etc. Take a notepad with you, and from sternotomy to the time you come off pump, just watch the surgery, listen to what is spoken, and write down any questions you have. Unless you have just the coolest cardiac surgeon ever, with 10 minutes free at the end of the case to discuss things with lowly you, I would ask surgery-specific questions to either your anesthesia attending or the cardiac PA/fellow. Ask the perfusionist about pump things. They're usually pretty receptive to genuine interest by us.
Some general things:
"Pump up/Pump down" describes the flow in L/min through the arterial cannula. During the pump run, if you hear them ask for "pump down" or "flows down", they are likely placing/removing a clamp or cannula. There is hypoperfusion during that period.
Look at the perfusion station. From the anesthesia workstation, the first thing you see is the venous reservoir. In addition to controlling the arterial flow rate, they can control the volume of blood circulating by keeping blood in that reservoir or adding it to the circulation. Terms like "leave some volume in" or "take some volume back" are used.
After the reservoir, the first pump you see is the arterial pump. It's red. Next is purple, the cardioplegia. Then you will see the other colors, in some order that I don't care to remember. These are for root vents, LV vents, and pump suckers (basically a suction line that sucks return into the venous reservoir instead of the cellsaver). "Up on yellow" or "Up on 3" tells the perfusionist to increase suction on that line to improve drainage.
