An Anaesthetist’s Prediction

Abstract

Change and challenge are inevitable in cardiac anaesthesia. For patients undergoing cardiac interventions, technology, techniques, and procedures will evolve. These will be driven by the economics and expectations for more rapid recovery, less utilisation of theatre and intensive care unit resources, and earlier discharge with more reliance on “recovery in the home”. Older patients will have to manage significant comorbidities. The subspecialty will adapt but needs to demonstrate its role in the whole perioperative pathway. Cardiac anaesthesia has always led in many technologies - echocardiography will continue to evolve to provide greater insights into real-time cardiac structure and function, and to assess the effectiveness of the many new minimally invasive procedures. Monitoring for organ ischaemia or injury will improve, with approaches such as multi-wavelength oximetry to assess cerebral and other organ function. Point-of-care biomarkers for tissue health will be able to be assessed and guide interventions. Systemic inflammation needs to be modulated to improve delirium and cognitive impairment, atrial fibrillation, and coagulopathy outcomes. Genomics and proteomics, and more functional rather than structural diagnostics will allow better understanding of any underlying pathology and its risk of harm, to guide precise and individualised interventions. Risk assessment will be much more specific across all organ systems. Anaesthesia will be more tailored to the procedure and the patient than now. When all else has failed, heart and lung transplantation, extracorporeal membrane oxygenation, and mechanical cardiac support technologies and management will inevitably be refined.