What Is a Cardiac Anesthesiologist and What Do They Do During Heart Surgery?

A cardiac anesthesiologist is a physician anesthesiologist with additional fellowship training in the anesthesia and physiological management of heart and vascular surgery. You encounter one if you are scheduled for procedures such as coronary artery bypass grafting, heart valve repair or replacement, aortic surgery, or certain structural heart and vascular interventions. Their job is distinct from your cardiologist (who diagnoses and manages heart disease) and your cardiothoracic surgeon (who performs the operation): the cardiac anesthesiologist keeps you unconscious, pain-free, and physiologically stable while the surgeon operates.

The three roles, side by side

A useful way to think about it: the surgeon repairs the structure, the cardiologist manages the disease over time, and the cardiac anesthesiologist manages you — breathing, blood pressure, rhythm, and comfort — while the repair happens.

What happens before surgery

Before a heart operation, the cardiac anesthesiologist typically performs a pre-operative anesthesia evaluation. This generally includes:

• Reviewing your history, medications, allergies, and prior anesthesia experiences
• Assessing your airway, heart function, lung function, and other organ systems
• Reviewing test results such as echocardiography, cardiac catheterization, and blood work
• Identifying risk factors and discussing the anesthesia plan with you and the surgical team

This is also your opportunity to ask questions about how you will be kept comfortable and what to expect when you wake up.

During the operation

Intra-operative duties center on continuous monitoring and adjustment. In a typical cardiac case, the anesthesiologist:

• Places and interprets invasive monitors, such as arterial lines and central venous catheters
• Manages the airway and mechanical ventilation
• Continuously tracks blood pressure, heart rhythm, oxygenation, and other vital parameters
• Adjusts anesthetic drugs and supports circulation, including during cardiopulmonary bypass, when the heart and lungs are temporarily supported by a machine
• Coordinates with the surgeon and perfusion team as the procedure progresses

The specifics vary by procedure and by patient, which is why the pre-operative evaluation matters.

After surgery

Post-operative care often continues in the cardiac intensive care unit, where the cardiac anesthesiologist or the ICU team manages:

• Pain control
• Safe emergence from anesthesia and, where needed, ventilator weaning
• Blood pressure, rhythm, and fluid balance in the immediate recovery period

Training and how to confirm credentials

Cardiac anesthesiologists complete medical school, an anesthesiology residency, and then additional fellowship training focused on cardiac and thoracic anesthesia. If you want to confirm a provider's credentials, you can:

• Ask the hospital or practice directly about the anesthesiologist's fellowship training
• Check state medical board records for licensure
• Look for board certification information through the relevant anesthesiology board

At a center like Huntsville Hospital's Heart Center, which lists cardiac anesthesiologists among its provider types alongside board-certified cardiologists and cardiothoracic surgeons, you can ask your surgical team who will provide your anesthesia and what their cardiac-specific training is.

Questions worth asking your care team

• Who will be my cardiac anesthesiologist, and what is their cardiac fellowship training?
• What monitors and lines should I expect before surgery?
• How will my pain be managed afterward, and when will I likely wake up?
• Who will manage my care in the cardiac ICU?