Cardiac anesthesia operating room tour: Open heart surgery setup

[@Skatejock21]

The surgeon who brought us the heart and lung machine we know today, he's the president of my church. I have so much respect for him as a surgeon. He helped pioneer so many medical things we have today

[@Rebander1549]

Hi Dr. Feinstein, my name is Becky Anderson and I am Jim's wife that is why I use his name as my handle. Thank you for these informative, clearly explained anesthesia videos. I had mitral valve repair surgery in 2005. Your video today has helped me to know and understand what was done to me during this surgery. The central line was one of the last things to be removed after surgery and wow did that hurt! After the first few days I began to really feel the incision and that was also quite painful. When the pacemaker wire was removed I thought I was going to pass out because that was done when I was fully awake. Almost 18 years after this repair I STILL have incredible pain and cramps along the path that was used for the pacemaker wire. I am so glad that I am doing much better than expected now and I may be fortunate enough not to need valve repair surgery again! Anyway, thank you again 😷 doctor.

[@thomashenden71]

That is a serious amount of equipment and knowledge going with it, what a time to be alive! 🥳👍

[@renegadeflyer2]

I had emergency open hart surgery about 7 years ago. I remember getting wheeled in . I had a quick look around the room and thought, wow there is a lot of stuff around here and all the people. I live in Canada, so I didn't have to pay for the operation. I had also thought of how much this would have cost me if I had to pay for it. Iove you videos, thanks

[@comcastjohn]

Just the memory to use that stuff, people who designed and so on is mind boggling. I never thought of how much effort went into this stuff! FASCINATING!!

[@eisgeistschiller5244]

Here's hoping you never need it :)

[@jessicas2379]

I know they make it look super easy! If only it was that easy if only man I would be in the medical field

[@prapanthebachelorette6803]

True! Someone had to invent these stuff right!? Kudos to all genius minds involved 🎉

[@looksirdroids9134]

It isn't memory, it's knowledge.

[@april984]

Thank you for sharing. I had open heart surgery almost two years ago. I find all of this very interesting, and am amazed at all that goes into the surgery. I am grateful for all medical professionals and others working in the hospital setting that care for patients in so many different ways.

[@B-T619]

I had triple bypass last month... It's pretty cool seeing all kinds of equipments that were used. I personally didn't get look around too much in the OR prior to being sedated.

[@RyukoPresents]

Just wanted to leave a note here to say thank you for your videos in general. I had a minor ENT procedure last week where I was placed under general anesthesia for the first time in over two decades. Prior to this, my two fears in life were vomiting (haven't vomited since I was a kid) and surgery (the last time I vomited ... as a kid). I've always found comfort in researching as much information about a medical procedure as possible, so I watched a lot of your videos about the anesthesia process and videos on the procedure I was having. I was able to advocate for myself and speak clearly about my concerns. I knew the names/function of the drugs they gave me to calm me down and prevent nausea before surgery, and I generally felt completely at ease with the whole process from beginning to end. So your videos really are making a difference for more than just people who are looking into pursuing the field as a profession. Thank you!

[@Crazycro905]

I had open heart surgery recently so really cool to see how much actually went into it. Things happen so fast so never got to appreciate how much is involve. Wheeled me in, slid me on the table, strap my arms down and they knocked me out after introducing everyone. I had a Pericardiectomy done, so they didnt need to stop my heart, however they were still prepared for it just in case. Also I had a central line installed but I dont think they ever used it, no one prepares you for how long it is when its pulled out of your neck lol.

[@danmason6116]

Keep that chest warm this winter if you are in a colder state nothing worse than when it's really cold it feels like you are having a heart attack and same thing with the ac in the car point it away from your chest

[@nurshark10]

WOW! I can’t imagine the education and skill that goes into this set-up and surgery! Totally impressed!

[@benpugsley296]

Had a lithotripsy today for kidney stones, I’m 20 years old and was absolutely TERRIFIED of the anesthesia, far more than the procedure itself. Your videos helped me immeasurably when it came to calming myself down as well as feeling more grounded throughout the scenario. Thanks a lot, wish I would’ve had a chance to thank my anesthesiologist afterward.

[@paulkoza8652]

I've had 2 surgeries, an appendectomy and then a colon resection that eliminated the cause of the appendicitis. In both instances, I had a great conversation pre-OR with the anestheisologist. I'm not allergic to any meds so no problems there. I was fascinated with the OR during my colon operation as they did not knock me out until after being wheeled in. Great surgical crew in both instances.

[@keithnichols7926]

I was cheated ! My lithotripsy involved no anesthetic at all. Maybe a little sedative and some sort of dye to make the stone more visible. But it was the most helpful procedure I've had, as it instantly and totally eliminated a nagging pain.

[@jamestamu83]

Helps you understand why this type of surgery is so expensive! The amount of equipment and training required is unbelievable! Thank goodness for doctors.

[@scrumptious9673]

Love you doc! Thanks for all these amazing videos, love all your content. I wish I were an anaesthesiologist too!

[@siddharthg_in]

The sheer complexity of things involved itself is overwhelming

[@phyllojoe5346]

I like the way you draw attention to things with your editing! The arrows and things do their job without being too much.

[@paulaneph3257]

It’s so cool to see all of the equipment I plan in my career as a medical equipment planner being put to use.

[@jillbecker8651]

Thanks so much. As a retired critical care nurse I find your videos very interesting and informative..

[@carlapatrick9076]

Hi Max, Another great video. I recently had Gallbladder Removal surgery 2weeks ago and I was telling the Anestegiologist staff about your KZbin Channel. I was able to recognize many of the monitors you discussed in previous videos. Thanks Again for educating me as a Patient about what to expect during Anestegia before surgery💖💖💖💖💖

[@DaVinciAcademyMed]

Fascinating video! I feel like anesthesia is a field that medical students do not get adequate exposure and education. Thank you for providing this very informative tour of how cardiac anesthesiologists keep things running smoothly during heart surgery!

[@williamlayton1827]

Damn these people are geniuses

[@nayanthota2044]

Thanks for the glimpse to Mt. Sinai’s Cardiac OT. As a final year Anaesthesiology resident from India I always wanted to have a glimpse into how other countries’ OTs function and operate. The stop cock arrangement was exquisitely soothing , pleasing. It soothes my mind to see such degree of organisation. Fumbling over entangled infusion lines sprawling all over is definitely a horrifying experience when an emergency occurs. Thanks again for the aesthetic video

[@carlosbarranco9688]

This is so cool! I was a former CVICU nurse and part of my training was to shadow an open heart surgery case (I watched a Bentall procedure) and then admit the patient postop. I’m in my didactic portion of CRNA school now so it’s fascinating to see the perioperative side now!

[@scrumptious9673]

So cool!

[@HisNameIsRobertPaulson01]

How did people figure out how to make those machines work and come up with the software to run it? That to me is amazing in of itself along with all the staff in the hospital that know how to use it.

[@MaxFeinsteinMD]

The first rule of the OR is, we do not talk about the OR.

[@adventure_hannah3841]

Woah, what an awesome video! My uncle had emergency open-heart surgery a few months ago, so this was an interesting video. :)

[@jules1983]

I love cardiac anesthesia; so much variation during 1 case. Had the opportunity to practice TEE last week, still a nooby but it was as informative as it was challenging! Love the video!

[@nikkitronic80]

Thanks for sharing this. I am having heart surgery in the morning to replace my aortic valve, again. The first time I had a porcine valve that wore out (I am young and very active) but this time I’m getting a mechanical valve so should not have to be replaced again, hopefully. I am nervous but videos like this help. Somehow education makes it slightly less scary.

[@meluckey5893]

I am so grateful to you for showing us what goes on. My other half has struggled with cardiac health and I always wondered what the OR his bypass took place looked like.....wow!

[@theoriginaljayz28]

Wowza….. that was scary! That’s so much to go through with a heart surgery! Good job Max!!

[@nicks3521]

I have had heart replacement surgery and continue to require left and right heart caths. Thank you for sharing this tour. I'm always looking at what these different tools do. Thank you for who you are and what you do!!!

[@curtpiazza1688]

Wow.. This is amazing ! We should all be thankful we live in the 21st century!

[@Robby334]

Amazing man

[@pokepawz8334]

I’m having my second OHS December 1st to re-replace my left-sided mechanical tricuspid valve. I have CCTGA so I had my first surgery as a baby and don’t remember anything. It’s comforting to know how much time and hard work is put into making sure patients like me are well taken care of. Thanks for posting this. 😊

[@danmason6116]

I am also part of the zipper club myself I had a triple bypass back in 12 I was 32 I would suggest getting a very comfortable recliner I was unable to sleep in bed for the first month and a half then was finally able to sleep in bed that was heaven make sure during the winter that you keep your chest warm and in the summer when you are in the car and have the ac on that you point it away from your chest it is the worst thing possible to get it really cold man hurts so bad best of luck to you hope everything goes well

[@pokepawz8334]

@@danmason6116 thank you for the advice!! I really appreciate it. 😇 I had heard that sleeping laying down is difficult for a while, and I don’t have the funds for a recliner so I bought a nice back support pillow with arm rests instead, to kind of mimic the position of a recliner, I’m hoping that will suffice. 🤞🏼 Thank you again! 🥰

[@danmason6116]

@@pokepawz8334 I don't know if u can afford to maybe rent one from a place I did that when I got mine

[@pokepawz8334]

@@danmason6116 that’s a great idea!!! Thank you so much. I hadn’t even considered that.

[@Rick062478]

I had CABG (3 bypass) emergency in 3/2019. I really, really appreciate this tour of the operating room (of which I was totally unaware since I was the one getting cut open ) . . . Thank you!!!

[@MsPea]

Just had a quintuple bypass 4 months ago. Interesting to see what the operating room set up was probably like for my surgery. The drugs did leave me with no memory from the time I arrived in the ER until a few days after surgery. I must have been conscious though, because I was told that I gave verbal consent for tests and the surgery and that I had spoken to various doctors prior to surgery. No memory at all of any of that. Seeing all the syringes of drugs prepared for the surgery sort of explains all that. Thanks for this video. I'm still piecing together my experience and this sort of helped that process.

[@darriontunstall3708]

Great tour ! I tried to go to college after I graduated high school in 08 to be a Anesthesiologist but It was gonna be too hard because of my cerebral palsy, I’m 31! I’m gonna become a Honorary Anesthesiologist soon! I love your videos! I always learn a lot

[@DominicNJ73]

LOL There is no such thing as an Honorary Anesthesiologist

[@darriontunstall3708]

@@DominicNJ73 lol I’m gonna start Donating to the Anesthesiologist Foundation since It was hard for me to go to college to be a Anesthesiologist after I graduated high because of my cerebral palsy

[@nikitamontgomery3188]

I'm having open heart surgery 5/2/2022. I'm having 2 valves replaced and a band around the other

[@eisgeistschiller5244]

We have been waitin' for EVER for a new vid. Much love!

[@Achievius]

LOVE your channel and all your videos, thank you sir

[@edkensalexandre7043]

Yay! He’s Back!!!

[@GracieD1970]

Great informative video. My husband had a mitral valve repair with maze procedure in 2017. B/c they could do only a replacement valve in Peoria and not a replacement, he had to go to Northwestern in Chicago. Dr. McCarthy said it was a lot more severe and complex then he anticipated and was on the bypass for almost 4 hrs. I'll never forget the swan catheter coming out of his neck after surgery - so many tubes/IV's. (Husband said it was a lot to take in when he went into the OR, but they knocked him out pretty fast).

[@jennifertayokefelja7879]

Salute to all doctors 👏

[@FacundoMD]

ER DOC HERE ! LOVE THE QUALITY OF THE VIDEOS MAN GETTING SO GOOD. HOPE ALL IS WELL ! WE SOMETIMES HAVE TO PLACE EMERGENT TRANS VENOUS PACEMAKERS IN PATIENTS.

[@kedmark]

Your best and most interesting & Informative video to date, thank you very much for producing and posting.

[@alliedtravelcareers4374]

Thanks for all your hard work!

[@danmason6116]

This brings back bad memories of when I went under for my triple bypass back in 2012 I was 32 years old when this happened and and scared shitless it took them 14 hours for them to do my surgery

[@embfly]

What more can I say... EXCELLENT !

[@chrisjones7375]

Thank you Doctor, interesting content, well produced. I am a solid fan.

[@shawnagain9418]

Great video Mark, thanks

[@R9RealMadridR9CR7]

I had an awesome time and learned quite a lot when I worked as a Cardiac Anes. Tech. I miss the adrenaline rush. 😎

[@musman9853]

If you have multiple infusions running, and you have an infusion reaction, how would you able to tell which medication is causing the reaction?

[@yanikehling3077]

I am not a physician (let alone an anesthesiologist) but I can imagine that any medication would be stopped and they would start to give only those medications needed to stabilize vital functions, so the patient would get only the most necessary ones (eg vasopressors or antiarrythmic agents) since the operation would be stopped anyways

[@mkithcart3]

Often, allergic reactions in anesthesia are to the neuromuscular blockade agents (paralytics), which are IV push and not infusions. If faced with a true infusion reaction, it certainly could be difficult to discern which infusion is causing the reaction, though many vasoactive medications like Vasopressin, Epinephrine, and Norepinephrine are hormones/neurotransmitters already found in the body, so there is less risk associated with reaction.

[@crh841]

@@yanikehling3077 I am one (anesthesiologist), typically stop the thing you started most recently (esp blood, antibiotics, paralytics, cholrehexidine, latex) and treat. Quite rare to be allergic to the vasopressors and antiarrhythmics. The ones listed are more likely. Look up the NAP6 study if interested in perioperative anaphylaxis. Great read.

[@ginapolman4968]

Wow I just got my mind blown. I had no idea so many things that could go wrong with just equipment alone. Wow

[@Shasari]

Hello Dr. Feinstein. Thank you very much for posting this video. As it happens, I've got an ascending aortic aneurysm / dilated aortic root with some aortic regurgitation - the largest diameter is 4.6cm measured July 2022, which progressed from 4.1cm 2 years prior. My surgeon and I had a long discussion, and it's pretty much understood that I'll be going in for OHS sometime in the next few years to replace the aneurysmal section of ascending aorta with a dacron graft, and do whatever is needed at that time for the root and valve. Thank you for the look at the OR setup for OHS / cardiac bypass. This is very much what I'll be going through, when the time comes. One question. As a patient looking at all of this, I'm not so sure that being aware of all this equipment etc will be a pleasant experience when being wheeled into the OR. How should I ask to be given something for my nerves in pre-op? Maybe just come straight to the point with the anesthesiologist and say "I'm nervous" or something? I've been under general a few times, and the last few times propofol was used to induce anesthesia - it's amazing how quickly it takes hold, and how relatively uneventful coming back to consciousness is. I had knee surgery back in the early 1980's and sodium pentathol was the induction drug. I woke up feeling so very sick and stayed so all that afternoon/evening in the hospital room. Glad that the newer meds don't have quite the same after-effects and that additional meds are brought on board to combat post-op nausea.

[@davidadams9391]

Wow Dr Max, that looks complicated! This is the one surgery I hope I never have to go through…I do love to look at all the stuff in the OR when I go in! Anesthesia always tells me to lay down. lol

[@mikeschulte4271]

That’s a Lot of equipment soo cool though to see what goes into such a complex procedure. Thanks for ur vids and take care. Cheers

[@Jerry_SWMO]

Great video from a layman's point of view. I've had several surgeries over the years and for some odd reason always enjoyed anesthesia. I guess I'm kinda weird that way. Anyway, thanks for the in depth explanation.

[@garyjsimm]

just excellent

[@bouchser000]

Holy crap so much of a set up

[@magneticman2003]

Hey Max, a couple of questions?, 1/ What happens in the case of a total electrical failure of the outside grid? I Would imagine back up generators are available but they would have to start and get on line which would take a few minutes? Does all the equipment have internal back up power to continue operating? 2/ With the computer equipment wouldn't it shut down momentarily with a 'black out' and have to 'reboot'. Obviously this would be fatal to the patient on bypass? Thanks for your interesting expose into the world of operations;-))

[@theredhead1900]

kzbin.info/www/bejne/e5ucfqWkZZWnpJo

[@Trevor_90]

This gives me anxiety thank goodness people are willing to do this type of work.

[@CutiePie4325]

“should we name this instrument something easy to remember, doctor?” “NO. you must use my name.”

[@joeglennaz]

Wow that’s a lot of stuff. You made a comment about I think it was the central line where you said there’s lidocaine to make this a less uncomfortable procedure. Could you explain that more? Why would it be uncomfortable if they’re asleep? Also when a person needs to get some things like that why can’t they wait to put them in until they are asleep? One other general question I noticed that you have fentanyl there for pain does a person that is under general anesthesia do they still need pain relief medication I thought if they were knocked out they couldn’t feel anything could you speak into that maybe thank you

[@binary964]

your patient's 'cable management' is chef's kiss🤌

[@lizzapaolia959]

Good video, could do without the background music 🎵

[@jillthompson4280]

The pt is induced with ketamine, versed and verconium. Sevoflurane gas is being used. Now what happens when the pt is put on a cpb machine for almost 90 min, and the lungs are not being ventilated, so how are they maintained on general anesthesia? Do they wake up? What else is used till the lungs are being ventilated again?

[@MaxFeinsteinMD]

The perfusionist administers isoflurane through the cardiopulmonary bypass machine.

[@captainjaber5610]

It’s interesting that the doctor says the patient is NON diabetic; what the doctor doesn’t say is whether the patient was insulin resistant or pre diabetic. Several cardiologists and randomized trials revealed most patients were either pre diabetic, insulin resistant or full fledged diabetics. I’ wonder if this same doctor believes meat and eggs are the cause( ridiculous).

[@DavidPearl23]

I have a question you’re talking about arterial lines and central lines At what point do you say you know what this patient is healthy enough and remove the central line or arterial line

[@KishoreRajput32]

Brother.. Didn't told about airway management (DLT).

[@akchcanadianhorses]

Thank you for sharing such amazing content. I had surgery a few months ago, and have to have surgery again soon and wondering what causes the ringing in your ears during the induction of anesthesia? The anesthesiologist did ask me to confirm if I was having ringing in my ears during the induction(I nodded as they were holding an oxygen mask). I am a registered paramedic. This made me very curious. What causes this?

[@bravo795mp]

It would interesting to do the difference between the EP cardio anesthesia now.

[@rockyford9049]

Totally interesting

[@SynfullyWkd67]

Been there 8 years ago for a double CABG and am now facing Aoritc Valve replacement and mitral valve prolapse. I am curious, I didn't ask last time because my mind was running 1,000 mph, is the heart/lung machine( I know that's not the proper medical term) what keeps the blood cold and does it keep the brain functioning while my heart is stopped? Thanks in advance and for all you do!.

[@Andrew-eq8jm]

I love doing cardiac Anaesthesia, is that going to be in your next rotation? If so I hope you enjoy it mate, heaps of fun but very long hours.

[@MaxFeinsteinMD]

I’ll be rotating through cardiac anesthesia soon, yes it is a lot of work but I think I’ll enjoy!

[@sherrydawson6253]

Omg I can't imagine learning. All that! Wow so interesting. Holly smokes! So for bypass surgery do u have to have extra training training as a anesthesiologist? Thanks

[@marilynsarkis2304]

Amazing

[@OurNewHampshireLife]

Thanks Dr Feinstein. As you might remember my brother is a cardiac anesthesiologist. Just yesterday he was doing a heart transplant. I have often wished one of these cases could be videotaped as the public (including me) has no idea what is involved. I know my brother often is in shock/trauma cases and I have to ask them how this all works when a critically ill patient is rushed in for surgery. In this video everything is laid out so nicely but how in the heck do you have time to get everything set up when time is of the essence?

[@Megaflamemon]

You start prepping about 30-60mins before the patient is brought in. Gives ample time to get everything ready, sorted and kept neat.

[@joshbritton]

Potentially dumb question but how is the autotransfusion machine different from hemodialysis?

[@mikeschulte4271]

Would this be the same setup as a hear transplant or would that be different? Would appreciate ur feedback

[@jaco9430]

Dr Feinstein I have a question. I have severe ankle pain. It is constant and nothing has ever helped me. Is it possible to permenantly sedate my ankle?

[@keithnichols7926]

By the time you'd gone through that roomful of gear, I was laughing my tuchus off. Then I thought, "if the guy in charge of all that bats an ordinarily respectable eighty percent in its use, the patient will probably be dead !" What a thought ! I'd say you have to bat a hundred percent. Medical gadgetry has come a long way in the sixty years since I was involved in a project with a local hospital to apply computer processing and electronic sensing devices to medicine. At that time, the x-ray and the electrocardiograph machine were about the only such devices one would see. And that hospital, which was and is a major medical center, was having trouble affixing photo plates to a wall for shooting standing chest x-rays.

[@rachel705]

What do you do if you need to give an infusion that cannot be run in the same line as another infusion being administered, since you cannot run it through the central stopcock?

[@MaxFeinsteinMD]

We also have other peripheral IV access that we can use

[@davidbrooks9787]

Any idea how to access Kaplans Cardiac question bank?

[@mikaeladevries24]

Hi there! I'm have to get an MRI in a few weeks, but they want to do it under anesthesia because I go into nonepileptic seizures. Do you know how the anesthesia works for something like that? Love your videos

[@mitchelltanner6306]

Another excellent video. What you call the Monster is nicknamed the cage where I'm at. Those pressure area care stickers -do you have the brand name of those?

[@creativfoxdev]

Anyone know why the trans-esophageal echo machine’s screen was blurred out?

[@MaxFeinsteinMD]

There was patient information loaded on the screen so I blurred it to protect that information.

[@robs3557]

Been there done that. I’m glad I was asleep.

[@mollysullivan6414]

i'm at sinai...is there any good data out yet on isolyte's compatibility with these meds? i always push for LR If we're mixing a lot of different drips because it has much more data

[@korysanchez6572]

I’m getting open heart surgery in 10 days but is it similar to closing an asd? Setup wise?

[@mistymanley4079]

glad i didn't see this before heart surgery

[@TempoDrift1480]

My dad had quadruple bypass and I've always been curious to know how that all works.

[@eduardodiaz9354]

Great video, curious about the dose of push dose norepinephrine???? Ive been researching and can’t find it

[@MaxFeinsteinMD]

It really just depends what you want to accomplish. The dilution I typically draw my norepinephrine to is 8mcg/CC and so will usually push 8mcg at a time for mild hypotension. I push more at once if hypotension is more significant.

[@MD-cn3zh]

yay u posted

[@Oljias]

Hi, thanks for video :) I have some questions about cardiac anaesthesia, so where can I ask you if you permit?

[@morganschiller2288]

Hey Max, Can I pick your brain about your thoughts on ionm cases? I am going to be starting my clinicals in a month. I’d love to hear from you.

[@MaxFeinsteinMD]

Sure Morgan, shoot me an email! [e-mail]

[@bettysmith4527]

Cool vide, thank you! Do they have sterile defib pads for OR use??

[@MaxFeinsteinMD]

Yes each set of pads is one-time use, meaning they’re brand new for each patient.

[@jillthompson4280]

Do you see precedex being used more in cabg surgery instead of propofol?

[@f-7670]

No, dexmedotomidine (Precedex) is not an appropriate agent for this. It is not a general anaesthetic and there are various advantages to using agents such as propofol, inhaled volatiles for brain protection in these cases.

[@dr.stevenpennym.d.3241]

Why don’t you use a glide scope?

[@MaxFeinsteinMD]

1. DL is cheaper 2. (Reusable) DL doesn’t product as much environmental waste as glide 3. Most important, routinely DL’ing keeps my skills up for situations where glidescope is either broken or not readily available. For example, I happened to be the closest person with airway skills in a remote hospital location where a code occurred recently, and an airway kit was nearby but no videoscope around

[@dr.stevenpennym.d.3241]

@@MaxFeinsteinMD Understand your point of view. I’m a trauma/cardiothoracic surgeon. Senior attending.

[@nsns9441]

Are you going todo a fellowship after residency?

[@MaxFeinsteinMD]

I’m planning to apply for pediatric anesthesiology!

[@im1random263]

What happens when you put a magnet near a pace maker?

[@MaxFeinsteinMD]

It depends on the pacemaker but usually it will make the pacemaker generate a rhythm at a specific rate and not receive any input from the electrical activity of the heart.

[@im1random263]

@@MaxFeinsteinMD And then the person willl die?

[@JohnGorman355]

And all I asked the Doctor for is the location of the Keurig machine and he shows me all these gizmos and gadgets!

[@mohammedalrbadi8189]

Hi How are you Would you like to talk about technical anesthesia about work and job in USA and study

[@rileydj8764]

What’s the CO2 used for in cardiac surgery? (CABGx3 patient)

[@f-7670]

Used to add or remove carbon dioxide to the 'sweep'. Normally, in specific types of bypass called deep hypothermic cardiac arrest, you can add CO2 into the patients blood which alters the blood flow to the brain. Also, you can flood the surgical field with CO2 (2LPM) which is heavier than air so it sinks, forming a 'blanket'. Stops air getting into the open heart.