Abstract
BackgroundPatients with left ventricular assist devices (LVAD) require specific anesthetic and hemodynamic considerations. We report the specific anesthetic preparation and management in this scenario.Case presentationWe present the case of a 66-year-old male with a HeartMate II LVAD undergoing robotic prostatectomy for prostate cancer in the steep Trendelenburg position. We employed central venous and radial arterial access, LVAD pump parameters, near-infrared sensor of cerebral oximetry, and transesophageal echocardiography for monitoring. Hemodynamics were managed with nicardipine, dobutamine, epinephrine, and phenylephrine during abdominal insufflation, operative positioning, and desufflation. The patient had a successful procedure, was discharged on postoperative day 2, and achieved surgical cure of his prostate cancer.DiscussionBy presenting the first detailed account of anesthetic management in this scenario, we provide a clinical vignette for use by the clinical anesthesiologist in his or her preparation prior to caring for this type of patient.
Highlights
The use of left ventricular assist devices (LVADs) for patients with heart failure has become widespread
Potential adverse events in LVAD patients during anesthetic administration included suction events (i.e., LVAD flow exceeding available left ventricle (LV) preload) which may precipitate ventricular arrythmia; there has been limited attention paid to the strategies of anesthetic and hemodynamic management employed in the care of these patients
We describe a case in which a patient with an LVAD underwent a robotic prostatectomy in the steep Trendelenburg position for treatment of prostate cancer and provide management detail not previously present in the literature
Summary
We share our experience with the anesthetic management of a patient with an LVAD. While Trendelenburg position may favor loading characteristics for the LVAD, the increased afterload associated with pneumoperitoneum likely decreases pump flow In this case report, we describe our experience with managing these conditions, including the need for afterload reduction during abdominal insufflation and preload management during induction of anesthesia and abdominal desufflation. This was demonstrated by Khemees et al, that report and others for laparoscopic nephrectomy [8] and sleeve gastrectomy [14] focus primarily on the surgical management and provide limited information regarding the anesthetic considerations and techniques employed [15]. General anesthesiologists with adequate motivation, proper preparation, and collaborative systems may be able to provide safe anesthetic care and positive outcomes for LVAD patients undergoing non-cardiac surgery
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