Abstract
Objective: This case exemplifies the understanding of the physiological changes associate with 1) Left Ventricular Assist Devices, 2) monitoring challenges associated with Left Ventricular Assist Devices and 3) the usefulness of peripheral nerve blocks in this subset of patients. Case report: A 73-year-old man was scheduled for left wrist arthroscopy and debridement to treat a very painful septic joint. He had undergone Heartmate II Left Ventricular Assist Device implantation uneventfully for Destination Therapy 4 months prior. The patient required maintenance of therapeutic anticoagulation. We elected for an ultrasound-guided axillary block, which limits the risks of vascular injury in presence of high INR. The axillary nerve block enabled us to overcome potential anesthetic problems in a patient with a continuous flow LVAD. Conclusion: The physiologic principles of Left Ventricular Assist Device function should be understood before the initiation of anesthesia. Regional Anesthesiologists can offer a very significant contribution to the safe care of patients with heart failure requiring a continuous flow Left Ventricular Assist Device.
Highlights
Treatment modalities for left ventricular failure are limited
The REMATCH trial showed a marked improvement in survival with surgically implanted Left Ventricular Assist Devices (LVAD)
General Anesthesia was maintained with inspired isofluorane at 0.5% - 0.6% with spontaneous ventilation
Summary
Treatment modalities for left ventricular failure are limited. The REMATCH trial showed a marked improvement in survival with surgically implanted Left Ventricular Assist Devices (LVAD). No support is provided to the right ventricle and a moderate degree of chronic anticoagulation is required. These patients can lead an active lifestyle and do not necessarily refer for their care to the center that implanted the device [3]. They often necessitate non-cardiac procedures presenting unusual problems for anesthetic management [4]. In spite of the issues with anticoagulation, regional blocks offer distinctive advantages for the anesthetic care of these patients
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