Increased survival with Left Ventricular Assist Device (LVAD) has led to a large number of patients with LVADs presenting for non-cardiac surgeries (NCS). With studies showing that a trained non-cardiac anesthesiologist can safely manage these patients when they present for NCS, it is vital that all anesthesiologists understand the LVAD physiology and its implications in various surgeries. This is even more relevant during the current pandemic where these complex cardiopulmonary interactions may be even more challenging in patients with COVID-19. We describe a case of a patient with COVID-19 with an LVAD who needed thoracoscopic decortication for recurrent complex pleural effusion and briefly discuss unique challenges presented and their management.

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As hospitals became overwhelmed during the Covid-19 pandemic in March-May in New York, Cardiology and Electrophysiology (EP) departments rapidly developed protocols for case selection as well modifying the practice of managing the cases. This process involved applying the American Heart Association (AHA) and Heart Rhythm Society (HRS) Guidelines for triaging the cases based on acuity, postponing the elective cases and modifying the way Cardiac Implantable Electronic Devices (CIEDs) interrogation. Procedural revisions were necessary for the workflow in the electrophysiology laboratory and that involved modifying the EP suite to accommodate a Covid procedure room, a decontamination equipment area and repurposed room for recovery in the context of personnel (EP attendings and fellows) and the main recovery area being diverted to Covid-19 ICU. The anesthesiology team had an integral and essential role in this process. This article describes in detail the collaborative planning, preparation and implementation of electrophysiology practice at one of the major tertiary centers in New York. It describes the type of EP procedures performed during mid-March to mid-May at this center, the decision process in case selection, anesthetic management and outcomes and the comparison with the previous year. Recommendations by the AHA/HRS as well as American Society of Anesthesiology (ASA) were considered in the multidisciplinary collaborative approach to patient care and personnel safety.

Hospitals rapidly developed new procedure and protocols and engaged in emergency construction projects to adapt their facilities and procedures to provide safe and effective patient care during the COVID- 19 pandemic surge in the New York metropolitan area. Physical and procedural revisions were necessary in the operating room to continue to care for emergent patients both with and without COVID. Similar adaptions in non operating room procedure suites, recognized commonly as Non-operating Room Anesthesiology (NORA), necessitated the engagement of multiple departments in order to develop protocols and to redesign procedural areas. This article describes in detail the collaborative planning, construction and preparation implemented in two academic medical centers with regard to their various NORA programs. In developing patient care, personal protective equipment training and repurposing of procedure suites, the multidisciplinary collaborative teams have taken into consideration the professional national societies governing Gastroenterology, Cardiology, and Interventional Radiology.