Con: Cardiothoracic Anesthesiologists Are Not Necessary for the Management of Patients With Ventricular Assist Devices Undergoing Noncardiac Surgery

Anaesthesia for children with left ventricular assist devices undergoing non-cardiac surgery

“…management of intracranial haemorrhage), insertion of intravascular catheters, wound management (for device-associated infections), airway interventions (after long-term tracheal intubation), endoscopies (for gastrointestinal bleeding), and any other surgical presentations common in childhood. 7,8 All surgical procedures should ideally be performed at centres experienced in the management of VADs, and the expectation would be that these patients will be transferred urgently to their VAD centre. However, with increasing numbers of children being discharged home with CF-VADs, the initial management of some acute emergencies may be necessary in their local, non-specialist centre.…”

“…It has been suggested that patients with VADs undergoing non-cardiac surgery can be safely looked after by general anaesthetists in conjunction with a VAD specialist. 8 We would suggest that for major non-cardiac surgery in children, such as craniotomy for intracranial bleeding, additional support is obtained from a cardiac-specialist anaesthetist.…”

“…LVAD function is independent of native heart rate, but abnormal sustained rhythms such as ventricular tachyarrhythmias can precipitate RV dysfunction and compromise left heart filling. 8 Chest radiography can be used to evaluate gross positioning of inflow and outflow cannulae and the pump.…”

“…This will provide a reliable MAP with the added advantage of the availability of arterial blood gas sampling. 8,11 Ultrasound will be helpful in arterial line placement in the absence of a pulse.…”

“…Bispectral index monitoring, although not validated in children, may be of value in assessing depth of anaesthesia. 6,8…”