Elective Total Knee Replacement in a Patient With a Left Ventricular Assist Device–Navigating the Challenges With Spinal Anesthesia

Fegley, Mark W; Gupta, Ragini G; Elkassabany, Nabil; Augoustides, John; Werlhof, Hazel; Gutsche, Jacob T.; Kornfield, Zev Noah; Patel, Nimesh; Sanders, Joseph; Fernando, Rohesh J.; Morris, Benjamin N.

doi:10.1053/j.jvca.2020.10.012

Cited by 4 publications

(6 citation statements)

References 57 publications

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“…neuraxial anesthesia has been infrequently used, less than 1%. [3,32,33] Basically, the American Society of Regional Anesthesia recommends that coagulation status be normalized before placing a neuraxial block. [34] When regional anesthesia is planned, an interruption of warfarin therapy for five days before the elective procedure and normalization of the clotting status has been recommended.…”

Section: Selection Of Anesthetic Techniquementioning

confidence: 99%

“…[34] When regional anesthesia is planned, an interruption of warfarin therapy for five days before the elective procedure and normalization of the clotting status has been recommended. [32] Another feared complication following neuraxial anesthesia is an acute sympathectomy that may provoke hemodynamic instability in patients with LVADs. Because patients with LVAD are dependent on adequate venous return, acute peripheral vasodilation and a subsequent decrease in preload can increase the risk for "suction" events with inflow cannula obstruction.…”

Section: Selection Of Anesthetic Techniquementioning

confidence: 99%

“…However, if the surgical procedure can be performed under local anesthesia or an ultrasound-guided peripheral nerve block, sedation with monitored anesthetic care may be a safe option for upper- or lower-extremity surgeries. Although regional anesthesia is not inherently contraindicated in the presence of an LVAD, literature supporting the use of spinal anesthesia in patients with LVADs is extremely limited, and the use of neuraxial anesthesia is particularly infrequent (< 1%) [ 3 , 32 , 33 ]. The American Society of Regional Anesthesia recommends that the coagulation status be normalized before placing a neuraxial block [ 34 ].…”

Section: Preanesthesia Assessmentmentioning

confidence: 99%

“…The American Society of Regional Anesthesia recommends that the coagulation status be normalized before placing a neuraxial block [ 34 ]. When regional anesthesia is planned, interruption of warfarin therapy for five days before the elective procedure and normalization of the clotting status are recommended [ 32 ]. Another worrisome potential complication following neuraxial anesthesia is acute sympathectomy, which may provoke hemodynamic instability in patients with LVADs.…”

Section: Preanesthesia Assessmentmentioning

confidence: 99%

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Anesthetic management for non-cardiac surgery in patients with left ventricular assist devices

Min

Cho

Lee

et al. 2024

Korean J Anesthesiol

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Section: Selection Of Anesthetic Techniquementioning

confidence: 99%

Section: Selection Of Anesthetic Techniquementioning

confidence: 99%

Section: Preanesthesia Assessmentmentioning

confidence: 99%

Section: Preanesthesia Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Anesthetic management for non-cardiac surgery in patients with left ventricular assist devices

Min

Cho

Lee

et al. 2024

Korean J Anesthesiol

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“…The case reported minimal blood loss and no anesthetic complications. The patient was taken to cardiac ICU for recovery on no drips [32].…”

Section: Case Studies For Lvad Patients and Non Cardiac Surgerymentioning

confidence: 99%

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Kathryn¹,

Silvonek²

2023

Updates in Anesthesia - The Operating Room and Beyond

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Heart failure is poorly tolerated and end stage heart failure (classified as New York Heart Association (NYHA) class IV) has a two-year survival with medical therapy that approaches 0%. Innovation in this sphere has yielded mechanical therapies, principally the left ventricular assist device (LVAD). In the last decade one-year survival rates of Left ventricular assist device patients have increased from 52–83%. As this therapy is more commonly used to treat advanced heart failure, coupled with the increase in patient survival after implantation, patients are increasingly encountered in the peri-operative arena requiring anesthesia for non-cardiac surgeries. The goal of this chapter is to provide the non-cardiac trained anesthesia provider a primer on what an LVAD is, how it functions, the physiological changes that occur with implantation, and considerations for administering anesthesia to patients with LVADs for non-cardiac surgery. Review of articles from 2018 to 2022 found from a search on PubMed and Google Scholar using the keywords: “Left Ventricular Assist Device”, “LVAD”, “anesthesia”, “non-cardiac surgery”, “Doppler blood pressure measurement”, “VAD coordinator”. Non-cardiac trained anesthesia providers can safely administer the anesthetics to LVAD patients undergoing non-cardiac surgery as long as appropriate considerations are taken.

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Combined General and Regional Anesthesia for a Patient With Duchenne Muscle Dystrophy With an Implanted Left Ventricular Assisted Device Undergoing Orthopedic Surgery

Elhamrawy,

Villalobos,

Heydinger

et al. 2024

J Med Cases

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Duchenne muscular dystrophy (DMD) is an X-linked inherited dystrophinopathy, with an incidence of 1 in 3,600 -5,000 male liveborn infants. The leading cause of death is often cardiomyopathyrelated heart failure. Given the progressive nature of the disorder with involvement of skeletal muscle, respiratory and cardiac function, perioperative care remains challenging with an increased incidence of perioperative morbidity and mortality. Perioperative care can be challenging due to life-threatening perioperative adverse events related to associated end-organ effects, as well as sensitivity to various anesthetic agents, rhabdomyolysis, hyperkalemia, hyperthermia, and cardiac arrest. We present a 22-year-old DMD patient with left ventricular assisted device (LVAD), who presented for repair of both left distal femur and tibial diaphysis fractures. Anesthetic care included the unique combination of total intravenous anesthesia with dexmedetomidine and remimazolam combined with regional anesthesia including a supra-inguinal fascia iliaca block, saphenous nerve block, and popliteal nerve block. The basics of dystrophinopathies are presented, perioperative concerns discussed, and previous reports of the use of regional anesthesia as an adjunct to general anesthesia in adult and pediatric patients with DMD are reviewed.

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Elective Total Knee Replacement in a Patient With a Left Ventricular Assist Device–Navigating the Challenges With Spinal Anesthesia

Cited by 4 publications

References 57 publications

Anesthetic management for non-cardiac surgery in patients with left ventricular assist devices

Anesthetic management for non-cardiac surgery in patients with left ventricular assist devices

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

Combined General and Regional Anesthesia for a Patient With Duchenne Muscle Dystrophy With an Implanted Left Ventricular Assisted Device Undergoing Orthopedic Surgery

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