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Anesthesia 

Anesthesia
Chapter:
Anesthesia
Author(s):

Christopher J. Plambeck

, Michael K. Loushin

, and Michael F. Sweeney

DOI:
10.1093/med/9780190909291.003.0024
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date: 07 June 2020

The anesthetic care of the left ventricular assist device (LVAD) recipient presents to the anesthesiologist a unique set of challenges which must be skillfully managed for the successful completion of this complex surgical procedure. The anesthesiologist must perform a thorough preoperative evaluation and carefully assess the patient’s cardiovascular, pulmonary, renal, and hepatic systems. Special consideration to the risk of post-implantation right ventricular (RV) dysfunction is critical. In patients with advanced heart failure, a well-formulated anesthetic management plan must be developed to provide adequate anesthesia while at the same time preventing hemodynamic deterioration. The performance of a comprehensive transesophageal echocardiogram study is essential for identifying potential issues that may need to be addressed during the surgery. The post-cardiopulmonary bypass period is fraught with several challenges which the anesthesiologist must address, such as RV dysfunction or failure, vasoplegia, and coagulopathy. The transition of care to the ICU is facilitated by the application of a standardized checklist to ensure that all critical information is conveyed to the critical care providers. The anesthesiologist also frequently provides care for the LVAD patient undergoing a non-cardiac surgery or procedure. A careful preoperative evaluation and a thorough understanding of the technology and physiology of the LVAD patient is essential to the development of a safe and sensible anesthetic management plan.

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