Anesthesia Issues in Patients with VADs Presenting for Noncardiac Surgery

Abstract

You are the anesthesiologist on call; it is around midnight, and things are winding down. You thought you could go to your on-call room and relax. Minutes later, you receive a call from surgeon Dr. Smith telling you he is booking a patient for an open appendectomy. You think that shouldn’t be that bad. He adds this patient is being transferred from another hospital and, by the way, the patient has a device. You ask what type of device? He replies one of these devices! Oh yeah ..a ventricular assist device! Then he asks how soon can we go to the operating room and start. Now you wonder what should you do? Should you call the cardiac anesthesiologist? Do we need a cardiac surgeon? What if the device malfunctions? Then what? What are the important considerations and preoperative evaluation for a patient with a ventricular assist device? What should you use for anesthetic agents, and what kinds of techniques are appropriate? If the patient is anticoagulated, do we need to reverse the anticoagulation for surgery? Is antibiotic coverage necessary, and what kind of drugs should we use? If the patient develops cardiac arrest, can we do chest compressions? One needs to have a plan and management strategy to address these questions before proceeding to surgery. Anesthesiologists should be acquainted with the unique issues associated with these patients and their mechanically assisted devices. As it is crucial for noncardiac anesthesiologists to familiarize themselves with the management of these patients, we have put together a roadmap that provides a stepwise approach to managing such challenging patients. This chapter highlights the most important points for the noncardiac anesthesiologist to consider when caring for patients with a ventricular assist device including the important features of the commonly used devices, the major perioperative considerations, and the anesthetic management.