AIM: The aim of this study was to describe our institutional experience, primarily with general anesthesiologists consulting with cardiac anesthesiologists, caring for left ventricular assist device (LVAD) patients undergoing noncardiac surgery. MATERIALS AND METHODS: This is a retrospective review of the population of patients with LVADs at a single institution undergoing noncardiac procedures between 2009 and 2014. Demographic, perioperative, and procedural data collected included the type of procedure performed, anesthetic technique, vasopressor requirements, invasive monitors used, anesthesia provider type, blood product management, need for postoperative intubation, postoperative disposition and length of stay, and perioperative complications including mortality. STATISTICAL ANALYSIS: Descriptive statistics for categorical variables are presented as frequency distributions and percentages. Continuous variables are expressed as mean ± standard deviation and range when applicable. RESULTS: During the study, 31 patients with LVADs underwent a total of 74 procedures. Each patient underwent an average of 2.4 procedures. Of the total number of procedures, 48 (65%) were upper or lower endoscopies. Considering all procedures, 81% were performed under monitored anesthesia care (MAC). Perioperative care was provided by faculty outside of the division of cardiacanesthesia in 62% of procedures. Invasive blood pressure monitoring was used in 27 (36%) procedures, and a central line, peripherally inserted central catheter or midline was in place preoperatively and used intraoperatively for 38 (51%) procedures. Vasopressors were not required in the majority (65; 88%) of procedures. There was one inhospital mortality secondary to multiorgan failure; 97% of patients survived to discharge after their procedure. CONCLUSION: At our institution, LVAD patients undergoing noncardiac procedures most frequently require endoscopy. These procedures can frequently be done safely under MAC, with or without consultation by a cardiac anesthesiologist.
ASAIO J. 2015 Nov-Dec;61(6):648-51. doi: 10.1097/MAT.0000000000000278.
The number of patients supported with left ventricular assist devices (LVADs) is rising rapidly, and noncardiac surgery (NCS) in these patients presents unique challenges. Given the controversy regarding the safety and timing of elective NCS, we performed a systematic review examining the perioperative morbidity and mortality of NCS in stable patients with LVADs. The published literature was searched using strategies created by a medical librarian. All reports involving five or more patients with implanted LVAD undergoing NCS were eligible for inclusion. One hundred and sixty one patients who underwent 252 surgeries were included from seven studies. Cohort size ranged from 8 to 47 patients undergoing 12 to 67 NCS. Median age ranged from 50.1 to 68 years and 75 to 100% were male. Thirty day postoperative mortality ranged from 6.4 to 16.7%, although four studies reported no deaths. Due to the small number of included studies with relative few patients and widely heterogeneous reporting of outcomes a formal quantitative meta-analysis was not performed. Noncardiac surgery in patients with LVADs appears to be safe and feasible in select patients. Future studies should use standard study design and reporting parameters to facilitate the systematic examination of safety and outcomes for elective NCS in LVAD patients.
ANESTESIA EN PACIENTE PORTADOR DE MARCAPASOS CARDIACO Y DESFIBRILADOR IMPLANTABLE
René Asenjo G, Carlos Montalván R
Rev Chil Anest, 2013; 42: 113-123
Desde que en 1958 se hizo el primer implante de un marcapaso (MP) se han realizado grandes adelantos en estos aparatos. Los equipos iniciales permitían evitar el síncope y la muerte por asistolía. Los avances tecnológicos han permitido agregar nuevas funciones, de modo que actualmente son capaces de mantener la sincronía aurículo-ventricular (AV), aumentar la frecuencia cardíaca (FC) según las necesidades del paciente, almacenar y entregar datos diagnósticos, y evaluar el estado del MP y de la integridad de los electrodos1,2. Equipos más sofisticados permiten realizar estimulación auricular y/o ventricular programada no invasivamente a través de ellos para convertir taquiarritmias, cambiar automáticamente su modo de estimulación si se produce una taquiarritmia supraventricular (SV) y monitorizar permanentemente la impedancia de los electrodos y cambiar a estimulación unipolar (UP) si se detecta una fractura o falla del asilamiento del electrodo, para evitar la pérdida de captura