Anesthetic management of a patient with left ventricular assist device undergoing robotic laparoscopic prostatectomy: a case report

Abstract

Background: Patients with left ventricular assist devices (LVAD) require specific anesthetic and hemodynamic considerations. We report the specific anesthetic preparation and management in this scenario. Case presentation: We present the case of a 66-year-old male with a HeartMate II LVAD undergoing robotic prostatectomy for prostate cancer in the steep Trendelenburg position. We employed central venous and radial arterial access, LVAD pump parameters, near-infrared sensor of cerebral oximetry, and transesophageal echocardiography for monitoring. Hemodynamics were managed with nicardipine, dobutamine, epinephrine, and phenylephrine during abdominal insufflation, operative positioning, and desufflation. The patient had a successful procedure, was discharged on postoperative day 2, and achieved surgical cure of his prostate cancer. Discussion: By presenting the first detailed account of anesthetic management in this scenario, we provide a clinical vignette for use by the clinical anesthesiologist in his or her preparation prior to caring for this type of patient.

Quality Improvement in Anesthetic Management of Patients with Left Ventricular Assist Device Support Presenting for Non-Cardiac Surgery: A Single Center Experience

“…The existing literature primarily reports mortality and major complication outcomes, with rates ranging from 0% to 7.7% and transfusion rates varying from 0% to 42.5% [ 12 , 13 , 14 ]. Anesthetic agent recommendations in the literature remain scarce [ 12 , 15 ], emphasizing the need for further investigations to establish comprehensive guidelines.…”

“…Very few recommendations for anesthetic agents exist in the current literature. Pisansky et al used fentanyl, propofol, and rocuronium for anesthesia induction in a patient with LVAD presenting for robotic prostatectomy [ 15 ]. Morgan et al reported the use of sevoflurane, isoflurane, and desflurane, along with propofol or etomidate, as induction agents, which were chosen according to the anesthesiologist’s preference [ 12 ].…”

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

“…When considering the impact of LVAD on anesthetic care, the following factors determine blood flow through the device: the pressure gradient across the pump, the pump speed, and filling of the left ventricle (preload). An increased pressure gradient across the pump, caused by an increased in systemic vascular resistance (SVR), decreases flow (cardiac output) [5,6]. This results in an inverse relationship between mean arterial pressure (MAP) and pump flow rate.…”

Anesthesia for Non-Cardiac Surgery for the LVAD Patient

“…All drips were weaned off; the patient was extubated and taken to the cardiac intermediate care unit to recover. No postoperative complications were noted and the patient was discharged to home 2 days postoperatively [33].…”