Difference between revisions of "Insertion of ventricular assist device"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = GA | ||
| airway = | | airway = ETT | ||
| lines_access = | | lines_access = Large bore IV, central access, arterial line | ||
| monitors = | | monitors = Standard ASA, arterial line monitor, CVP, TEE | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = Typically critically low EF requiring titrated induction | ||
| considerations_postoperative = | | considerations_postoperative = | ||
}} | }} | ||
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|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |Critically low EF (15-20%) is not atypical. May also have underlying CAD, pulmonary HTN, and Grade 3 RHF | ||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
Review cardiac studies including TTE, cardiac catheterization, etc. | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
Prepare infusions of norepinephrine and epinephrine. Also can consider infusions for insulin, dexmedetomidine, ketamine, cefazolin. | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
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=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
Pre-induction arterial line typically indicated. Very careful titrated induction due to critically low EF. | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
Revision as of 10:54, 18 August 2022
| Anesthesia type |
GA |
|---|---|
| Airway |
ETT |
| Lines and access |
Large bore IV, central access, arterial line |
| Monitors |
Standard ASA, arterial line monitor, CVP, TEE |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Typically critically low EF requiring titrated induction |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A ventricular assist device (VAD) is a pump designed to assist the left or right ventricle in severe heart failure. These devices may help the left ventricle (LVAD), the right ventricle (RVAD), or bilateral ventricles (BiVAD). The device may be placed as a permanent solution or as a bridge to cardiac transplant.
Overview
Indications
Severe heart failure
Surgical procedure
LVAD
Surgeons will perform sternotomy for exposure and either cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO). The device is placed at the apex of the left ventricle with an outflow graft anastomosed to the ascending aorta.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | Critically low EF (15-20%) is not atypical. May also have underlying CAD, pulmonary HTN, and Grade 3 RHF |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Review cardiac studies including TTE, cardiac catheterization, etc.
Operating room setup
Prepare infusions of norepinephrine and epinephrine. Also can consider infusions for insulin, dexmedetomidine, ketamine, cefazolin.
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Pre-induction arterial line typically indicated. Very careful titrated induction due to critically low EF.
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Tony Wang